From the Guidelines
The recommended treatment for a 6-year-old boy with a right undescended testicle is surgical correction through orchiopexy, which should be performed promptly. This procedure involves locating the undescended testicle, freeing it from surrounding tissues, and securing it in the scrotum. Surgery is typically performed as an outpatient procedure under general anesthesia and takes about 45-90 minutes. The optimal timing for orchiopexy is before age 2, so at age 6, intervention should not be delayed further. Hormonal therapy with human chorionic gonadotropin (hCG) is generally not recommended as primary treatment for this age group due to limited efficacy, as stated in the evaluation and treatment of cryptorchidism guideline 1.
Surgical correction is important because undescended testicles have increased risks of:
- Infertility
- Testicular cancer
- Testicular torsion
- Psychological impacts if left untreated, as highlighted in the guideline on evaluation and treatment of cryptorchidism 1.
Following surgery, the child should have regular follow-up appointments to monitor the position of the testicle and assess for any complications. Parents should watch for signs of infection post-surgery, such as increased pain, swelling, redness, or fever. The success rate for orchiopexy is high, with approximately 95% of testicles remaining in proper position after the procedure, as reported in the evaluation and treatment of cryptorchidism guideline 1.
It is essential to counsel boys with a history of cryptorchidism and/or monorchidism and their parents regarding potential long-term risks and provide education on infertility and cancer risk, as recommended in the guideline on evaluation and treatment of cryptorchidism 1.
In some cases, an orchiectomy may be considered if a boy has a normal contralateral testis and either very short testicular vessels and vas deferens, dysmorphic or very hypoplastic testis, or postpubertal age, as stated in the guideline on evaluation and treatment of cryptorchidism 1. However, this decision should be made on a case-by-case basis, taking into account the individual child's circumstances and the potential benefits and risks of each treatment option.
Key points to consider:
- Orchiopexy is the recommended treatment for undescended testicles
- Hormonal therapy is not recommended as primary treatment
- Surgical correction is important to reduce the risk of infertility, testicular cancer, and other complications
- Regular follow-up appointments are necessary to monitor the position of the testicle and assess for any complications
- Counseling and education on potential long-term risks and infertility and cancer risk are essential, as highlighted in the guidelines 1.
From the Research
Recommended Treatment for Undescended Testicle
The recommended treatment for a 6-year-old boy with a right undescended testicle (cryptorchidism) is:
- Orchiopexy, which is a surgical procedure to move the undescended testicle into the scrotum 2, 3, 4, 5, 6
Benefits of Orchiopexy
The benefits of orchiopexy include:
- Improving spermatogenesis and fertility potential 5
- Reducing the risk of testicular cancer 2, 3, 5
- Allowing for earlier detection of testicular malignancy through self-examination of the testicles 3
Timing of Orchiopexy
The ideal timing of orchiopexy is:
- Between 6 and 12 months of age, as this may optimize fertility potential and protect against testicular malignancy 5
- Before 1 year of age, as fertility potential is greatest when orchiopexy is performed at this age 5
- Not before 6 months of age, as testes may descend spontaneously during the first few months of life 5
Other Considerations
Other considerations for the treatment of undescended testicle include:
- Monitoring until adolescence to determine whether the testis will spontaneously descend into the scrotum is not recommended, as data do not support this approach 2
- Routine inguinal/scrotal ultrasound is not recommended, although it may be appropriate in certain cases, such as in an older boy who is overweight 2