18 Devonshire Street
London
W1G 7AQ
info@londonurologyspecialists.co.uk
Adolescent Urology
Undescended Testes (Cryptorchidism)
Adolescent and adult management of cryptorchidism — long-term monitoring of fertility, cancer risk, and testicular health after childhood orchidopexy, delivered by our specialist transitional urology team.
Clinically reviewed by
Mr Anthony Noah
Consultant Urological Surgeon · Reviewed August 2026 · Review due August 2027
What is Cryptorchidism?
Cryptorchidism — the medical term for an undescended testicle — describes a testis that has failed to descend into the scrotum during foetal development. It is the most common congenital abnormality of the male genitalia and affects approximately 3% of full-term newborn boys (and a higher proportion of premature babies). Most cases resolve spontaneously in the first few months of life, with most undescended testes settling into the scrotum by 6 months of age.
When the testicle has not descended by 6 months, surgical correction with an operation called orchidopexy is typically recommended in the first 1–2 years of life. Early surgery protects testicular function and reduces (though does not eliminate) the long-term risks associated with cryptorchidism. Most boys treated in childhood will have been discharged from paediatric urology long before adolescence.
However, the long-term implications of cryptorchidism continue into adolescence and adulthood. Issues such as fertility, cancer risk, ascended or retractile testes, and testicular self-examination need to be addressed by an adolescent or adult urologist with experience in transitional care. At London Urology Specialists, Mr Anthony Noah leads our adolescent urology service and provides this continuity of care.
Childhood surgery is only the start
Even after a successful orchidopexy in early childhood, men with a history of undescended testes need lifelong awareness of fertility and cancer risk. Our adolescent urology clinic provides specialist transitional care — bridging paediatric and adult services with clear, structured follow-up.
Why Long-Term Care Matters
Even after a successful childhood orchidopexy, men with a history of undescended testes carry a number of long-term considerations that warrant ongoing awareness and, in some cases, specialist follow-up:
Increased Testicular Cancer Risk
Men with a history of cryptorchidism have a higher lifetime risk of testicular cancer than the general population. Risk is highest between the ages of 20 and 40 and applies to both the previously undescended testis and (to a lesser degree) the contralateral side.
Possible Fertility Issues
Reduced sperm count is more common in men with a history of cryptorchidism, particularly with bilateral cases or an atrophic testicle. Most men with unilateral disease have normal fertility, but a baseline assessment can be very reassuring when starting a family.
Risk of Testicular Torsion
Maldescended and ascended testes are at higher risk of torsion (twisting of the testicle on its blood supply). Sudden severe scrotal or groin pain should always be treated as a urological emergency and assessed within hours.
Self-Examination Education
Monthly testicular self-examination from puberty onwards is the single most important habit for men with a history of cryptorchidism. We teach this in clinic and provide written guidance for ongoing reference.
Ascended or Retractile Testicle
A testicle that was descended at birth can occasionally rise back into the groin during childhood or adolescence (an ascended testis). This can require later orchidopexy. A retractile testis — one that moves up briefly but returns — usually does not.
Atrophic Testicle
Some previously cryptorchid testes shrink over time and become small and non-functional. In selected cases, removal (orchidectomy) with placement of a testicular prosthesis offers a cosmetic and psychological benefit.
How Cryptorchidism Presents in Adolescents
By adolescence and early adulthood, men with a history of undescended testes typically present with one or more of the following clinical scenarios:
Late-Presenting or Ascended Testes
A testicle that was previously felt in the scrotum has risen up into the groin. Late orchidopexy is often required to bring it back down and fix it in place. This is more common in boys with a history of retractile testes.
Testicular Asymmetry or an Atrophic Testicle
One testicle appears noticeably smaller than the other — often the previously undescended side. This is best assessed with examination and a scrotal ultrasound to measure volume and exclude any focal lesion.
Concerns About Fertility
Many young men — particularly those with bilateral undescended testicles or an atrophic testicle — want clear information about their future fertility before starting a family. A semen analysis and hormone profile usually answer the question quickly.
Anxiety About Cancer Risk
Adolescents and young adults who have read about the increased cancer risk may seek reassurance and guidance on what to monitor. A structured consultation, examination, and education about self-examination is usually all that is needed.
Need for Self-Examination Teaching
Some young men have never been formally taught how to examine themselves. We provide a clear, age-appropriate, and unhurried demonstration in clinic and back this up with written and visual guidance.
