Endocrine/Reproductive - Undescended Testes

Question 1

Defintion

Answer 1

The testes develop in the abdomen and then gradually migrate down through the inguinal canal and into the scrotum. They have normally reached the scrotum prior to birth
In about 5% of boys the testes have not made it out of the abdomen by birth.
Might be palpable in the inguinal canal (in the inguinal region) = not technically UD although they have not fully descended at that point
The longer the testes take to descend, the less likely it is this will happen spontaneously.

Question 2

What are older children with undescended testes more at risk of

Answer 2

Testicular torsion
Infertility
Testicular cancer

Question 3

Risk factors for undescended testes

Answer 3

FHx
Low birth weight
Small for gestational age
Prematurity
Maternal smoking during pregnancy

Question 4

Management

Answer 4

Newborns: watch and wait
- most cases the testes will descend in the first 3-6 months

Unilateral undescended testis:
referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age
orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age
Bilateral undescended testes:
Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation

Question 5

Retraction testes

Answer 5

It’s normal in pre-pubertal boys for their testes to move out of the scrotum and into the inguinal canal when:
- it is cold
- cremasteric reflex is activated
= retractile testicles and is considered a normal variant.
This usually resolves as they go through puberty and the testes settle in the scrotum. Occasionally they may fully retract or fail to descend and require surgical correction with orchidopexy.