Management of Undescended Right Testis in a 14-Month-Old Child
The correct answer is C: Right orchiopexy should be performed promptly, as this 14-month-old child is already past the recommended 6-month referral window and approaching the critical 18-month surgical deadline.
Rationale for Immediate Surgical Intervention
At 14 months of age, this child requires urgent surgical referral and orchiopexy because:
- Spontaneous descent is extremely unlikely after 6 months of corrected age, and this child is well beyond that window 1
- Progressive testicular damage is actively occurring, particularly after the first year of life, with accelerating germ cell loss after 15-18 months 2, 3, 4
- Surgery must be completed by 18 months to preserve fertility potential and reduce testicular cancer risk 2, 3, 4
Why Other Options Are Incorrect
Option B (Reassure and wait until 3 years) is WRONG:
- Waiting until age 3 would cause irreversible testicular damage and significantly compromise fertility outcomes 2, 3
- The AUA guidelines explicitly state that referral should occur by 6 months, with surgery by 18 months 1
- Delaying beyond 18 months should be avoided as progressive histologic damage continues 2, 3
Option D (Diagnostic laparoscopy) is WRONG for initial management:
- Laparoscopy is indicated for non-palpable testes only 3, 4, 5
- This case describes an empty right scrotum, which requires physical examination to determine if the testis is palpable 1
- Approximately 70% of undescended testes are palpable and require standard inguinal orchiopexy, not laparoscopy 1
Option A (Left orchiopexy) is WRONG:
- The problem is the right testis, not the left [@question context@]
Surgical Approach Based on Testis Location
If the testis is palpable (most likely scenario - 70% of cases):
- Standard inguinal orchiopexy is the primary approach with >96% success rate and <2% testicular atrophy risk 2, 4, 6
If the testis is non-palpable (30% of cases):
- Laparoscopy becomes mandatory to identify testicular vessel status and determine surgical approach 3, 4, 5
- Approximately 30% will be in the inguinal-scrotal area, 55% intra-abdominal, and 15% absent/vanishing 1
Critical Timing Considerations
The urgency in this case cannot be overstated:
- This child has only 4 months remaining before the 18-month deadline 2, 3, 4
- Prepubertal orchiopexy reduces testicular cancer risk by 2-6 fold compared to postpubertal surgery 2, 4
- Progressive germ cell degeneration worsens during the second year of life 2
Long-Term Counseling for Parents
Parents should be informed that: