Question Title: Undescended Testical

Hello

I'm a 44 year old male. In 1978 I was operated on for for an undescended testicle. The doctor could not bring the testicle down to the proper location. When I asked him why he did not remove it, he said that it still produced hormones.
I went in for a physical last week. My doctor suggested that I see a Urologist concerning my testicle. My orginal Urologist has retired, so I had to find a new one. To make a long story short, the new Urologist suggested that I should have the right testicle removed. He said that it could cause major health problems, cancer being one of those. My original Urologist told me that once your reached the age of 37+ the risk of cancer was considerbly lower. The new doctor is saying that is not really true. I have no problems or symtoms of cancer. Should I leave well enough alone, or consider the removal of my right testical? If I do have it removed what is going to happen to my hormone level, and what else should I be concerned with? Do I still run a high risk if cancer at 44 years of age?

Thank You Very Much

Bill

Dear Bill,
The three main reasons for relocating the testis are to provide an environment favoring normal organ maturity, the accessibility for self examination later in life, and the psychologic advantage of a normal full scrotum. At age 44, the major concern is the accessibility of the testis for self evaluation.
It has been well established that undescended testicles are more likely to form cancer than testicles that have descended. About 10% of all testicular cancers arise from cryptorchid testes. The undescended testis is reported to be 35-48 times more likely to undergo malignant degeneration and abdominal testes even are 4 times greater. Despite these numbers, at times, testes are left in place even when they are unable to be brought into the scrotum to allow for puberty and the growth of secondary sexual characteristics. The age that your original urologist talks about, is not necessarily an age when the chances of cancer drops, but rather an age when the risks of surgery and possible morbidity of that procedure, outweighs the risk of having testicular cancer. I’m familiar with a study similar to what he is quoting but the age quoted was 32. But not all urologists agree. The current trend is to attempt orchidopexy and placement of the testis in an accessible location. If this cannot be accomplished, orchiectomy is the safest option. However, the fact that neoplastic degeneration of an UDT is so rare and the majority of tumors develop at the time of puberty, if your testis is palpable it may be followed with self evaluation but still a good argument can be made to remove it.
Some doctors will tell you that if the testis can be evaluated, ie. high in the scrotum or inguinal canal, the testis could be left in place. Others may tell you that it still needs to be removed. I don’t have all the knowledge of your full history and physical exam, but I feel that if the testis can be evaluated, even if it is high in the scrotum or inguinal canal, it need not be removed. However, if the testis cannot be evaluated or is intra-abdominal, a CT scan might be obtained before making the decision to remove the testis.
Good luck with your decision. I think your current urologist is quite capable of helping you make the correct one.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:Testis Cancer

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