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Management of bilateral nubbin testis, past and present controversies: a case report

  • Dian Adi Syahputra ,
  • Vita Indriasari ,
  • Fransiska Kusumowidagdo ,


Introduction: Testicular nubbin is the most common case of impalpable testis found by pediatric urologists. Diagnostic and surgical management, including long-term follow-up, is still a debate, especially in cases of bilateral testicular nubbin.

Case presentation: A 5-year-old boy with bilateral impalpable testis was brought to a hospital. A diagnostic laparoscopy was performed, and both internal inguinal rings were closed with testicular blood vessels, and the vas deferens had entered the inguinal canal. We found bilateral testicular nubbin on inguinal exploration and subsequently performed only right orchidopexy because it was larger than the left testis.

Conclusion: Evidence-based medicine, comprehensive management, and consultation between doctor and patient are needed in bilateral management of testicular nubbin for a good patient outcome.


  1. Nataraja RM, Yeap E, Healy CJ, Nandhra IS, Murphy FL, Hitsun JM, Kimber C. Presence of viable germ cells in testicular regression syndrome remnants: Is routine excision indicated? A systematic review. Pediatric Surgery International 2017 ;34,353-356,
  2. Nataraja RM, Asher CM, Nash R, Murphy FL. Is routine excision of testicular remnants in testicular regression syndrome indicated? Journal of Pediatric Urology 2015;11, 151.e1e151.e5.
  3. Yagiz B, Kara YA, Hancioglu S, Demirel BD, Karaman A, Bicakci U, Nilufer A, et al. Sentinel nubbin: A potential pitfall in the management of undescended testis secondary to epididymo-testicular nonunion. Journal of Pediatric Urology 2020;15 (5), 635.e1-635.e7,
  4. Woodford E, Eliezer D, Deshpande A, Kumar R. Is excision of testicular nubbin necessary in vanishing testis syndrome? Journal of Pediatric Surgery 2018;53,2495–2497.
  5. Law H, Mushtaq I, Wingrove K, Malone M, Sebire NJ. Histopathological features of testicular regression syndrome: relation to patient age and implications for management. Fetal Pediatric Pathology 2006; 25, 119e29.
  6. Storm D, Redden T, Aguiar M, Wilkerson M, Jordan G, Sumfest J. Histologic Evaluation of the Testicular Remnant Associated with the Vanishing Testis Syndrome: Is Surgical Management Necessary? Urology 2007; 70,1204–1206,
  7. Agha RA, Franchi T, Sohrabi C, Mathew G, for the SCARE Group. The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines, International Journal of Surgery 2020;84:226-230.
  8. Kehoe JE, Christman MS. To ‘Pex or Not to ‘Pex: What to Do for the Contralateral Testis When a Nubbin Is Discovered. Current Urology Report 2017;18(2) doi: 10.1007/s11934-017-0657-z.
  9. Heksch RA, Matheson MA, Tishelman AC, Swartz JM, Jayanthi VR, Diamond DA, et al. Testicular Regression Syndrome: Practice Variation in Diagnosis and Management. Endocrine Practice 2019 ;25(8), 779-786
  10. Kolon TF, Herndon CD, Baker LA, Baskin LS, Baxter CG, Cheng EY, et al. Evaluation and treatment of cryptorchidism: AUA guideline. The Journal of Urology 2014;192(2):337-45. doi: 10.1016/j.juro.2014.05.005.
  11. Pirgon O, Dundar BN. Vanishing Testis : A Literature Review. J Clin Res Pediatr En docrinol 2012;4(3):116-120, DO I: 10.4274/Jcrpe.728
  12. Papparella A, Zamparelli M, Cobellis G, Amici G, Saggiomo G, Parmeggiani P, Fioretti GP. Laparoscopy for nonpalpable testis: is inguinal exploration always necessary when the cord structures exit the inguinal ring? Pediatric Endosurgery Innovative & Technique 1999;3:29-33.
  13. Van Savage JG. Avoidance of inguinal incision in laparoscopically confirmed vanishing testis syndrome. Journal of Urology 2001;166:1421-1424. doi: 10.1097/00005392-200110000-00060.
  14. Plotzker ED, Rushton HG, Belman AB, Skoog SJ. Laparoscopy for nonpalpable testis in childhood: is inguinal exploration also necessary when vas and vessels exit the inguinal ring? Journal of Urology 1992;148:635-638. doi: 10.1016/s0022-5347(17)36676-4.
  15. Emir H, Ayik B, Elicevik M, Buyukunal C, Danismend N, Dervisoglu S, Soylet Y. Histological evaluation of the testicular nubbins in patients with nonpalpable testis: assessment of etiology and surgical approach. Pediatr Surg Int 2007;23:41-44. DOI 10.1007/s00383-006-1802-9
  16. Rozanski TA, Wojno KJ, Bloom DA. The remnant orchiectomy. Journal of Urology. 1996;155(2):712–3.
  17. Cendron M, Schned AR, Ellsworth PI. Histological evaluation of the testicular nubbin in the vanishing testis syndrome. Journal of Urology 1998;160:1161-1162. doi: 10.1097/00005392-199809020-00054

How to Cite

Syahputra, D. A., Indriasari, V. ., & Kusumowidagdo, F. . (2022). Management of bilateral nubbin testis, past and present controversies: a case report. Bali Medical Journal, 12(1), 74–76.




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Dian Adi Syahputra
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Vita Indriasari
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Fransiska Kusumowidagdo
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