Adhesions may develop under the prepuce (foreskin) as a result of recurrent balanitis. This prevents retraction and may lead to ballooning of the foreskin during urination. If asymmetric, a cyst may then develop at the coronal groove more proximally.
Bilateral impalpable testes at birth are associated with complex endocrine disorders and prune belly syndrome, so should be investigated immediately.
A testis can be undescended but palpable eg in the inguinal canal. If retractile, then needs no intervention (though rarely non retractile testes found later in childhood ?cord shortening).
If not palpable then may be intraabdominal, absent, small (dysplastic, but in the right place) or else ectopic. Imaging is not sensitive so often diagnostic laparascopy is required. Ectopic testes are found in the perineum or femoral triangle, they are usually normal and orchidopexy is straightforward.
An undescended testis is seen in 5% of term infants but less than 2% of 1yr olds. It is theorized that part of the reason for poor descent is that they are fundamentally abnormal. If left for more than 4yrs then histological abnormalities often seen so generally repaired/removed between 1 and 4 yrs of age. Commonly associated with inguinal hernia, in which case fixed earlier with the hernia.
In infants, high rate of complications so should be fixed early.
Only need fixed if persist after first year of life or develop later in childhood, as regression of processus is less likely to occur.
This work is licensed under a Creative Commons
Attribution-Noncommercial-Share Alike 2.5 UK: Scotland License.