A 9-month-old boy is brought to the office for follow-up of an undescended testis. Developmentally, the infant sits without support, babbles, and can pick up objects with his pointer finger and thumb. He is fed formula and eats table foods 3 times a day. He was born at 38 weeks gestation without complications during pregnancy or labor and delivery. The patient takes no medications and has no allergies. He is up to date with vaccinations. Length, weight, and head circumference are at the 50th percentile. On physical examination, the infant is nondysmorphic, alert, and active, and is crawling on the floor. The abdomen is soft, nontender, and nondistended. Genital examination shows absent rugae on the left hemiscrotum with a palpable testicle in the left inguinal canal; the right testicle is palpable in the right hemiscrotum. The penis appears normal with a centrally located urethral meatus, and urinary stream is normal. The anus is patent with no lesions. Which of the following statements regarding this patient's genitourinary condition is most accurate?

Question

A 9-month-old boy is brought to the office for follow-up of an undescended testis.  Developmentally, the infant sits without support, babbles, and can pick up objects with his pointer finger and thumb.  He is fed formula and eats table foods 3 times a day.  He was born at 38 weeks gestation without complications during pregnancy or labor and delivery.  The patient takes no medications and has no allergies.  He is up to date with vaccinations.  Length, weight, and head circumference are at the 50th percentile.  On physical examination, the infant is nondysmorphic, alert, and active, and is crawling on the floor.  The abdomen is soft, nontender, and nondistended.  Genital examination shows absent rugae on the left hemiscrotum with a palpable testicle in the left inguinal canal; the right testicle is palpable in the right hemiscrotum.  The penis appears normal with a centrally located urethral meatus, and urinary stream is normal.  The anus is patent with no lesions.  Which of the following statements regarding this patient's genitourinary condition is most accurate?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfcf_7fa2_8f63_2bb3ed156376_MD0005_00 This patient with a palpable testicle in the left inguinal canal and a left empty hemiscrotum has cryptorchidism, or an undescended testicle. Normal testicular descent from the intra-abdominal space through the inguinal canal occurs at 28 weeks gestation. Any interruption of this process results in an undescended testis. Although cryptorchidism is common in newborns, the spontaneous descent typically occurs during the first few months of life. However, those with an undescended testis at age 6 months are referred for orchiopexy, as spontaneous descent is unlikely to occur after this age (Choice A). Without surgery, patients are at increased risk for numerous complications, including inguinal hernias, testicular torsion, subfertility, and testicular cancer. If an undescended testis is bilateral or intra-abdominal, the risk of developing testicular cancer is even greater. Although orchiopexy decreases the rate of malignant transformation, the risk remains higher than that of the general population. However, surgical fixation of the testis in the scrotum enables detection of testicular masses on examination. (Choice B) Parental consent is sufficient to proceed with surgical intervention in a minor. Deferring surgery until the patient is age 18 increases the risk for complications related to cryptorchidism. (Choices C and E) The risk of infertility and testicular torsion decreases after orchiopexy. Early orchiopexy, ideally by age 1, is recommended to maximize fertility potential. Educational objective: Infants age >6 months with an undescended testis should be referred for orchiopexy. Although the risk of testicular malignancy is decreased after orchiopexy, it remains higher than in patients without a history of cryptorchidism. References: Management of undescended testes: European Associated of Urology/European Society for Paediatric Urology Guidelines. (http://www.ncbi.nlm.nih.gov/pubmed/27687532) Evaluation and treatment of cryptorchidism: AUA guideline. (http://www.ncbi.nlm.nih.gov/pubmed/24857650)

A 9-Month-Old Boy Is Brought to the Office for Follow-Up Of