Timing of Surgery for Undescended Testis in Inguinal Canal
Surgery should be performed between 6-18 months of age, with the optimal window being 6-12 months, making option B (after few months) the correct answer. 1
Rationale for Timing
The current guideline consensus is clear that immediate surgery in the newborn period is not indicated, but waiting beyond 18 months causes irreversible damage. Here's the algorithmic approach:
Age-Based Decision Algorithm
Birth to 6 months (corrected for gestational age):
- Monitor for spontaneous descent, which can occur during this period 1, 2
- Refer to pediatric urologist/surgeon by 6 months if testis remains undescended 1
- Spontaneous descent after 6 months is extremely unlikely 1, 2
6-18 months:
- Perform orchiopexy during this window 1, 3
- Optimal timing is 6-12 months to maximize fertility preservation 2, 4
- Surgery must be completed before 18 months at the latest 1, 5
Why not immediately (Option A)?
- Recent high-quality evidence from 2024 demonstrates that immediate repair in newborns with undescended testis provides no benefit and actually results in higher orchiectomy rates compared to delayed surgery 6
- Spontaneous descent can still occur in the first 6 months 1, 2
Why not after 2 years (Option C)?
- Germ cell damage begins after 15-18 months of age 1, 5
- By delaying beyond 18 months, approximately 40% of bilateral cryptorchid boys will have no germ cells by age 8-11 years 1
- Prepubertal orchiopexy reduces testicular cancer risk 2-6 fold compared to postpubertal surgery 1, 5
Critical Evidence Supporting 6-18 Month Window
The most recent and authoritative guidelines (2025) from multiple sources consistently recommend:
- Referral by 6 months (corrected age) 1
- Surgery between 6-18 months 1, 3
- Completion before 18 months to prevent fertility damage 1, 5
Important Caveats
Special circumstance - concurrent inguinal hernia:
- Even when inguinal hernia is present alongside undescended testis, immediate repair in newborns shows no benefit 6
- Readmission rates for incarceration are minimal (<1%) when surgery is deferred to 6-12 months 6
- Early repair paradoxically increases orchiectomy risk 6
Risk of torsion:
- While torsion of undescended testis can occur before the recommended surgical age, this rare complication does not justify routine immediate surgery 7
- Parents should be counseled about acute symptoms (groin swelling, abdominal pain) that warrant emergency evaluation 7
Surgical Approach for Inguinal Canal Testis
For a testis confirmed in the inguinal canal (palpable):
- Standard inguinal or prescrotal orchiopexy is appropriate 1, 3
- Success rates exceed 96% with testicular atrophy <2% 1
- Imaging (ultrasound) is unnecessary and should not delay referral 1, 5
Answer: B (After few months) - specifically at 6-12 months of age, with surgery completed before 18 months.