A 9-month-old boy has a right testis palpable high in the scrotum that cannot be brought down. Examination under anaesthesia confirms a true undescended testis. What is the recommended management?

• A Reassess at 3 years, as descent may still occur spontaneously
• B Orchiopexy between 6 and 12 months of age ✓
• C Human chorionic gonadotropin therapy for six months first
• D Orchiectomy, because malignancy risk makes salvage pointless

Explanation

Current guidance, reflected in Indian postgraduate teaching, is orchiopexy between 6 and 12 months of age, certainly before 18 months. Beyond this window histological loss of germ cells and Leydig cell changes progress, impairing future fertility. Spontaneous descent is unlikely after 6 months, so watchful waiting to age 3 is wrong. Hormonal therapy has low and unreliable success rates. Orchiopexy allows palpable surveillance but does not eliminate the elevated lifetime malignancy risk, which peaks in the intra-abdominal testis.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.