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Background <p>In boys with non-palpable testes (NPT), the clinical significance of excised testicular remnants—and whether gross phenotype predicts histologic viability—remains uncertain. We evaluated remnant phenotype, histology, and ultrasonographic (US) findings to inform surgical management.</p> Methods <p>We retrospectively reviewed boys undergoing surgical exploration for NPT (2010–2025) following examination under general anesthesia. Testes were classified as intra-abdominal (IAT) or excised remnants; remnants were categorized as nodular versus non-nodular and stratified by internal ring pattern. The primary outcome was residual testicular elements; secondary outcomes included US detection and contralateral testicular size.</p> Results <p>Among 346 patients (370 testes), 120 were IAT and 250 excised remnants. Germ cells were identified in 7/250 (2.8%), exclusively in nodular specimens; seminiferous tubules in 38/250 (15.2%), and Leydig cells in 21/250 (8.4%). US detected a testicular structure in 39.3% of patients and missed 37.5% of IAT (62.5% vs. 24.4% for IAT vs. remnants, <i>p</i> &lt; 0.001). Contralateral hypertrophy showed moderate discrimination in children &lt; 6 years (AUC up to 0.820) but substantial overlap beyond 72 months.</p> Conclusion <p>Excised testicular remnants were predominantly degenerative, with viable germ cell–containing elements confined to macroscopically nodular specimens. Preoperative ultrasonography showed low diagnostic yield and did not alter operative management. Within the limitations of a single-center retrospective design, these findings suggest that the remnant excision strategy may be informed by macroscopic phenotype and intraoperative anatomy, while routine preoperative US warrants reconsideration.</p>

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Testicular remnant phenotype, histology, and ultrasonographic findings in non-palpable testes: implications for surgical management

  • 期刊论文

  • 发表日期：

    2026年7月20日

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  • Özkan Okur,
  • Ayşe Gül Tavukcu Tantay,
  • Mehmet Can,
  • Arzu Şencan

摘要

Background

In boys with non-palpable testes (NPT), the clinical significance of excised testicular remnants—and whether gross phenotype predicts histologic viability—remains uncertain. We evaluated remnant phenotype, histology, and ultrasonographic (US) findings to inform surgical management.

Methods

We retrospectively reviewed boys undergoing surgical exploration for NPT (2010–2025) following examination under general anesthesia. Testes were classified as intra-abdominal (IAT) or excised remnants; remnants were categorized as nodular versus non-nodular and stratified by internal ring pattern. The primary outcome was residual testicular elements; secondary outcomes included US detection and contralateral testicular size.

Results

Among 346 patients (370 testes), 120 were IAT and 250 excised remnants. Germ cells were identified in 7/250 (2.8%), exclusively in nodular specimens; seminiferous tubules in 38/250 (15.2%), and Leydig cells in 21/250 (8.4%). US detected a testicular structure in 39.3% of patients and missed 37.5% of IAT (62.5% vs. 24.4% for IAT vs. remnants, p < 0.001). Contralateral hypertrophy showed moderate discrimination in children < 6 years (AUC up to 0.820) but substantial overlap beyond 72 months.

Conclusion

Excised testicular remnants were predominantly degenerative, with viable germ cell–containing elements confined to macroscopically nodular specimens. Preoperative ultrasonography showed low diagnostic yield and did not alter operative management. Within the limitations of a single-center retrospective design, these findings suggest that the remnant excision strategy may be informed by macroscopic phenotype and intraoperative anatomy, while routine preoperative US warrants reconsideration.