Cryptorchidism in a 10-Year-Old: Diagnosis and Treatment Options

A 10-year-old boy has a left testicle located at the upper part of the scrotum, which has not descended to the bottom of the scrotum. It is palpable but smaller in size?

Dear Doctor, my 10-year-old son has his left testicle located at the upper part of the scrotum and has not descended to the bottom of the scrotum.
It is palpable but smaller in size, while the right testicle is normal and located at the bottom of the scrotum.
Could this be a case of left-sided cryptorchidism? What treatment options are available? Thank you for your response.

Chen Ming, 40~49 year old female. Ask Date: 2019/05/29

Dr. Xiao Kaiwen reply Pediatrics

Sometimes during a physical examination, the testicles may be elevated due to the cremasteric reflex (contraction of the cremaster muscle), which can occur when a person is nervous, making the testicles difficult to palpate or even causing them to be undetectable.
It is advisable to check the testicles after soaking in warm water for a while, as this can reduce the likelihood of the cremasteric reflex.
If the testicles can be palpated in their normal position at that time, it is considered normal.
The size of the testicles is not as critical; being able to palpate them and ensuring they are in the correct position is more important.

Reply Date: 2019/05/29

More Info

Cryptorchidism, or undescended testis, is a condition where one or both testicles fail to move down into the scrotum before birth. In your case, it appears that your 10-year-old son has a left testicle that is positioned at the upper end of the scrotum and has not descended fully, while the right testicle is in a normal position at the bottom of the scrotum. This situation does suggest that the left testicle may be classified as cryptorchidism.

Diagnosis
The diagnosis of cryptorchidism is typically made through a physical examination. In your son's case, the left testicle is palpable but not fully descended, which is consistent with this condition. The testicle's position can vary; it may be located in the inguinal canal (the passage in the lower abdominal wall) or may be absent altogether (anorchia). An ultrasound may be performed to confirm the presence and location of the testicle if it is not palpable.

Treatment Options
The treatment for cryptorchidism is generally recommended if the testicle has not descended by the age of 6 months to 1 year. However, since your son is already 10 years old, it is important to address this issue promptly. The primary treatment options include:
1. Hormonal Therapy: In some cases, hormonal treatments may be used to stimulate the descent of the testicle. This is less common and may not be effective in older children.

2. Surgical Intervention (Orchidopexy): The most common and effective treatment for cryptorchidism is a surgical procedure called orchidopexy. This surgery involves moving the undescended testicle into the scrotum and securing it in place. This procedure is typically performed under general anesthesia and is usually done as an outpatient procedure. The surgery is recommended not only for cosmetic reasons but also to reduce the risk of complications such as infertility and testicular cancer later in life.

3. Monitoring: In some cases, if the testicle is in a position that is not causing any issues and is not at risk for complications, a doctor may recommend monitoring the situation. However, given your son's age and the position of the left testicle, surgical intervention is likely the best course of action.

Risks of Untreated Cryptorchidism
If left untreated, cryptorchidism can lead to several complications, including:
- Infertility: The higher temperature in the abdomen can affect sperm production and lead to infertility issues later in life.

- Testicular Cancer: There is an increased risk of testicular cancer in individuals with a history of cryptorchidism.

- Inguinal Hernia: There is a higher risk of developing an inguinal hernia, which can occur if abdominal contents protrude through the inguinal canal.

Conclusion
It is essential to consult with a pediatric urologist or surgeon who specializes in this area to discuss the best treatment options for your son. They will be able to provide a thorough evaluation and recommend the most appropriate course of action based on your son's specific situation. Early intervention is key to minimizing potential complications associated with cryptorchidism.

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