Undescended Testis:  The Most Common Genital Problem in Pediatrics

BY DR. BOYD WINSLOW

An undescended testis is a testicle that's not in the scrotum. It's the most common genital problem encountered in pediatrics-occurring in 3% of full-term male newborns and decreasing to 1% in infants aged 6 months to 1 year. Factors that increase the risk of having an undescended testis include prematurity, low birth weight, small size for gestational age, twinning, maternal exposure to estrogen during the first trimester, and family history.

Early diagnosis is important. If left untreated, an undescended testicle will not develop normally, and spontaneous descent after the first year of life is uncommon. The most useful method to diagnose an undescended testis is physical examination. Although this is seemingly self-explanatory, it's occasionally difficult to accurately determine the exact location of the testis. Body type, testicular position, and compliance of the child all are factors affecting the physical examination. Approximately 80% of undescended testes can be felt on physical exam. Testicles not detected may be in the abdomen or absent.

If a testicle is truly undescended, it may require surgery to relocate it inside the scrotum. This relocation is important for many reasons. Children's self esteem is intimately related to their physical appearance, including the appearance of their genitalia.  Also, having testes in their proper location will aid in maintenance of fertility, facilitation of self-examination for testicular cancer, and correction of an associated hernia and prevention of testicular torsion.

An orchiopexy, the surgical procedure for an undescended testis, should be performed between 6 and 12 months of age. This is routinely a same-day surgical procedure. Treatment, however, should not end with the first postoperative visit. The primary care provider or surgeon should evaluate the child at 2-3 weeks and 6-12 months following surgery to determine testis location, size, and viability. When the child reaches puberty, the physician should readdress the potential issues of fertility and testicular cancer and give instructions concerning the boy's monthly testicular self-examination.

If you would like more information regarding this and other urological conditions affecting children, please contact Children's Urology of Virginia at 804.272.2411 or at www.childrensurologyofvirginia.com.