Retractile Testes in 12 Month Old

[hparsh]

This is cross posted in Health. Someone suggested I post here. Sorry if it's not the appropriate forum.

My pediatrician said DS may have retractile testes and that I should see a urologist and he possibly may need surgery. I google this and am finding conflicting information. I've read where it often corrects itself by adolescence and you only need surgery if it does not correct itself by then.

My pediatrician said her son had it done at around a year old and that DS may need it done now too, but this is also the same person who told me to stop BFing at 15 months and to switch to cow's milk.

[glongley]

This issue is not directly related to this forum, so hopefully you will find more info elsewhere. We can fill you in on things relating to the foreskin, but testicles per se are out of the scope of this forum.

First, question is, is your son intact (not circumcised)? If he is intact, and you do see a urologist about the testicle business, the main thing is to be prepared to protect him from unnecessary foreskin retraction (either for examination, or catheterization if he has surgery), and be prepared to protect him from any suggestions for circumcision "while he's under anesthesia."

Several good articles relating to protecting intact boys when dealing with non-foreskin-knowledgeable doctors are:
http://www.mothering.com/articles/ne...uncircson.html
http://www.kindredmedia.com.au/libra...ractions/401/1

Good luck, Gillian

[hparsh]

Now that you mention it, the pediatrician did mention that we could get DS circumcised since he'd already be put under. : I asked her why and what risks there would be if I didn't, and she said it would just look better.

*sigh* I need a new pediatrician.

[Fellow Traveler]

Disgusting. You do need a new pedi., I hope you told him/her off. I hope you find the info you need. Perhaps someone here can help you even though we aren't experts on that issue.

[Vancouver Mommy]

I know nothing about the condition you mentioned, but in all honesty, I wouldn't let this person touch my child for any reason. Get a new doc.

[Night_Nurse]

Originally Posted by hparsh

... I asked her why and what risks there would be if I didn't, and she said it would just look better.

Oh. My. Goodness!

Regardless of if your pedi thinks a circed penis looks "prettier" than an intact one or not, she should keep that kind of opinion to herself.

Concerning your son's testes, everything I ever remember reading about it (and by doing a quick search just now too) seems to suggest it's okay to just wait and see if the problem self corrects by puberty. It is fully mobile, right? It doesn't stay stuck in the groin for prolonged time or cause any pain, correct? If that is true, personally, I'd be hesitant to do surgery right now. My literature states it's not thought to cause any fertility issues so if it easily moves from the scrotum to the groin back to the scrotum then it's appropriate to just wait and check on it periodically.

On the other hand, I suppose getting a pedi. urology consult wouldn't hurt anything (make sure he/she doesn't retract the foreskin AT ALL). However, if they are quick to recommend surgery at such a young age, please remember they make $$$ by performing surgeries. If they recommend surgery now, ask what harm there is to take a wait and see approach. Because I'm not finding anything that suggests surgery for retractile testes at one year. (My disclaimer is my textbooks are a bit older and maybe the recommendations have changed recently - but I doubt it).

[hparsh]

Thanks everyone! Yeah, that ped. is a whackjob (sorry if that offends anyone). I go to a practice, and I sometimes end up with different doctors.

Anyway, I thought I would check with all of you since I didn't really trust her when she told me he might need surgery. She refered me to a urologist, but I'm afraid if I go that they will undoubtedly suggest surgery because, like you said, they make money and (let's face it) some HCP do so many things that are unnecessary as a "precaution."

I was nervous though because I read some scary stuff at Mayo Clinic.

However, a boy with a retractile testicle may be vulnerable to these complications:

Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. What causes these cells to develop into cancer is unknown. Men who have had an undescended testicle have a greater risk of testicular cancer.

Fertility problems. Low sperm counts, poor sperm quality and low fertility rates are more likely among men who have had an undescended testicle.
Testicular torsion. Testicular torsion is the twisting of the spermatic cord. This painful condition cuts off blood to the testicle. If not treated promptly, it may result in the loss of the testicle. An undescended testicle increases the risk of testicular torsion.

