The mother of a 2-month-old infant brings the child to the clinic for a well-baby check. She is concerned because she feels only one testis in the scrotal sac. Which of the following statements about the undescended testis is the most accurate?
A. Normally, the testes are descended by birth.
B. The infant will likely require surgical intervention.
C. The infant probably has only one testis.
D. Normally, the testes descend by one year of age.
Correct Answer: D. Normally, the testes descend by one year of age.
Normally, the testes descend by one year of age. In young infants, it is common for the testes to retract into the inguinal canal when the environment is cold or the cremasteric reflex is stimulated. About 3% of full-term and 30% of premature male infants are born with one or both testicles undescended. Approximately 80% of cryptorchid testes descend by the third month of life. This makes the true incidence around 1%.
Option A: Normally, the testes descend by one year of age. One contributing mechanism for the reduced function of cryptorchid testes is temperature. It is also likely that transient hormone deficiencies may lead to a lack of testicular descent and impair the development of spermatogenic tissue.
Option B: If it does not descend by a year, a full assessment will determine the appropriate treatment. The undescended testicle can usually be palpated in the inguinal canal. In a minority of patients, the missing testicle may be located in the abdomen or be nonexistent.
Option C: It is most likely that both testes are present and will descend by a year. Without surgical correction, an undescended testicle is likely to descend during the first three months of life. If it remains undescended, to reduce risks and minimize infertility, the testis should be brought into the scrotum with an orchiopexy starting at age six months.