A 3-year-old recently adopted Romanian boy is referred after his initial pediatrician's assessment for an undescended testicle. On exam his left testicle is normal and in place. He has no evidence of hernias. However, his right hemiscrotum is empty and there is a testicule sized mass plapable at the pubic tubercle. The most appropriate next step is
Although waiting until age 1 is acceptable, there should be little further delay. Waiting until puberty would subject the child to a high probability of abnormal development. Abdominal USG can be useful to search for an intra-abdominal testicle but this child's testicle was palpable. Since all cryptorchid testicles are accompanied by an inguinal hernia; herniorrhaphy should always accompany an orchiopexy for cryptorchidism. Testicular biopsy is unnecessary and may be injurious. The risk of malignancy, although increased 20-fold, does not manifest itself until at least the early twenties.
Observation until age 5
Right orchiopexy
Right orchiopexy and right inguinal hernia repair
Right orchiopexy and right testicle biopsy
Plastic & Reconstructive Surgery