Optimal management of bilateral undescended testicles in an infant is
By the second year, a testicle not in the cooler environment of the scrotal sac will begin to undergo histologic changes characterized by reduced spermatogonia. Testicles left longer in the undescended state not only have a higher incidence of malignant degeneration but are inaccessible for examination. If a malignancy should occur, diagnosis will be delayed. There is also a substantial psychological burden when children reach school age or are otherwise subjected to exposure of their deformed genitalia. Gel-filled prostheses are generally inserted when a testicle cannot be placed in the scrotum. Close follow-up by a physician until the late teens is indicated in all patients who have had an undescended testicle. Since these patients may be at increased risk for malignancy throughout life, careful training should be given in self-examination.
Immediate surgical placement into the scrotum
Chorionic gonadotropin therapy for 1 month; operative placement into the scrotum before age 1 if descent has not occurred
Observation until the child is 2 years old because delayed descent is common
Observation until age 5; if no descent by then, plastic surgical scrotal prostheses before the child enters school
Urinary Tract