Undescended testis

Question 1

An undescended testis (aka cryptorchidism) is present in about 1-4.5% of newborns and about 30-45% of premature newborns.

Around 25% of cases are bilateral.

By the first year of life, two thirds will have spontaneously descended.

Answer 1

On cold days, retractable testes may hide in inguinal pouch
=> need careful examination
=> squatting, legs crossed, hot bath - they can be milked down in position
=> retractable testes don’t need surgery

If truly undescended, it lies along the path of descent from the abdominal cavity

Question 2

What are the complications of undescended testes?

Answer 2

=> infertility

=> torsion

=> testicular cancer (increased chance of a testicular tumor being diagnosed late as it is more difficult to notice a testicular lump in the inguinal region)

=>psychological

Question 3

How do you manage unilateral undescended testes?

Answer 3

=> referral considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age

=> Orchidopexy (performed at around 1 year of age)

=> early (at 1 year) fixing within scrotum (orchidopexy) may prevent infertility and reduces later neoplasia (untreated, risk increases 5-fold)

Question 4

How do you manage bilateral undescended testes?

Answer 4

Reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation

=> early (at 1 year) fixing within scrotum (orchidopexy) may prevent infertility and reduces later neoplasia (untreated, risk increases 5-fold)