Diagnosis & Assessment
At London Urology Specialists, we provide a focused, age-appropriate workup tailored to the individual concern, from a single reassuring consultation to a full reproductive and oncological assessment:
Clinical Examination
Careful examination of both testes in a warm room, both standing and supine. This helps distinguish a truly undescended, ascended, retractile, or atrophic testis and is often the only investigation needed.
Scrotal Ultrasound
A quick, painless ultrasound to confirm the location, size, and internal appearance of each testis. It is highly accurate for testes within the scrotum or groin and helps exclude focal lesions or microlithiasis.
MRI for Non-Palpable Testes
If a testis cannot be felt and is not seen on ultrasound, a pelvic or abdominal MRI is the best non-invasive way to locate an intra-abdominal testis or confirm an absent/vanishing testis prior to laparoscopy.
Hormonal Testing
In bilateral cases or where there is concern about an atrophic testis, a hormone profile (Testosterone, LH, FSH and inhibin B) helps assess hormonal output and overall reproductive potential.
Semen Analysis
Where fertility is a concern, a simple semen analysis gives a clear picture of sperm count, motility, and morphology. We can arrange this discreetly through our partner laboratories and review the results together.
Treatments We Offer at LUS
The right approach depends on your age, the position and quality of the testis, your symptoms, and your priorities (fertility, cosmetic appearance, cancer surveillance). The following treatments are delivered directly by our adolescent urology team:
Orchidopexy for Late-Presenting or Ascended Testes
Surgical TreatmentFor some adolescents and young adults with an ascended or late-presenting testicle, we can perform orchidopexy; mobilising the testis, releasing any tethering structures, and fixing it securely in the scrotum. This is a day-case operation performed under general anaesthetic, and the recovery is typically quick. It is not always feasible in adults and orchidectomy (removal of the testis) may be required.
Removal of an Atrophic Inguinal or Intra-Abdominal Testis (Orchidectomy)
Selected CasesA severely atrophic or intra-abdominal testis that cannot be brought into the scrotum carries little or no useful function and a higher relative cancer risk. In selected adolescents and adults, laparoscopic or open removal is recommended, usually combined with placement of a testicular prosthesis at the same time or later on.
Testicular Prosthesis Insertion
Cosmetic & PsychologicalA modern silicone testicular prosthesis restores a natural-looking and natural-feeling scrotum for adolescents and adults who are missing a testis or have had one removed. It is inserted as a short day-case operation and can be sized to be similar to the contralateral side. The cosmetic and psychological benefit is often substantial.
Surveillance of a Single or Atrophic Testis
Long-Term Follow-UpFor men with a solitary testis or an atrophic testis on one side, we offer structured surveillance, periodic clinical examination, ultrasound where appropriate, and proactive review of any new symptoms. This is most useful between the ages of 20 and 40.
Testicular Self-Examination Training
EducationA clear, unhurried, age-appropriate demonstration of how to examine your own testes, supported by written and visual material. We help you build a monthly habit and explain exactly what to do (and not do) if you find something that worries you.
Coordination of Fertility Assessment
Reproductive PlanningWe arrange semen analysis and hormone profiling, interpret the results in context, and where appropriate discuss sperm banking before further surgery. If advanced fertility treatment is needed, we make a prompt onward referral to a specialist fertility clinic.
A single consultation often resolves the main concerns
For many adolescents and young adults, a focused consultation, a careful examination, and a short conversation about cancer and fertility risk is all that is needed. We are unhurried, clear, and happy to involve a parent or another person of your choice where helpful.
Other Treatments
A small number of patients need treatments that are best delivered in dedicated tertiary specialist centres. In these cases, we coordinate prompt onward referral and remain involved in your overall urological care:
Complex Fertility Treatment (IVF / ICSI)
Referred to Fertility ClinicIf semen analysis shows a very low count or surgical sperm retrieval is needed, we refer to a specialist fertility clinic with on-site IVF and ICSI services. We share clinical information and work jointly with the fertility team to plan the best route forward.
Oncology Referral
If Cancer DetectedIf testicular cancer is diagnosed, we refer immediately to a specialist testicular cancer multidisciplinary team for staging and treatment planning. Testicular cancer is highly curable when caught early, and a clear, rapid pathway gives the best outcomes.
Cancer Surveillance & Self-Examination
Men with a history of undescended testis have a higher lifetime risk of testicular cancer than the general population. While the absolute lifetime risk is still relatively low, this risk is highest between the ages of 20 and 40 — precisely the age range when self-awareness and early presentation make the biggest difference.
