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Forum Name: Pediatric Topics

Question: 2 1/2 yo with a undescended testicle


 centicknap84 - Tue Aug 03, 2010 3:38 pm

My son has just been diagnosed with a undescended testicle they are both sitting just above his pelvis one doctor told us he needs to go for an op asap and another one later tried to force one of them down with his hands causing my son a lot of pain and he still seems to be in pain now I'm just wondering if this is normal and should I be worried
 Dr.M.Aroon kamath - Sat Aug 07, 2010 1:48 am

User avatar Hi,

Cryptorchidism is perhaps, the most common genital problem encountered in pediatric practice.

Cryptorchidism is a broad term which includes incompletely descended, retractile, absent ,ectopic, or atrophic testes.

Clinically, undescended testes may be
- palpable or
- nonpalpable.
Approximately 80% of undescended testes are palpable and 20% are nonpalpable. Nonpalpable testes may be either intra-abdominal or absent.

Some types of “palpable” testes may be at times, difficult to palpate. For example,
- testes which just come out of the internal inguinal ring on straining but get back into the abdomen otherwise, are sometimes called as the “emergent” or "peeping" testes, and
- those in the superficial inguinal pouch in obese individuals.

The undescended testis poses certain problems, notably...
- the risk of testicular cancer
- Risk of torsion of the testicle
- risk of reduction in spermatogenesis and
- risk posed by an associated inguinal hernia.

For undescended testicle discoverd at birth, there is not much controversy about the management.These are treated by orchidopexy between 12-18 months of age (some prefer at 9-12 months of age).The American Academy of Pediatrics recommends surgical correction at one year of age.

In any case, surgery before 6 months of age is not preferred due to the following reasons...
- The blood vessels of the testis are of very thin caliber and thus prone to damage.
- some of the undescended testes(rather low lying) may descend spontaeneously upto 6 months of age.

From the age of 2 years, changes occur in the testis which can be found on light microscopy as well as electron microscopy.
Bringing the testis down into the scrotum before this age can improve semen quality and fertility later in life. Men born with bilateral undescended testes usually have very poor sperm quality, even if corrected by surgery.

Unilateral cryptorchidism has a reported infertility rate of about 10%, compared with about 6% reported for the general population of adult men.The fertility reduction following orchiopexy for bilateral cryptorchidism is more marked, about 38%, or 6 times that of the general population.

As for the anesthetic risk, risk between 6 months of age and 2 years is far less compared to the risks in adults (more the age, more the risk, generally).

In recent times, laparoscopic management of intra-abdominal testes has become possible.

Your child needs to be assessed by a pediatric surgeon and the best course of management should be planned. I trust this information may be useful to you.
Best wishes!

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