Approximately 30% of preterm male infants have an undescended testis.
Spontaneous descent into the scrotum usually occurs in the ensuing 3 to 6
postnatal months. Orchiopexy, a surgical procedure to place a testis in the
scrotum, is indicated for a testis that fails to descend by 6 months of age and
usually is performed at 9 to 15 months of age. Histologic changes representing
degeneration of the seminiferous tubules that decreases the quality and quantity
of spermatogenesis can be seen at 6 to 12 months of age and are progressive. The
longer the testis remains in a location other than the scrotum, the greater the
fertility impairment. Accordingly, observation until age 2 years is not
appropriate. Orchiopexy improves fertility but does not change the malignancy
risk. Ten percent of all testicular tumors occur in patients who have an
undescended testicle. The relocated testis continues to have a malignancy
potential that is 35 to 48 times greater than a normal testis. However, the
contralateral testis in these patients also has an increased malignancy risk.
Orchiopexy places the testis in a location that facilitates examination and
early detection of a mass or torsion. Counseling should include recommendations
to obtain immediate medical assessment of acute testicular pain. Parents or
older patients should be instructed to perform monthly examination of both
Neither human chorionic gonadotropin nor testosterone has been effective in treating undescended testes. A radionuclide scan of the testis has nothing to offer in the assessment and management of a palpable or nonpalpable undescended testis. Imaging studies are frequently not successful in localizing a nonpalpable testis. Laparoscopy is the most reliable method.
Retractile testes that result from a brisk cremasteric reflex most often are bilateral and may be found in children older than l year of age (most commonly between ages 5 and 6 years). Frequently, these testes can be reduced gently by milking the retracted testes into the scrotum. Placing the patient in a relaxed, frog-leg position in a warm room enhances the success of the procedure. The examiner places gentle pressure on the upper inguinal canal with the thumb and finger of one hand and uses the other hand to manipulate the testes.
Virilization of the female infant associated with the absence of testes suggests congenital adrenal hyperplasia. Palpation of inguinal masses in a female infant suggests testicular feminization syndrome.
The finding of cryptorchidism with a midpenile proximal hypospadias suggests an intersex disorder and the need for karyotyping. Karyotyping should be considered in any infant who has ambiguous genitalia.
Elder JS. Disorders and anomalies of the scrotal contents. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders Co; 2000:1650-1651
Pillai SB, Besner GE. Pediatric testicular problems. Pediatr Clin North Am. 1998;45:813-830