Testicular Size Discrepancy and Cancer Risks in Cryptorchidism - Urology

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Cryptorchidism and asymmetrical testicular size?


Hello, doctor: I had right-sided cryptorchidism as a child, with the testis located in the right inguinal canal.
I remember having surgery around the age of 5-8 to bring the testis down and secure it in the right scrotum.
Recently, I came across some medical reports indicating that individuals with cryptorchidism have a 40 times higher risk of developing testicular cancer compared to those without.
I recently examined my left testis, which measures approximately 4x3x2.5 cm and hangs down normally, while the right testis is noticeably smaller, measuring about 2.5x2x2 cm (estimated by palpation), and is less mobile, positioned higher up.
When I palpated the left testis, I did not feel any masses or lumps, but due to the smaller size and limited mobility of the right testis, I could not fully assess whether there are any lumps present.
Given the significant size difference (the left is about twice the size of the right), is this normal? Is there a possibility of testicular cancer? Should I visit a urologist for further evaluation?

greenchen, 30~39 year old female. Ask Date: 2012/11/21

Dr. Xu Weikai reply Urology


Hello, in general, orchidopexy surgery involves returning the testicle to the scrotum for easier observation.
If there are malignant changes, they can be detected more readily.
A smaller testicle may be due to developmental issues.
Typically, the recommended optimal time for surgery is before the age of 2, with some suggesting around 18 months is ideal.
If surgery is performed between ages 5-8, the testicle may have already been affected by high temperatures, leading to slower development.
Additionally, there may have been pre-existing issues with the testicle that caused the cryptorchidism.
Testicular tumors can be easily diagnosed as they typically present with noticeable enlargement.
If there is uncertainty, it is advisable to visit a hospital for a testicular ultrasound and blood tests for testicular cancer.
If you have further questions, feel free to ask for more discussion and research.
Online responses should only be used as a reference; it is essential to seek medical care at a healthcare facility when necessary.
This message is from Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2012/11/21

More Info


Cryptorchidism, or undescended testis, is a condition where one or both testicles fail to move down into the scrotum before birth. This condition is associated with several long-term health risks, including an increased risk of testicular cancer. Studies have shown that men who had cryptorchidism have a significantly higher risk of developing testicular cancer—up to 40 times greater than those with normally descended testicles. This elevated risk is thought to be due to the abnormal development of the testicle and the potential for hormonal imbalances that can occur when the testicle is not in its normal position.

In your case, you mentioned that you had surgery to correct the right-sided cryptorchidism when you were a child. It is important to monitor the health of both testicles, especially since you have a history of cryptorchidism. The size discrepancy you noted—where the left testicle measures approximately 4x3x2.5 cm and the right testicle is significantly smaller at about 2.5x2x2 cm—can be concerning. It is not uncommon for the testicle that was previously undescended to be smaller or have a different consistency compared to the normally descended testicle. However, significant differences in size, especially when accompanied by a lack of mobility or changes in texture, warrant further investigation.

While the absence of palpable lumps in the left testicle is reassuring, the right testicle's smaller size and fixed position could suggest a few possibilities, including atrophy (shrinkage) of the testicle, which can occur after cryptorchidism, or other pathological changes. Testicular cancer can present as a hard lump or mass, but it can also manifest as changes in size or shape of the testicle.
Given your history and the current observations, it is advisable to consult a urologist for a thorough examination. The urologist may recommend imaging studies, such as an ultrasound, to assess the structure of both testicles and to rule out any malignancy or other abnormalities. Regular self-examinations are also crucial; you should be familiar with the normal size and shape of your testicles so that you can detect any changes early.

In summary, while a size discrepancy between the testicles can be normal, especially in the context of previous cryptorchidism, the degree of difference you described, combined with the history of undescended testis, suggests that a medical evaluation is warranted. Early detection and intervention are key in managing any potential issues, including testicular cancer. Therefore, I recommend scheduling an appointment with a urologist as soon as possible for a comprehensive evaluation.

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