UNDESCENDED TESTIS:
Dear Sumner:
At what age should I start to worry if a testis has not descended? I have read various reports giving conflicting ages, going from 6 months to 13 years. Henry is now one year of age and his parents have requested that you examine him and give your opinion. They would also like to know if hormone shots can bring the testes down without surgery.
Dear Gail:
I had a good discussion with Henry’s parents (with Henry listening attentively) re the various aspects of undescended testes. There is, indeed, conflicting advice in the literature. Many years ago it was advised that if a testis had not descended by the time of puberty, surgery to bring the testis into the scrotum (orchiopexy) should be done then. However, by that time, not only is the testis often atrophic, lacking spermatogenic activity, but there is also an increased risk of subsequent testicular tumor. An undescended testis is histologically normal at birth. However, by one year of age failure of development and atrophy may be detected and by the 2nd year of life the number of germ cells is significantly reduced. Therefore, I recommend that orchiopexy be performed around one year of age. Since almost all undescended testes have an associated hernia, a hernia repair would be done as well at that time.
