Undescended Testes Treatment in Adults Singapore

• Adult men with palpable undescended testis in the inguinal region
• Patients with non-palpable testis requiring evaluation and treatment
• Men experiencing discomfort or pain from an undescended testis
• Individuals with cosmetic concerns about scrotal asymmetry
• Patients seeking fertility preservation if testicular function remains
• Men with previously untreated or incompletely treated cryptorchidism
• Adults with ascending testis syndrome (previously descended testis that has retracted)
• Patients requiring cancer risk reduction through surgical intervention

• Severe cardiovascular conditions preventing safe anaesthesia
• Active urinary tract or systemic infections requiring treatment first
• Bleeding disorders requiring optimisation before surgery
• Certain medications that increase surgical risks (require adjustment)
• Unrealistic expectations about fertility restoration in long-standing cases
• Medical conditions that significantly increase surgical risks

The decision for surgical intervention requires careful evaluation by an MOH-accredited urologist. Individual assessment considers the duration of cryptorchidism, testicular function, patient age, and overall health status. Some adults may have lived with this condition for years without realising treatment options exist. A thorough consultation helps determine whether surgical intervention offers meaningful benefits based on individual circumstances and goals.

Orchidopexy involves surgically mobilising the undescended testis and fixing it in the scrotum. This procedure is considered when the testis appears viable and the patient desires preservation. The surgeon makes an incision in the groin to locate the testis, carefully frees it from surrounding tissues, and creates adequate cord length for scrotal positioning. The testis is then secured in a scrotal pouch to prevent retraction. This approach preserves the organ while addressing anatomical abnormality.

Orchiectomy becomes necessary when the testis is atrophic (shrunken), non-functional, or poses significant cancer risk. Long-standing undescended testes in adults often have minimal function and elevated malignancy risk. The procedure involves complete removal of the affected testis through an inguinal or scrotal approach. Many adult patients opt for orchiectomy due to the reduced likelihood of fertility benefit from orchidopexy and the elimination of cancer risk.

For non-palpable testes, laparoscopic exploration helps locate and assess the testis. Small incisions allow camera insertion to visualise the abdomen and identify testicular position. If found, the surgeon can perform laparoscopic orchidopexy or orchiectomy depending on testicular viability. This minimally invasive approach reduces recovery time and provides good visualisation of intra-abdominal structures.

Modern surgical techniques utilise high-definition laparoscopic equipment for enhanced visualisation during exploration. Doppler ultrasound assists in assessing testicular blood flow and viability. Surgical loupes provide magnification for delicate tissue handling during open procedures. These tools enable precise surgical technique while minimising tissue trauma.

Before surgery, patients undergo comprehensive evaluation including physical examination, ultrasound imaging, and blood tests for hormone levels and tumour markers. MRI or CT scanning may locate non-palpable testes. Patients receive instructions about fasting requirements, typically nothing by mouth after midnight before surgery. Medications requiring adjustment are identified and modified appropriately. Arrangements for post-operative transportation and recovery assistance should be made. The surgical team reviews the procedure, obtains informed consent, and addresses any remaining questions.

The procedure begins with anaesthesia administration, typically general anaesthesia for patient comfort. For orchidopexy, the surgeon makes an inguinal incision to access the undescended testis. Careful dissection frees the testis and spermatic cord from surrounding tissues. The processus vaginalis is ligated if present. The surgeon creates a dartos pouch in the scrotum and positions the testis, securing it to prevent retraction. For orchiectomy, the testis and spermatic cord are removed after vessel ligation. Laparoscopic procedures involve insufflation of the abdomen with CO2 gas and insertion of camera and instruments through small incisions. The procedure typically takes 30-90 minutes depending on complexity.

Following surgery, patients recover in the post-anaesthesia care unit with vital sign monitoring. Pain management begins immediately with appropriate medications. Ice packs help reduce swelling and discomfort. Most patients can consume clear liquids once fully awake. Discharge home typically occurs the same day for uncomplicated cases. The surgical team provides detailed aftercare instructions, prescription medications, and emergency contact information. A scrotal support garment may be recommended for comfort. Patients should arrange for someone to drive them home and stay with them for the first 24 hours.

Initial recovery focuses on pain management and swelling reduction. Apply ice packs for 20 minutes every 2-3 hours while awake. Take prescribed pain medications as directed before pain becomes severe. Limit movement to essential activities and keep the surgical site clean and dry. Some scrotal swelling and bruising are normal. Watch for signs of infection including fever, increasing pain, or unusual discharge. Avoid lifting anything heavier than 5kg. Rest with legs elevated when possible to reduce swelling.

Gradually increase activity levels while avoiding strenuous exercise. Continue wearing supportive underwear or athletic support for comfort. Shower normally after 48 hours but avoid soaking in baths. Keep follow-up appointments for wound check and suture removal if non-absorbable sutures were used. Most patients can return to desk work after 3-5 days. Swelling typically peaks at day 2-3 then gradually improves. Continue pain medication as needed, transitioning to over-the-counter options. Report any concerns about healing or unusual symptoms to your surgical team promptly.

Full recovery typically occurs within 4-6 weeks. Normal activities including exercise can resume gradually after 2-3 weeks with surgeon approval. Sexual activity may resume after 3-4 weeks when comfortable. For orchidopexy patients, regular self-examination becomes important for monitoring testicular position and detecting any abnormalities. Follow-up appointments at 6 weeks and periodically thereafter monitor healing and testicular position. Patients who underwent orchiectomy may consider testicular prosthesis placement for cosmetic symmetry after complete healing.

Temporary scrotal swelling and bruising affect most patients, typically resolving within 2-3 weeks. Mild to moderate post-operative pain responds well to prescribed medications. Some patients experience temporary numbness around the incision site due to small nerve irritation. Minor bleeding or wound oozing may occur initially but usually stops spontaneously. Constipation from pain medications can be managed with stool softeners and adequate hydration. These effects are generally self-limiting and improve progressively during recovery.

Infection at the surgical site occurs in less than 5% of cases and responds to antibiotic treatment. Haematoma formation may require drainage if significant. Testicular atrophy after orchidopexy is possible if blood supply becomes compromised. Recurrence of ascent can occur but is uncommon with proper fixation technique. Chronic pain syndrome develops rarely and may require pain management consultation. Injury to surrounding structures including vas deferens or blood vessels is minimised through careful surgical technique.

MOH-accredited urologists minimise these risks through meticulous surgical technique, appropriate patient selection, and comprehensive post-operative care. Most complications, when they occur, are manageable with prompt recognition and treatment. The overall safety profile of these procedures is favourable when performed by experienced surgeons in accredited facilities.