Dear Dr. Soukup, The pediatrician can’t feel one of the testicles on my newborn son, but they want to wait and see what happens. I’m not sure what this could mean? -Krysten O.
You are most likely describing something called an “undescended testicle.” This is actually a pretty common finding amongst newborn boys (found in up to 2-3%) and is even more common in premature boys. During development, the testicles start out high inside the abdomen. In the final weeks before birth, the testicles “descend” down the abdomen and find their way into the scrotum. If this has not yet completed by birth for one or both testicles, we call it an undescended testicle. This is usually noticed right away during the baby’s first newborn exam by the pediatrician. About half of the time, the testicle will continue to come down and reach the scrotum on its own. For this reason, we observe babies for the first 6 months and only recommend repair around 6-12 months of age, if it has not come down on its own by then. Prompt repair during infancy is not only important for a good cosmetic result (normal testicle size and location), but also for the best functional outcome so that fertility and hormone production are preserved. There is also a slight association with rare testicular tumors, so it is important for your pediatrician to be able to monitor and examine the testicles easily during routine checkups as they grow.
Repair of an undescended testicle is called an “orchiopexy.” With a brief general anesthesia (or often a spinal anesthesia can be done to avoid the effects of anesthesia during infancy), the testicle is freed up and brought down into the scrotum surgically. A hernia is also commonly found alongside an undescended testicle, and is repaired at the same time. Rarely, if the testicle is still so high in the abdomen that it cannot be felt, we start with a tiny camera (called laparoscopy) to help decide if a more complicated repair (requiring more than one surgery) may be necessary. Thankfully this is much less common. I will sometimes also see older boys who have developed an “acquired” form of undescended testicle which need repair. Overall, boys do very well following orchiopexy and have very good outcomes. But as with everything, regular pediatrician check-ups will still be important as they grow!
Thanks for your question! Dr. Soukup
Dr. Soukup earned her Bachelor of Science from the Massachusetts Institute of Technology and her Doctor of Medicine from the University of Chicago Pritzker School of Medicine, where she received the Outstanding Achievement Award in Medicine, graduating first in her class. She completed her General Surgery training at the Massachusetts General Hospital and her fellowship in Pediatric Surgery at Children’s Hospital Boston. During her time in Boston, she also completed a Masters of Medical Sciences degree in clinical investigation from Harvard Medical School. She was awarded Elliot Hospital’s “Physician of the year” for 2018. She is board-certified in both Pediatric Surgery and General Surgery. She has specialized training and experience in minimally invasive surgical treatment for babies, children and teenagers. Her practice includes all areas of general pediatric surgery, including common pediatric surgical problems as well as neonatal surgery, congenital anomalies, minimally invasive surgery, and complex thoracic surgical problems.