A 9-month-old boy is brought for review. Both testes were impalpable at birth, and repeat examination confirms bilateral testes lying high in the inguinal canals. What is the appropriate management?

• A Annual review until puberty, then orchiopexy if descent has not occurred
• B Bilateral orchiofixation (orchiopexy) now ✓
• C Bilateral orchidectomy with prosthetic replacement
• D Intramuscular hCG course now, with surgery reserved for non-responders

Explanation

Undescended testes that have not descended by around 6 months of corrected age will rarely descend spontaneously thereafter. Current practice is orchiopexy between 6 and 12 months of age to preserve fertility potential and allow detection of malignancy, since germ cell loss is progressive after the first year. Hormonal therapy with hCG gives low, unreliable success rates and is no longer recommended as primary treatment, and deferring surgery to puberty forfeits testicular function.

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.