UNDESCENDED versus HYPERMOBILE TESTIS:

UNDESCENDED versus HYPERMOBILE TESTIS:

Dear Sumner:

I am sending you Josh, a boy who I have followed since his birth 3 years ago. I thought I could feel both testes in the scrotum at birth as well as at 3 and 6 months of age. However, since then his scrotal sac has been quite tight, and I’ve uncertain as to the location of the testes, particularly the left one. Although his mother says she has felt both testes when Josh is having a bath, I would feel more comfortable having your opinion.

Dear Bert:

When I first examined Josh, I was unable to feel either testis in the scrotum. In fact, he was not at all happy about lying on the examining table. Both Mom and I decided that Josh and his testes might be more relaxed on Mom’s lap. Indeed, in the comfortable and secure environs of Mom’s lap, Josh’s testes were able to be found within the confines of the scrotal cavity.

It is often very difficult to feel testes in the scrotum in little guys, particularly with their small and tight scrotal sacs along with the usual active cremasteric reflexes present at this age. The fact that Mom was able to feel his testes in the warm tub was reassuring. If I get the history that a parent has been able to feel both testes in the scrotum, and I have confidence in the parent’s observational skills, I feel comfortable avoiding surgical intervention. However, as I did with Josh’s family, I always mention the possibility, albeit slight, that with the hyperactive cremasteric reflexes in young boys, a testis may move upward into the inguinal canal and “get stuck” there, necessitating eventual surgery. More likely, however, the hypermobile testis spends most of its time residing happily in the scrotum.