From the Guidelines
For a 9-month-old with a high riding right scrotum that descends with gentle palpation, referral to pediatric urology should be made now, as the infant is already past the recommended 6 months of age for spontaneous testicular descent. According to the American Urological Association (AUA) guideline 1, testes that remain undescended by six months (corrected for gestational age) are unlikely to descend spontaneously, and referral to a surgical specialist is recommended.
The fact that the testicle descends with gentle palpation suggests it may be retractile, but evaluation by a specialist is still necessary to confirm proper development and rule out true cryptorchidism 1. The specialist will determine if observation or surgical intervention (orchiopexy) is needed. Early evaluation is important because undescended testicles are associated with increased risks of infertility, testicular cancer, and torsion.
Key points to consider in the evaluation and management of this patient include:
- Gestational age and birth weight, as these factors can influence the likelihood of spontaneous testicular descent 1
- The importance of regular well-child visits to monitor testicular position and development until puberty, even after specialist evaluation
- The potential benefits and risks of surgical intervention, including the potential to reduce the risk of long-term complications such as infertility and testicular cancer 1
- The fact that hormonal therapy is generally not recommended for isolated cryptorchidism in infants 1
From the Research
Monitoring and Referral for Treatment
- A high riding right scrotum in a 9-month-old that descends with gentle palpation may be a case of undescended testis, which is a common genitourinary disease in male neonates 2.
- The probability of spontaneous descent is low if the testes do not descend by 6 months of age, and a surgical specialist referral is recommended if descent does not occur by this age 2.
- In this case, since the child is 9 months old, monitoring for spontaneous descent may not be necessary, and referral to a surgical specialist may be considered.
- The risk of testicular torsion, a surgical emergency, is higher in undescended testes, and prompt referral and treatment are crucial to prevent complications 3, 4, 5.
Diagnostic Challenges and Treatment
- Diagnostic challenges may arise in cases of torsion of an undescended testis, and a high index of suspicion is necessary to prompt a quick and thorough examination 4.
- Ultrasound examination may be of limited value and should not delay acute surgical treatment 4.
- Orchiopexy is recommended between 6 and 18 months to protect fertility potential and decrease the risk of malignant changes 2.
- Patients with undescended testis have a higher risk of infertility and testicular cancer, emphasizing the importance of timely referral and treatment 2.