Increased Risk After Orchiopexy for Undescended Testis
Despite successful orchiopexy, this patient remains at significantly increased risk for testicular seminoma (and other germ cell tumors), with a 3.6-7.4 times higher lifetime risk compared to the general population, and a 2-6% absolute lifetime risk of developing testicular cancer. 1
Primary Long-Term Risk: Testicular Cancer
The most critical counseling point for this family is the persistent elevated cancer risk:
Orchiopexy reduces but does not eliminate testicular cancer risk. Even when performed before puberty (as in this case with Tanner stage 3), the risk remains 2-6 fold higher than in males without cryptorchidism history. 2
Seminoma is the most common tumor type in patients with cryptorchidism history, particularly when the testis was located outside the scrotum (as with inguinal location). 3
The 2025 European Association of Urology guidelines emphasize that even men who undergo early orchiopexy still harbor a higher risk of testicular cancer than men without cryptorchidism. 1
Essential Post-Operative Counseling
The patient must be taught monthly testicular self-examination after puberty to facilitate early cancer detection. 1
Secondary Risk: Fertility Concerns
For unilateral cryptorchidism (as in this case), paternity rates are nearly equivalent to the general population (approximately 89.5%). 1
However, the contralateral descended testis may also have structural abnormalities, including smaller volume and reduced markers of fertility potential, even though it descended normally. 1
Why Other Options Are Incorrect
A. Incomplete virilization - Not supported. The patient already demonstrates Tanner stage 3 development, indicating normal androgen production. Leydig cell function is typically preserved in unilateral cryptorchidism. 1
B. Leydig cell tumor - Incorrect. While cryptorchidism increases germ cell tumor risk dramatically, there is no established increased risk for Leydig cell tumors specifically. The overwhelming concern is germ cell malignancy (seminoma, nonseminoma). 1
D. Testicular torsion - Not the primary concern. While orchiopexy actually reduces torsion risk by fixing the testis in the scrotum, this is not a long-term increased risk after successful fixation. 4
E. Varicocele - No association. Cryptorchidism and orchiopexy do not increase varicocele risk. 1
Critical Clinical Pitfall
A common misconception is that successful orchiopexy "cures" the condition and eliminates cancer risk. The 2014 AUA guidelines explicitly state that successful scrotal relocation may reduce but does not prevent potential long-term sequelae, particularly testicular malignancy. 1