Management of Right Undescended Testis in the Inguinal Canal
Immediate surgical referral to a pediatric urologist or pediatric surgeon for orchiopexy is required, with surgery ideally performed between 6-18 months of age to preserve fertility and reduce cancer risk. 1, 2
Age-Based Management Algorithm
If the child is under 6 months (corrected for gestational age):
- Monitor monthly for spontaneous descent, as testes may still descend naturally during the first 6 months of life 2
- Refer to a surgical specialist by 6 months if the testis remains undescended, as spontaneous descent after this age is extremely unlikely 2
If the child is 6-18 months old:
- Refer immediately for surgical orchiopexy 1, 2
- Surgery should be performed before 18 months of age because germ cell damage begins after 15-18 months, causing progressive fertility loss 1, 2
- The testis is palpable in the inguinal canal, so a standard inguinal or scrotal orchiopexy approach is appropriate 2, 3
- Success rates for open surgical intervention exceed 96%, with testicular atrophy occurring in less than 2% of cases 2
If the child is older than 18 months:
- Urgent surgical referral is still mandatory despite the delayed timing 1, 2
- Prepubertal orchiopexy still reduces testicular cancer risk by 2-6 fold compared to postpubertal surgery 1, 2
- For postpubertal males, orchiectomy or biopsy may be considered instead of orchiopexy, particularly if the contralateral testis is normal 2
Critical Actions to Take Now
Do NOT order imaging studies (ultrasound, CT, or MRI) as they rarely assist in decision-making and should not delay referral 1, 2. The American Urological Association notes that ultrasound has only 45% sensitivity and 78% specificity for locating non-palpable testes 1.
Do NOT attempt hormonal therapy with hCG or GnRH, as evidence shows low success rates (6-38%) and lack of long-term efficacy 1, 2.
Examine for inguinal hernia, as this is the most common associated condition with undescended testis and is a primary indication for treatment 4. Approximately 80% of undescended testes are located in the inguinal region 5.
Key Counseling Points for Parents
Fertility risks: By 8-11 years of age, approximately 40% of bilateral cryptorchid boys have no germ cells in testicular biopsies 2. Infertility occurs in about 40% of unilateral and 70% of bilateral cryptorchidism cases 6
Cancer surveillance: Even with successful orchiopexy, the child will need lifelong surveillance for testicular cancer, with a relative risk 2.75-8 times higher than the general population 1. After puberty, teach monthly testicular self-examination 1
Surgical timing is critical: The window between 6-18 months represents the optimal period to prevent irreversible germ cell damage 1, 2
Common Pitfalls to Avoid
- Delaying referral beyond 6 months of age while "watching and waiting" 2
- Ordering unnecessary imaging that wastes time and resources 1, 2
- Attempting hormonal therapy instead of proceeding directly to surgery 1, 2
- Confusing this with a retractile testis (which can be easily manipulated into the scrotum and remains there without traction) 1