A 7-year-old boy is brought to the office for a follow-up visit after orchiopexy last week. The patient was recently adopted and, at his well child check a month ago, was diagnosed with an undescended left testicle that was palpable in the inguinal canal. The surgery was uncomplicated, and he is doing well. The patient is otherwise healthy and takes no medications. Height and weight are at the 40th and 50th percentiles, respectively. Physical examination shows a well-nourished boy. Abdomen is soft, nontender, and nondistended. The penis is circumcised, and the meatal opening is at the tip of the phallus. Both testes are palpable in the scrotum. Healing surgical scars are present in the groin. Compared to the general population, this patient is at an increased risk for which of the following conditions?

Question

A 7-year-old boy is brought to the office for a follow-up visit after orchiopexy last week.  The patient was recently adopted and, at his well child check a month ago, was diagnosed with an undescended left testicle that was palpable in the inguinal canal.  The surgery was uncomplicated, and he is doing well.  The patient is otherwise healthy and takes no medications.  Height and weight are at the 40th and 50th percentiles, respectively.  Physical examination shows a well-nourished boy.  Abdomen is soft, nontender, and nondistended.  The penis is circumcised, and the meatal opening is at the tip of the phallus.  Both testes are palpable in the scrotum.  Healing surgical scars are present in the groin.  Compared to the general population, this patient is at an increased risk for which of the following conditions?

Quizplus · Accepted Answer

11ec25c8_d6dc_6e34_bc81_79dcd860fee5_MD0003_00 Cryptorchidism, or an undescended testis, is a common genitourinary anomaly caused by failure of in utero testicular descent from the abdomen into the scrotum. At birth, boys typically have an empty, poorly rugated scrotum; however, the condition may go undetected until later in life, as in this case. empty, poorly rugated scrotum Spontaneous descent is rare after age 6 months, and orchiopexy is optimally performed before age 1 year to avoid complications. Uncorrected cryptorchidism increases the risk of infertility, testicular torsion, and testicular malignancy. Following surgical correction, the risk of infertility decreases, particularly if orchiopexy is performed early. In addition, once the testis is surgically affixed to the scrotal wall, risk of testicular torsion is minimal (Choice E). Although surgery partially decreases the rate of malignant transformation in the undescended testis, patients should be counseled that the risk of testicular germ cell tumor remains elevated postorchiopexy compared to the general population (Choice A). Cancer detection is improved after orchiopexy because abnormal testicular masses are more easily palpated in the scrotum compared to the groin or abdomen. (Choice B) Cryptorchidism can impair testicular growth during puberty but does not delay the timing of pubertal onset, which is controlled by the hypothalamic-pituitary axis. (Choice C) Risk of recurrent urinary tract infections is increased in patients with vesicoureteral reflux or anatomic genitourinary abnormalities (eg, posterior urethral valves). Isolated cryptorchidism, as in this patient, is not associated with an increased incidence of infections. (Choice F) Varicoceles are typically a chronic, benign dilation of pampiniform plexus veins but can occur secondary to venous obstruction from an abdominal mass or thrombus. Undescended testes are not associated with varicoceles. Educational objective: Cryptorchidism, or an undescended testis, is ideally corrected with orchiopexy by age 1 year to reduce the risk of complications (eg, infertility, testicular torsion, testicular malignancy). However, even after surgery, the risk of testicular germ cell tumor remains elevated compared to the general population. References: Long-term follow-up after treatment of cryptorchidism. (http://www.ncbi.nlm.nih.gov/pubmed/27589079) Cryptorchidism: a practical review for all community healthcare providers. (http://www.ncbi.nlm.nih.gov/pubmed/28265313) Testicular growth during puberty in boys with and without a history of congenital cryptorchidism. (http://www.ncbi.nlm.nih.gov/pubmed/27049351)

A 7-Year-Old Boy Is Brought to the Office for a Follow-Up