Cryptorchidism in Infants: When to Consider Surgery

Baby

Hello Doctor: On November 22, I took my baby to the hospital for vaccinations.
During the pediatric check-up, I asked the doctor to examine my son's genitalia because I recently noticed that one of his testicles seemed to be missing.
The doctor diagnosed it as cryptorchidism.
As a result, I was referred to a urologist.
The urologist was able to feel the testicle through my son's groin, and it descended.
The doctor advised to observe until he is two years old, and if it hasn't descended by then, surgery may be necessary.

When I bathed him at home, I carefully felt in the water and found both testicles, but during the bath, they seemed to disappear again.
During regular diaper changes, it seems like only the right one is present.
I did some online research and found that it is best to have surgery by 18 months.
However, I also read that cold weather can cause the testicles to retract, which is quite concerning.
I am unsure if surgery is truly necessary and whether delaying until two years old could affect the function of his testicles.
Additionally, my son has had skin allergies since birth, with red spots appearing on the back of his neck and behind his ears, which can become warm and swollen, resembling pig ears.
I apologize for asking so many questions.
I would greatly appreciate your answers.
Thank you from a worried mother.
91.11.26

Danxin de mama, 0~9 year old female. Ask Date: 2002/11/26

Dr. Zhao Yongkang reply Pediatrics

Dear Concerned Mother,
1.
Generally, the recommended timing for surgery for cryptorchidism is when the child is about 9 to 15 months old.
However, based on your description, if your child can feel the testicle during bathing, it may be a case of retractile testis.
In this situation, it is advisable to continue monitoring every 6 to 12 months, as some children may have normal testicular descent, while others may develop acquired cryptorchidism.
Therefore, I recommend that you consult a pediatric surgeon for a detailed examination to confirm whether it is true cryptorchidism.
You can follow up with Dr.
Huang Yuan-Hui at the Pediatric Surgery Clinic at Hsinchu Hospital.
2.
Children's skin is more sensitive, so it is advisable to wash with baby soap and then apply baby moisturizer for care.
Additionally, avoiding plush items at home can help improve the condition.
I apologize for the delayed response and appreciate your understanding.
Wishing you peace and health,
Dr.
Zhao Yong-Kang
Director, Department of Pediatrics
Hsinchu Hospital

Reply Date: 2002/11/26

More Info

Cryptorchidism, or undescended testicles, is a common condition in infants where one or both testicles fail to move down into the scrotum before birth. This condition is often diagnosed during routine pediatric examinations, and while it can resolve on its own, there are important considerations regarding timing for surgical intervention and potential long-term effects.

In your case, it seems that your son has been diagnosed with cryptorchidism, but the testicle can sometimes be felt in the groin area, indicating that it may not be completely undescended. The recommendation from the urologist to observe until he is two years old is standard practice, as many cases of cryptorchidism resolve spontaneously within the first year of life. However, if the testicle does not descend by the time he reaches two years, surgery is generally recommended.

The reason for this recommendation is that undescended testicles can lead to several complications if not treated. These include:
1. Infertility: Testicles that remain undescended are often at a higher risk of infertility later in life. The temperature in the abdomen is higher than in the scrotum, which can affect sperm production.

2. Testicular Cancer: There is an increased risk of testicular cancer in men who had cryptorchidism, particularly if the condition was not corrected early.

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

4. Psychosocial Issues: As boys grow older, the presence of undescended testicles can lead to body image issues and psychological distress.

Regarding the timing of surgery, while some sources suggest that surgery is best performed between 6 to 18 months of age, the decision should be made in consultation with a pediatric urologist. They will consider your child's specific situation, including the position of the testicle and any other health factors.

As for your concerns about the testicle retracting during colder weather, this is a normal physiological response. The cremaster muscle contracts in response to cold, pulling the testicle closer to the body for warmth. This does not necessarily indicate a problem but is a normal reflex.

In terms of your son's skin allergies, it is important to manage these separately. Allergies in infants can manifest as rashes, and it is advisable to consult a pediatric dermatologist for appropriate management strategies. Keeping the skin moisturized and avoiding known irritants can help alleviate symptoms.

In conclusion, it is essential to follow up with your pediatrician or a pediatric urologist to monitor your son's condition closely. If the testicle does not descend by the age of two, surgical intervention will likely be necessary to prevent potential complications. Regular check-ups will also help manage any skin issues your son may be experiencing. Always feel free to ask your healthcare provider any questions or express concerns you may have regarding your child's health.

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