Undescended testes (cryptorchidism) with thanks to Dr Sara Waise
Occasionally when you are examining a male infant, you may think that one or both of his testes has not yet descended into the scrotal sac. Infant testes are actually quite retractile; ask parents if they are visible in the scrotum when the baby has a warm bath. At 6 weeks some babies’ testes may still be palpable within the inguinal canal, especially if they were born a bit early. Infants with a true undescended testis need to be referred to a paediatric surgeon any time from 6 months of age and definitely by 1 year of age. Our local paediatric surgery service is at the Royal London Hospital, Whitechapel.
One of the junior doctors, Dr Sara Waise, has put together the following notes on undescended testes for Paediatric Pearls:
Check whether testes are:
- Present or absent
- In the inguinal canal
- High in the scrotum
- Able to be brought down into the scrotum
Identify any other congenital defects
- May be isolated
- Can occur as part of genetic or endocrine disorders and for this reason, my colleague with an interest in endocrinology asked me to remind you that bilateral undescended testes need immediate referral.
If the testis remains undescended at 1 year of age, referral to a urologist is needed.
Early correction maximises future fertility potential
- Outcome is poorer for bilateral undescended testes
- Unclear whether surgical correction fully normalises this
Surgical correction reduces malignancy risk
- Facilitates self-examination
- Risk remains 5-10 times greater than normal following orchidopexy
References
Kurpisz,. M., Havryluk, A., Nakonechnyj, A., Chopyak, V. & Kamieniczna, M. (2010). Cryptorchidism and its long-term consequences. Reproductive Biology 10 19-35
Hutson, J.M., Balic, A., Nation, T. & Southwell, B. (2010). Cryptorchidism. Seminars in Pediatric Surgery 19 215-234
http://www.patient.co.uk/health/Undescended-Testis.htm provides a useful, printable overview for parents of boys in whom you have found an undescended testis.
http://www.patient.co.uk/doctor/Undescended-and-Maldescended-Testes.htm has information for medical professionals and includes information about the ascending testis syndrome in the older child (around 8 to 10 years old).