Management of Non-Descended Testis in Adults
For adult men with a unilateral undescended testis and normal hormonal function/spermatogenesis, orchidectomy is the recommended treatment to reduce the risk of testicular cancer. 1
Treatment Algorithm Based on Clinical Presentation
Unilateral Undescended Testis
Normal contralateral testis function:
- Orchidectomy is strongly recommended 1
- Rationale: Reduces risk of malignancy while preserving fertility through the normal contralateral testis
Impaired contralateral testis function:
- Orchidopexy with simultaneous testicular biopsy to detect intratubular germ cell neoplasia in situ 1
- Rationale: Preserves potential hormone production and fertility while monitoring cancer risk
Bilateral Undescended Testes
- Bilateral orchidopexy with simultaneous testicular biopsies if technically feasible 1
- Rationale: Preserves hormone production and potential fertility
Important Considerations
Cancer Risk
- Men with cryptorchidism have 3.6-7.4 times higher risk of testicular cancer than the general population 1
- 2-6% of men with cryptorchidism history will develop testicular cancer 1
- Risk remains elevated even after orchidopexy, though early childhood orchidopexy reduces risk 1
Fertility Implications
- Men with history of bilateral cryptorchidism have significantly reduced fertility (paternity rates of 35-53%) 1
- Men with history of unilateral cryptorchidism have near-normal fertility compared to general population 1
Diagnostic Approach
- Scrotal ultrasound may be helpful in overweight patients but is not routinely recommended 2
- For non-palpable testes, identification of testicular vessels is critical during surgical exploration 1
Surgical Considerations
- Hormonal treatment is not recommended for cryptorchidism in postpubertal men (strong recommendation) 1
- When performing orchidopexy in adults, simultaneous testicular biopsy is mandatory to detect intratubular germ cell neoplasia 1
- If testicular cancer is suspected, radical orchiectomy through an inguinal incision is the standard approach 3
Special Situations
Intra-abdominal Testes
- Higher risk of malignancy compared to inguinal or scrotal position 4
- Orchidectomy strongly recommended if unilateral with normal contralateral testis 1
Post-surgical Follow-up
- Regular testicular self-examination is recommended for early cancer detection 1
- Long-term monitoring for hypogonadism may be necessary 1
Pitfalls to Avoid
- Delaying treatment in adults with undescended testes increases cancer risk
- Failing to perform testicular biopsy during orchidopexy in adults
- Using hormonal treatment for cryptorchidism in adults, which has poor success rates 1
- Scrotal violation for biopsy or open surgery should be strongly avoided 3
The management approach for adult cryptorchidism differs significantly from pediatric cases, where early intervention (before 18 months) is recommended to preserve fertility and reduce cancer risk 5. In adults, the primary concern shifts toward cancer prevention while preserving hormonal function when necessary.