Trauma. A testicle located in the groin may be susceptible to trauma or injury from compression against the pubic bone.

When I googled this, some sites are saying surgery may be necessary if they don't fully come down into the sac by adolescence, and then some say it is totally normal and that no treatment is needed and there is no increased risk of cancer.

Then I have this pediatrician telling me he could possibly need surgery right now. She tried to diminish it by saying it was minor and they would put him under and only do a few cuts in the groin. She considers that minor? :


Edit to add: it does not cause him any pain or discomfort. I would not have noticed this if the ped. did not point it out to us.

[latinalonestar]

My honest opinion:
Right now all his penis needs to do is pee. If it does that then it is doing it's job.

If there is a possibility of this resolving itself by puberty, I would do nothing. Surgery is only asking for complications.

As others have said, if you do take him to a urologist remember these things.
1. Tell the urologist not to lay a finger on his foreskin.
2. Urologist are surgeons and thus they often prescribe surgery, even if it is not necessary. In general, they don't like to wait to see if something resolves itself.

[Bea]

Originally Posted by hparsh

Thanks everyone! Yeah, that ped. is a whackjob (sorry if that offends anyone). I go to a practice, and I sometimes end up with different doctors.

Anyway, I thought I would check with all of you since I didn't really trust her when she told me he might need surgery. She refered me to a urologist, but I'm afraid if I go that they will undoubtedly suggest surgery because, like you said, they make money and (let's face it) some HCP do so many things that are unnecessary as a "precaution."

I was nervous though because I read some scary stuff at Mayo Clinic.



When I googled this, some sites are saying surgery may be necessary if they don't fully come down into the sac by adolescence, and then some say it is totally normal and that no treatment is needed and there is no increased risk of cancer.

Then I have this pediatrician telling me he could possibly need surgery right now. She tried to diminish it by saying it was minor and they would put him under and only do a few cuts in the groin. She considers that minor? :


Edit to add: it does not cause him any pain or discomfort. I would not have noticed this if the ped. did not point it out to us.

I see your dilemma from that Mayo clinic quote you included. The problem there is the writer is using the terms retractile testicle and undescended testicle interchangeably. They are not the same thing. The undescended testicle is stuck in the abdomen and the retractile testicle is descended but pops back up.

The undescended carries a risk of cancer and infertility if untreated apparently, the retractile carries no risk.

I think it might be worth getting a second opinion to double check the diagnosis so you are clear what if anything you are dealing with and what if anything needs done. It seems your ped isn't entirely sure.

Just remember to threaten any urologist you consult with a slow and painful death (j/k) if he so much as touches your sons foreskin.

[3pink1blue]

no doctor here, of course, but my nephew has one retractile testicle. he is 10 months. sil's ped said do nothing - this was after an ultrasound and everything. id get a second opinion if it were me.

[eepster]

It's normal for testicles to retract up into the groin when they are cold. This pprevents frostbite. This is only a problem if the testicle doesn't come back down when he is warm. Over heated testicles can become infertile, etc.

Dr offices are often chilly, so it is not unusual for a child testicle to occassionally be retracted during an exam. This happened with DS.

If a previously descended testicle is retracted during an exam, the Dr should have the parent check the testicle in question during diaper changes or while pottying to see if it comes down when it is warmer.

If your DS's testicle descends sometimes then there is no problem.


ETA: BTW commenting on the appearance of a child's normal genitles, especially in front of the child, is extremely inappropriate.

[hparsh]

Thanks for all the replies. I have decided that this is completely normal and I probably won't be going to a urologist. I'm almost sure they'll recommend unnecessary surgery.

His testes just retract. I have been feeling them at home and after a warm bath, and they are always descended into the scrotum. Sometimes I don't feel them in there, but it's really cold where I live right now, and I'm sure the doctor's office was chilly and he was not in a good mood when the ped. was touching him.

I am really annoyed that the ped. made it sound like some unusual condition that would need surgical correction if it hadn't corrected itself within a couple of months. Everything I have been reading says it's normal and should correct itself by puberty.