At a 9-month well-child visit, a boy has both testes impalpable in the scrotum. One testis can be milked down to the upper scrotum but retracts immediately on release. The other is palpable in the superficial inguinal pouch and cannot be brought down. What is the appropriate management?
- A Reassure and review at 5 years of age
- B Orchiopexy for the true undescended testis between 6 and 12 months of age, ideally as soon as diagnosed now ✓
- C Human chorionic gonadotropin stimulation course for both sides and reassess at puberty
- D Orchiectomy of the undescended testis because malignancy risk is unavoidable
Correct answer: B. Orchiopexy for the true undescended testis between 6 and 12 months of age, ideally as soon as diagnosed now
Explanation
A testis that can be brought to the bottom of the scrotum even transiently is a retractile testis, which needs only reassurance and follow-up. A truly undescended testis requires orchiopexy, currently recommended between 6 and 12 months of age, and certainly completed before 12 to 18 months, because germ cell loss is progressive after that. Hormonal therapy has poor success rates and is not standard. Orchiectomy is wrong since orchiopexy preserves the testis while allowing surveillance for malignancy risk.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.