Absent Testes

Saw a fifteen year old boy brought by parents because he had developed ‘hernia’. On history and examination what was found was that he had absent testes on both sides, with a largish lump in the right groin and a smaller swelling present in left superficial inguinal ring area. What he was suffering from was bilateral undescended testes with some tumour in the right side.

So how is an undescended testicle treated?

The most important risk factor is undescended testicle (cryptorchidism). In male babies inside the womb, the testicles develop
inside the abdomen. They usually move down into the scrotum at birth, or within the first year of life. If they move down later, or need surgery to bring them down, this is called undescended testicle. A large Swedish study found that if surgery is done to bring the testicle down before the age of 13, the risk of testicular cancer is about twice that of the rest of the population. But if the operation is not done until 13 or older, the risk is increased about 5 times.

So the current recommendations for undescended testes presenting after puberty are

• “Younger than 32 years with a unilateral undescended testis – Orchiectomy

• Older than 32 years with a unilateral undescended testis – Close observation
and physical examination (orchidopexy vs orchiectomy if difficult to

• Any man with bilateral undescended testes – Bilateral testicular biopsy and orchidopexy.”

In case of an adult with an undescended testicle, moving the testicle to the scrotum probably won’t improve testis’ ability to make sperm. So in adult men, an undescended testicle is usually just taken out. Doctors often don’t do anything about an undescended testicle in men over 40.

Further information from wikipedia.