Management of Undescended Testis in a 6-Year-Old Boy
Orchiopexy should be performed to improve spermatogenesis and reduce the risk of testicular cancer in this 6-year-old boy with a right undescended testicle. 1, 2
Explanation for Parents and Consent Information
When obtaining consent for orchiopexy, parents should be informed of the following key points:
Purpose of Orchiopexy
- The procedure aims to relocate the undescended testicle into the scrotum
- Primary benefits include:
- Improved potential for fertility (spermatogenesis)
- Reduced risk of testicular cancer
- Prevention of testicular torsion
- Treatment of any associated inguinal hernia 1
Timing and Urgency
- While optimal timing for orchiopexy is between 6-18 months of age, there are still clear benefits to performing the procedure in this 6-year-old boy 2
- Delaying surgery further may result in:
- Progressive adverse histologic changes to the testis
- Increased risk of testicular malignancy
- Further compromise to fertility potential 1
Surgical Procedure
- For a palpable testis, a standard inguinal or scrotal approach will be used
- If the testis is non-palpable, laparoscopic exploration may be necessary
- The procedure has a high success rate (>96%) with very low risk of testicular atrophy (<2%) 1
Alternative Treatments
- Hormonal therapy (hCG or GnRH) is not recommended due to:
- Poor efficacy (only 15-20% success rate)
- High rate of testicular re-ascent (20% of initially successful cases)
- Potential harm to future spermatogenesis 3
- Observation alone is not recommended as spontaneous descent is unlikely at this age 1, 2
Long-term Outcomes and Follow-up
- Parents should be informed that while orchiopexy reduces risks, it does not completely eliminate them:
- Prepubertal orchiopexy results in a 2-6 fold reduction in testicular cancer risk compared to postpubertal orchiopexy 1
- Unilateral cryptorchidism typically has minimal impact on overall fertility (paternity rates similar to general population) 1, 2
- Regular testicular self-examination after puberty will be recommended 1
Important Considerations and Potential Complications
Parents should be informed about potential complications:
- Surgical risks: bleeding, infection, injury to the vas deferens or testicular vessels
- Testicular atrophy (rare, <2%)
- Possibility of finding an abnormal testis requiring removal
- Need for potential follow-up procedures if the initial surgery is not successful 1
Conclusion
The American Urological Association and European Association of Urology guidelines clearly support orchiopexy as the standard treatment for undescended testes at this age. While earlier intervention (before 18 months) would have been ideal, there are still significant benefits to performing orchiopexy now to improve fertility potential and reduce cancer risk 1, 2. Hormonal therapy is not recommended due to poor efficacy and potential harm to spermatogenesis 3. Observation alone is not appropriate as spontaneous descent is unlikely at this age 4.