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Testicular regression syndrome revisited: Insights from a 15-year retrospective study and evolving perspectives on

Celine Sarah Thomas1, Lianne Dmello1, Tarun John K Jacob1

  • 1Department of Paediatric Surgery, Christian Medical College and Hospital, Vellore, 632004, India.

Journal of Pediatric Urology
|February 26, 2026
PubMed
Abstract

Insights

Testicular Regression Syndrome (TRS) remnants rarely contain viable germ cells (GCs), with no reported malignancies. Excision is advised for intra-abdominal remnants, but selective management may suit inguino-scrotal cases.

Area of Science:

  • Pediatric Surgery
  • Urology
  • Developmental Biology

Background:

  • Testicular Regression Syndrome (TRS) is a form of cryptorchidism where testicular tissue is absent, but cord structures persist.
  • Routine excision of TRS remnants is common due to concerns about malignant potential from seminiferous tubules (SNTs) or germ cells (GCs), though this risk is debated.

Purpose of the Study:

  • To evaluate the histopathological findings in testicular remnants from children with clinically impalpable testes.
  • To determine the incidence of SNTs and GCs in TRS remnants and assess risk factors for malignancy.

Main Methods:

  • Retrospective review of 262 children with impalpable testes undergoing diagnostic laparoscopy or inguinal exploration (2008-2022).
  • Detailed histopathological examination of excised testicular remnants for SNTs, GCs, and regression features.

Main Results:

  • SNTs were found in 10.3% of remnants, and viable GCs in only 1.1%.
  • Intra-abdominal remnants had a significantly higher incidence of SNTs/GCs (62%) compared to inguinal (10%) or scrotal (4%) remnants (p < 0.0001).
  • No invasive malignancy was reported in any remnant.

Conclusions:

  • TRS remnants seldom contain viable GCs, and invasive malignancy is not a significant risk.
  • Excision of intra-abdominal remnants is recommended, while selective management of inguino-scrotal remnants may be considered.
  • Further prospective studies are needed to develop evidence-based guidelines for TRS management.
Keywords:
Germ cell tumourTesticular regressionVanishing testes

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