An 8-month old boy is seen by pediatrician for the first time. The physician notes that there are no testis in the scrotum. Optimal management in this infant is
|A||Immediate surgical placement into the scrotum|
|B||Chorionic gonadotropin therapy for 1 month; operative placement into the scrotum before age 1 if descent has not occurred|
|C||Observation until the child is 2 years old because|
|D||delayed descent is common|
|E||Observation until age 5; if no descent by then plastic surgical scrotal prostheses before the child enters school|
a. Proper identification of the anatomy, position, and viability of the undescended testis
b. Identification of any potential coexisting syndromic abnormalities
c. Placement of the testis within the scrotum in timely fashion to prevent further testicular impairment in either fertility potential or endocrinologic function
d. Attainment of permanent fixation of the testis with a normal scrotal position that allows for easy palpation
e. No further testicular damage resulting from the treatment
b. When the testicle is not within the scrotum, it is subjected to a higher temperature, resulting in decreased spermatogenesis.
c. It is now recommended that the undescended testicle be surgically repositioned by 2 years of age.
e. The use of chorionic gonadotropin occasionally may be effective in patients with bilateral undescended testes, suggesting that these patients are more apt to have a hormone deficiency than children with unilateral undescended testicle.
f. If there is no testicular descent after a month of endocrine therapy, operative correction should be undertaken.
g. The operation is typically performed through a combined groin and scrotal incision.
h. The cord vessels are fully mobilized, and the testicle is placed in a dartos pouch within the scrotum.
i. An inguinal hernia often accompanies a cryptorchid testis. This should be repaired at the time of orchidopexy.