TESTICULAR SURGERY • MALE FERTILITY • TESTICULAR CANCER RISK • BRISBANE
Undescended Testis in Adults
Specialist assessment of persistent or previously treated undescended testes, with attention to cancer risk, fertility, hormone function and the choice between orchidopexy and orchidectomy.
An undescended testis that remains outside the scrotum after puberty requires a different discussion from childhood cryptorchidism. The appropriate adult plan depends on where the testis is located, whether the opposite testis is normal, fertility goals, hormone function, testicular size and cancer risk.
Educational information only. A website cannot determine whether an individual testis should be preserved or removed.
UNDERSTANDING CRYPTORCHIDISM
What is an undescended testis?
Cryptorchidism means that one or both testes have not reached a normal position within the scrotum. The testis may lie in the groin, within the abdomen, or less commonly in an ectopic position.
Some men know they had an undescended testis from childhood. Others discover the problem during fertility investigation, examination for a groin lump, imaging, or assessment of an apparently absent testis.
Adult management differs from paediatric management because the developmental opportunity to optimise germ-cell maturation has already passed. The focus becomes preservation of useful testicular function, cancer-risk management and creating a testis that can be examined and followed when preservation is appropriate.
WHY AN ADULT UNDERSCENDED TESTIS MATTERS
Cancer risk, fertility and hormone function
Cryptorchidism is associated with abnormal testicular development. Its clinical importance in adulthood extends beyond the physical position of the testis.
Testicular cancer risk
A history of cryptorchidism is associated with a higher risk of germ-cell neoplasia in situ and testicular germ-cell tumour. Bringing the testis into the scrotum allows easier examination but does not eliminate that background risk.
Reduced sperm production
Germ-cell development is affected by prolonged maldescent. Fertility impairment is more likely with bilateral disease than with a corrected unilateral undescended testis.
Reduced hormone-producing function
Some men have impaired Leydig-cell function and reduced testosterone production, particularly when both testes are affected or the opposite testis is abnormal.
RELATED CANCER INFORMATION
Undescended testis is an important testicular-cancer risk factor
A new lump, increasing firmness or change in a palpable undescended or previously corrected testis requires direct assessment.
ANATOMY CHANGES THE OPERATION
Where can an undescended testis be located?
Palpable inguinal testis
The testis can be felt in the groin. Surgical assessment focuses on testicular size, cord length, surrounding anatomy and whether scrotal positioning is technically feasible.
Intra-abdominal testis
A testis within the abdomen cannot be routinely examined and may be small or dysplastic. Removal is often discussed in post-pubertal patients when the opposite testis is normal.
Non-palpable testis
A non-palpable testis may be intra-abdominal, severely atrophic, absent or located in an unusual position. Further evaluation is required to establish the anatomy.
Acquired or ascending testis
Some testes previously documented in the scrotum later sit persistently higher. Previous childhood records and current examination can help distinguish acquired maldescent from other causes.
ADULT ASSESSMENT
What should be checked before deciding on surgery?
Adult cryptorchidism management is based on testicular anatomy and function, not age alone.
Examine both testes
The position, size and consistency of the undescended testis and the size and health of the opposite testis are assessed.
Clarify previous history
Childhood surgery, prior orchidopexy, hernia repair, testicular trauma, fertility history and previous imaging can all matter.
Semen analysis when fertility matters
Semen testing can show whether sperm production is normal, reduced or absent and can materially affect whether preserving testicular tissue is valuable.
Hormonal assessment when indicated
Reproductive hormone testing can assess testicular endocrine function, particularly in bilateral disease, small testes, infertility or symptoms suggesting reduced androgen production.
Imaging selectively
Ultrasound may help characterise a palpable inguinal testis or the contralateral scrotal testis. Imaging does not always establish the anatomy of a truly non-palpable testis.
Discuss cancer-risk management
If the testis is preserved in adulthood, biopsy and subsequent surveillance can form part of the discussion.
THE CENTRAL ADULT QUESTION
Orchidopexy or orchidectomy?
