Cryptorchidism: Concerns and Next Steps for Your Child

Undescended testicle?

My younger brother underwent surgery to remove a testicle, but after a few days, it was reported that it was missing again.
The doctor mentioned it was a case of retractile testis, but now that he is almost two years old and it hasn't descended, we are concerned about its impact on fertility.
Does this constitute medical negligence, or will he need to undergo another surgery?

Da Bao, 0~9 year old female. Ask Date: 2019/07/25

Dr. Lin Yishou reply Pediatrics

Please quickly consult a pediatrician or a pediatric surgeon to recheck the position of the testicles.

Reply Date: 2019/07/25

More Info

Cryptorchidism, or undescended testicles, is a condition where one or both testicles fail to move down into the scrotum before birth. This is a common condition in newborns, particularly in premature infants, and it can resolve on its own as the child grows. However, if the testicle does not descend by the age of one, medical intervention is often recommended.

In your case, it seems that your child underwent surgery to address the issue, but the testicle has not descended as expected. The term "retractile testis" refers to a condition where the testicle can move back and forth between the scrotum and the groin, which may explain why it was not visible after the surgery. This can be a normal variant, but it is essential to monitor the situation closely.

Concerns about fertility and testicular health are valid. Undescended testicles can lead to several complications, including:
1. Infertility: The temperature in the abdomen is higher than in the scrotum, which can affect sperm production and quality.

2. Testicular Cancer: There is an increased risk of testicular cancer in men who have a history of cryptorchidism, even after surgical correction.

3. Hernia: There is a higher risk of inguinal hernias in boys with undescended testicles.

Given that your child is approaching two years old and the testicle has not descended, it is advisable to consult a pediatric urologist. They can perform a thorough examination and may recommend further imaging studies, such as an ultrasound, to assess the location of the testicle. Depending on the findings, the urologist may suggest a second surgery, known as orchidopexy, to reposition the testicle into the scrotum.

As for whether this situation constitutes medical negligence, it is essential to consider the standard of care provided. If the initial surgery was performed correctly and the retractile nature of the testicle was not anticipated, it may not be considered negligence. However, if there was a failure to adequately inform you of the potential for the testicle to remain undescended or if the surgical technique was flawed, you may want to seek a second opinion or consult with a medical malpractice attorney to discuss your concerns.

In the meantime, it is crucial to monitor your child's development and any potential symptoms, such as pain or swelling in the groin area. Regular follow-ups with a healthcare provider will help ensure that any issues are addressed promptly.

In summary, while it is understandable to be concerned about your child's reproductive health, there are steps you can take to address the situation. Consulting with a pediatric urologist will provide clarity on the next steps and help ensure the best possible outcome for your child's health and future fertility.

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