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Forum Name: Urology Topics

Question: Deciding between orchidopexy and orchidectomy?


 heinz2 - Tue Nov 03, 2009 3:10 pm

Hi

I would appreciate your medical opnion on my situation which is as follows:

I am a 29 year old male married for 3.5 years and undergoing fertility investigation. In my US they found a unilateral undescended testes at the distal inguinal canal with normal echogenicity measured at 4-5ml. Now i have been given the option to choose between orchidopexy and orchidectomy. I really don't want to lose tissue that may be possibly producing sperm. I would like to maximise my chances of conceiving. Is it possible that because the testes is prescrotal it may be producing sperm and if so is there a way to determine this? would you recommend a biopsy or some other kind of scan which may show activity of that testes? lastly theUS report also said that the technician could not visualise a epididymis on the same side. Is it possible to have only agenesis of the epididymis on one side or do you think he just could localise it?

Thank you very much for your time and attention. Your advice will be much appreciated
 Dr.M.Aroon kamath - Thu Nov 19, 2009 8:37 am

User avatar Hi,
The undescended testis poses certain problems, notably...
- the risk of testicular cancer
- Risk of torsion of the testicle
- risk of reduction in spermatogenesis.
For undescended testicle discoverd at birth, there is not much controversy about the management.These are treated by orchidopexy between 12-18 months of age.
(some prefer 9-12 months of age).

The following discussion is about undescended testicle presenting late(in adults).

Generally, there are 3 options in the management of the undescended testicle --
- orcidopexy
- orchidectomy and
- monitoring of the testis(close observation).

Firstly, the risk of testicular cancer is significantly higher in an undescended testicle than in a descended one(the risk of testicular cancer is 20-40 times higher in undescended testes compared to normally descended testes).

Most cancers of the testis occur in the 15-40 year age group. The overall risk of testicular cancer even in men with descended testis is relatively small (3 per 1,000 in the USA). This excess risk appears to remain following orchidopexy.There appears to be a higher risk for testicular cancer in the other(normaly descended) testis as well! Therefore, it is debatable whether prophylactic removal of the undescended testicle is indicated.
Moreover, any benifit has to be weighed against the inherant risks of surgery and anesthesia in the adults.

Risk of torsion is increased. In malignant intra-abdominal testicles,the risk is higher.

Placing the testicle in he scrotum, however, allows for easy periodic examination so that if a tumor does develop, it can be detected early.

As far as sprem production is concerned, most undescended testes in adult men produce little or no mature sperm.

Pain, impalpability of the testicle, and torsion are indications for orchidectomy.

Following unilateral orchiectomy, it is unclear whether there is need for close observation of the remaining testicle.

Agenesis of the epididymis,blind- ending vas deference and other congenital abnormalities are known to occur in some cases of undescended testicles.It is not always possible to identify these anomalies on imaging.
Best wishes!

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