Current adult management is individualised according to the function of the opposite testis, fertility goals, hormone status, testicular anatomy and cancer-risk considerations.
WHEN REMOVAL MAY BE FAVOURED
Orchidectomy
Removal may be offered to an adult with a unilateral undescended testis when the opposite testis has normal hormone and sperm-producing function.
- Removes testicular tissue that has an increased germ-cell tumour risk.
- Avoids the need to preserve a severely atrophic or poorly functioning testis.
- Is often relevant for an intra-abdominal testis after puberty when the contralateral testis is normal.
- Provides definitive histopathological examination of the removed testis.
Removal of a testis does not mean the opposite testis is risk-free; the overall history remains relevant to future testicular awareness.
WHEN PRESERVATION MAY MATTER
Orchidopexy
Orchidopexy may be considered when retaining viable testicular tissue could contribute to fertility or hormone production, particularly when the opposite testis is impaired or when both testes are undescended.
- Moves the testis to a scrotal position when technically feasible.
- Allows easier clinical examination and surveillance.
- May preserve functioning testicular tissue in selected men.
- Does not eliminate the pre-existing increased cancer-risk context.
Preserving an adult undescended testis does not guarantee sperm production, normal testosterone or freedom from future testicular cancer.
IF THE TESTIS IS PRESERVED IN ADULTHOOD
Why is testicular biopsy discussed?
Current EAU reproductive guidance recommends biopsy when an undescended testis is corrected in adulthood to assess for germ-cell neoplasia in situ. Finding this microscopic precursor condition can materially change subsequent cancer-risk management and surveillance.
POST-PUBERTAL MANAGEMENT
Can an adult undescended testis be brought down without surgery?
In post-pubertal males, treatment intended to induce testicular descent medically is not recommended. Adult management is surgical when intervention is appropriate.
The question is therefore not usually whether to try a medicine first, but whether the testis should be preserved with orchidopexy or removed, based on function, anatomy and cancer-risk considerations.
BILATERAL CRYPTORCHIDISM
When both testes are undescended, fertility and hormone preservation become more important
Bilateral cryptorchidism has a greater association with impaired sperm production than unilateral disease. Removing both testes would also eliminate endogenous testicular hormone production.
Assess hormone function
Reproductive hormone testing helps determine whether the testes are contributing meaningful endocrine function.
Assess fertility
Semen analysis can identify residual sperm production and help determine whether preserving testicular tissue has reproductive value.
Preserve viable tissue when reasonable
Orchidopexy may be considered when technically feasible, with biopsy and ongoing surveillance forming part of adult preservation planning.
MALE FERTILITY
Cryptorchidism can be part of an infertility or azoospermia presentation
Men with abnormal semen parameters may benefit from a full male reproductive assessment rather than treating the testicular position in isolation.
NON-PALPABLE UNDERSCENDED TESTIS
What if the testis cannot be felt?
A non-palpable testis may be located within the abdomen, be very small or atrophic, or occasionally be absent.
In an adult, operative evaluation can be used to establish the anatomy when this remains clinically necessary. Minimally invasive abdominal exploration can identify an intra-abdominal testis and allow definitive management according to the patient's circumstances.
If a post-pubertal intra-abdominal testis is found in a man with a normal opposite testis, removal is commonly discussed because surveillance is difficult and cancer risk remains relevant.
PREVIOUS CHILDHOOD ORCHIDOPEXY
What if the testis was brought down as a child?
Childhood orchidopexy improves the ability to examine the testis and is intended to support testicular development, but a history of cryptorchidism remains relevant in adult cancer and fertility assessment.
Check current position
A previously operated testis can occasionally sit high or become difficult to examine and may need reassessment.
Be aware of new changes
A new lump, firmness or enlargement should be assessed rather than attributed to previous surgery.
Fertility can still be relevant
Previous bilateral cryptorchidism or a small affected testis can be relevant when semen parameters are abnormal.
The opposite testis matters
Adult reproductive assessment should consider both testes rather than focusing only on the previously undescended side.