The single most important habit you can build is monthly testicular self-examination. It takes a minute, costs nothing, and saves lives. Any new lump or change in testicular size, hardness, or shape warrants urgent assessment — testicular cancer is highly curable when caught early.
Examine Monthly
Once a month is enough. A warm bath or shower relaxes the scrotal skin and makes self-examination easier. Pick a date you will remember — the first of the month works for most people.
Feel Both Sides
Roll each testicle gently between your thumb and fingers. You are looking for a new lump or hardness, a change in size, or a noticeable difference between the two sides.
Know What is Normal
One testicle being slightly larger or sitting slightly lower than the other is normal. The epididymis (a soft, sausage-shaped structure at the back) is also normal — we go through the anatomy in clinic.
Act Promptly on Changes
Any new lump, hardness, or change in size warrants prompt assessment — ideally within a week or two. Most lumps turn out to be benign, but early diagnosis of cancer is what makes it curable.
Fertility Considerations
Most men with a history of unilateral cryptorchidism have normal or near-normal fertility, particularly when childhood orchidopexy was performed in the first 1–2 years of life. Many father children without any difficulty.
Men with bilateral cryptorchidism or with an atrophic testicle have a higher chance of reduced sperm count and may benefit from a baseline semen analysis and hormone profile in late adolescence or early adulthood. The good news is that even mildly reduced parameters are often compatible with natural conception, and where they are not, modern fertility techniques (including IVF and ICSI) offer high success rates.
In selected cases — for example before removal of an atrophic intra-abdominal testis or where a semen analysis shows borderline parameters — we discuss sperm banking (cryopreservation) as a sensible, future-proofing step. This is a quick, painless, well-established option that simply provides reassurance and choice further down the line.
Meet your Specialist
Assessment and treatment of undescended testes (cryptorchidism) is led by our experienced consultant urologist. Your care will be personally overseen by our senior specialist.
Key Takeaways
Childhood orchidopexy is only the beginning of the story. If you have a history of undescended testes, structured adolescent and adult follow-up, combined with a monthly self-examination habit and a clear plan around fertility, gives you the best long-term outcome. Most men do extremely well; the key is awareness, prompt action when something changes, and access to a specialist who knows the condition inside-out.
Frequently Asked Questions
Cryptorchidism is the medical term for an undescended testicle — a testis that has failed to descend into the scrotum during foetal development. It affects approximately 3% of full-term newborn boys, with most cases resolving spontaneously by 6 months of age. Persistent cryptorchidism is typically corrected surgically by orchidopexy in the first 1–2 years of life, but the long-term implications continue into adolescence and adulthood, which is why specialist follow-up matters.
Most men with a history of unilateral cryptorchidism have normal or near-normal fertility, particularly if orchidopexy was performed in the first 1–2 years of life. Men with bilateral cryptorchidism or with an atrophic testicle have a higher chance of reduced sperm count and may benefit from early fertility planning. A simple semen analysis and hormone profile (testosterone, LH, FSH, inhibin B) can quickly clarify the picture and inform decisions such as sperm banking.
Men with a history of undescended testis have a higher lifetime risk of testicular cancer than the general population, even after successful orchidopexy. The absolute lifetime risk is still relatively low, but it is highest between the ages of 20 and 40. The most important thing you can do is perform monthly testicular self-examination from puberty onwards and seek prompt assessment for any new lump, change in size, or persistent ache.
We recommend monthly testicular self-examination, ideally during or just after a warm bath or shower when the scrotal skin is relaxed. Gently roll each testicle between your thumb and fingers, feeling for any new lump, hardness, swelling, or change in size. Any new lump or persistent change should be reviewed urgently — most lumps are benign, but early assessment is essential to rule out testicular cancer, which is highly curable when caught early.
Yes. A testicular prosthesis can be placed at any age and provides a natural-looking and natural-feeling restoration of scrotal appearance after removal of an atrophic or absent testis. Modern silicone implants are safe, well-tolerated, and inserted as a short day-case procedure under general anaesthetic. Many of our adolescent and adult patients with a history of cryptorchidism choose a prosthesis for cosmetic and psychological benefit, and outcomes are excellent.
Concerned About an Undescended Testicle?
Whether you are an adolescent moving from paediatric to adult care, a young adult seeking reassurance about fertility or long-term cancer risk, or a parent looking for specialist guidance, we offer expert assessment, compassionate care, and a clear, personalised management plan.