An 8-year-old boy presents with an inguinal testis. Which of the following is not true?
A. The most likely explanation is that his undescended testis was missed on postnatal checksAnswer A
There had previously been an assumption that boys presenting at this late age with an undescended testis had previously had this finding missed at previous checks. However this age group represent a significant proportion of boys undergoing orchidopexy. At post-natal checks, where there is little adipose, the cremasteric reflex is weak and the testes are prominent, identifying undescended testes is relatively easy. It was realised from carefully documented examinations that testes that had previously been identified in the scrotum had subsequently ascended.
The mechanism for testicular ascent is not clear. One possibility is the presence of a processus vaginalis remnant, which because of a relatively slower rate of growth than the rest of the child would drag the testis up as the inguinal canal lengthened. Alternatively, it is possible that a proportion of these boys originally had retractile testes an overactive cremaster had permanently brought these testes up.
In the Netherlands and Scandinavia ascending testes are managed expectantly as about half will descend spontaneously. However the UK practice (according to the 2011 consensus from the British Association of Paediatric Urologists) is to offer surgery. It is not clear what effect there will be on the testis and on sperm production if the testis is left in the groin waiting for puberty. There is evidence that performing orchidopexy before puberty may halve the risk of malignancy for undescended testes. Although it is not clear that ascended testes are at increased risk of malignancy, it can be difficult in practice to distinguish an ascended from a missed undescended testis.