SURGICAL PATHWAY
What does adult surgery involve?
The operation depends on whether the testis is palpable, its location and whether preservation or removal is planned.
Confirm anatomy and goals
Review examination, fertility and hormone status, previous surgery and whether preservation would provide meaningful benefit.
Surgical exploration
The approach is selected according to testicular location. A palpable inguinal testis and a non-palpable intra-abdominal testis require different approaches.
Orchidopexy or orchidectomy
The testis is either positioned within the scrotum when preservation is appropriate and technically feasible, or removed when orchidectomy has been selected.
Biopsy or pathology
A preserved adult testis may undergo biopsy to assess for germ-cell neoplasia in situ. A removed testis is sent for histopathological examination.
Plan follow-up
Follow-up depends on pathology, whether the testis was preserved, fertility or hormone abnormalities and the health of the opposite testis.
BALANCED SURGICAL INFORMATION
Risks and limitations of adult surgery
Bleeding & infection
As with other surgery, bleeding, infection, bruising, pain and wound complications can occur.
Testicular atrophy after orchidopexy
A preserved testis can lose blood supply and become smaller or non-functional, particularly when substantial mobilisation is required.
Failure to reach a satisfactory scrotal position
Cord length or vascular anatomy may limit how far the testis can be mobilised safely.
Persistent cancer-risk context
Orchidopexy does not erase the historical association between cryptorchidism and germ-cell tumour.
Further surgery
Additional surgery may be required for atrophy, abnormal biopsy findings, recurrent malposition or another subsequent testicular problem.
Fertility may remain impaired
Moving an adult testis to the scrotum does not guarantee recovery of normal sperm production.
Hormone function may remain impaired
Orchidopexy does not guarantee normal testicular hormone production, particularly when the testis is small or dysplastic.
Loss of testicular tissue with orchidectomy
Removing a testis permanently removes any remaining reproductive or hormone-producing function from that side.
This is not an exhaustive list. Individual risks depend on testicular location, vascular anatomy, previous surgery, the opposite testis and the operation performed.
AFTER ADULT ORCHIDOPEXY
What follow-up may involve
A preserved testis remains part of the patient's long-term testicular-health history.
Postoperative position & size
Examination assesses wound healing, testicular position and evidence of postoperative atrophy.
Biopsy result
If biopsy has been performed, the pathology result may change future surveillance or treatment.
Fertility or hormones
Repeat reproductive assessment may be appropriate when infertility or endocrine dysfunction was part of the original presentation.
Testicular awareness
A new lump, increasing firmness, enlargement or other significant testicular change should be assessed promptly.
PREPARING FOR REVIEW
What information is useful?
Childhood records can be surprisingly helpful in adults because they may clarify whether the testis was always undescended, had previous surgery or was once documented in the scrotum.
Previous orchidopexy or groin operative reports
Childhood or previous ultrasound reports if available
Semen analysis if fertility is a concern
Previous fertility treatment information
Previous reproductive hormone results if available
History of testicular cancer in you or close male relatives
Information about the opposite testis
Your priorities regarding fertility and preservation of testicular tissue
INTERSTATE & INTERNATIONAL PATIENTS
Seeking an adult cryptorchidism opinion from outside Brisbane?
Previous operative reports, ultrasound findings, semen-analysis results and reproductive hormone tests can be provided for review. The likely need for further assessment and whether preservation or removal needs to be discussed can then be clarified before major travel arrangements.
ADULT UNDERSCENDED TESTIS FAQ
Common questions
What is an undescended testis?
It is a testis that has not reached a normal position within the scrotum. It may lie in the groin, abdomen or another ectopic position.
Is an undescended testis dangerous in an adult?
Cryptorchidism is associated with increased risk of germ-cell neoplasia and testicular cancer, as well as impaired fertility and sometimes reduced hormone-producing function. The appropriate management depends on the individual anatomy and function.
Does an adult undescended testis always need to be removed?
No. Removal is commonly offered when one testis is undescended and the opposite testis has normal sperm and hormone function. Preservation with orchidopexy may be considered when retaining testicular function is important, particularly with bilateral disease or an abnormal opposite testis.
When is orchidectomy usually discussed?
It is often discussed for a unilateral post-pubertal undescended testis when the opposite testis is normally functioning, particularly if the undescended testis is intra-abdominal, small or unlikely to provide meaningful reproductive or hormonal function.
When might orchidopexy be considered in an adult?
Orchidopexy may be considered when the undescended testis could contribute to fertility or hormone production, particularly if the opposite testis is impaired or both testes are undescended and scrotal positioning is technically feasible.
Does adult orchidopexy remove the risk of testicular cancer?
No. Moving the testis to the scrotum makes examination and surveillance easier but does not erase the underlying cancer-risk association of cryptorchidism.
Why might a biopsy be taken during adult orchidopexy?
Current European reproductive guidance recommends biopsy when an undescended testis is corrected in adulthood to assess for germ-cell neoplasia in situ, a microscopic precursor of many testicular germ-cell tumours.
Can orchidopexy improve my fertility as an adult?
Preserving viable testicular tissue may have value in selected men, but adult orchidopexy does not guarantee improved sperm production. Semen analysis and function of the opposite testis help guide the decision.
What if both testes are undescended?
Bilateral cryptorchidism requires particular attention to fertility and hormone production. Orchidopexy may be considered when technically feasible because removal of both testes would eliminate endogenous testicular hormone production and any remaining reproductive function.
What if I have no sperm in my semen?
Azoospermia requires a complete male infertility assessment. Bilateral cryptorchidism can contribute to impaired sperm production, but other genetic, hormonal and obstructive causes may also need investigation.
Can a non-palpable adult testis be found with ultrasound?
Imaging can sometimes provide useful anatomical information, but a truly non-palpable testis is not always reliably located by ultrasound. Operative assessment may be required when determining the anatomy remains clinically important.
What if the testis is inside the abdomen?
In a post-pubertal man with a normal opposite testis, removal of an intra-abdominal testis is commonly discussed because examination is not possible and the long-standing cancer-risk context remains relevant.
Can hormone treatment bring an adult undescended testis down?
Treatment intended to induce testicular descent medically is not recommended in post-pubertal males. Adult intervention, when appropriate, is surgical.
I had orchidopexy as a child. Do I still need to think about testicular cancer?
Yes. Early childhood correction is beneficial, but the history of cryptorchidism remains relevant. A new testicular lump, firmness or significant change should still be assessed.
Can an adult testis shrink after orchidopexy?
Yes. Testicular atrophy can occur if the blood supply is insufficient after mobilisation. The risk depends on testicular location and vascular anatomy.
Should I have a semen analysis before surgery?
It is particularly useful when future fertility matters or when the opposite testis is abnormal, because baseline sperm production can materially affect whether preserving the undescended testis is worthwhile.
Does having one normal testis usually allow normal fertility?
Many men with one healthy testis have adequate sperm and hormone production, but individual fertility cannot be assumed. Semen analysis provides direct information when fertility is important.
What if I find a lump in an undescended or previously corrected testis?
A new lump or firm area requires prompt direct assessment and testicular imaging. It should not be assumed to be scar tissue from previous surgery.
TESTICULAR SURGERY & MALE REPRODUCTIVE UROLOGY
Adult cryptorchidism sits between cancer prevention and fertility preservation
Dr Jack Crozier is a Brisbane urologist whose practice includes male infertility, testicular cancer and testicular surgery. Adult undescended-testis assessment focuses on whether the testis provides meaningful reproductive or endocrine function, the health of the opposite testis and how best to manage the long-term cancer-risk context.
INDIVIDUAL ADULT ASSESSMENT
Have you reached adulthood with an undescended testis?
Individual assessment can clarify testicular location and function, the health of the opposite testis, fertility priorities and whether orchidopexy, orchidectomy or continued surveillance should be discussed.