I hadn't seen my 7-year-old patient for a while, and though I'd missed the boy and his delightful family, I was certainly happy for them. After experiencing a number of minor pediatric illnesses from infancy through preschool, the child was now enjoying a long stretch of good health. In addition, since the family lived quite a distance from my office, the boy's last complete checkup had been done elsewhere, at a facility closer to home.
The boy showed up in my exam room because mom was very concerned about what had been found, or rather, not found during the boy's most recent physical. The outside practitioner was unable to find either of the boy's testicles while performing the genital exam. Since both testes had been easily felt in the scrotum on my previous exams, I reassured the mother that they must, in fact, exist.
The testicular exam is a sensitive but very important part of a boy's physical exam. For younger kids, I explain that this portion of the physical is just a normal part of the head-to-toe exam, and that it's OK if it's done by a doctor with a parent in the room.
In my patient's case, I was able to find the boy's left testicle, but not the right. I sent the family on for a consultation with a pediatric urologist to help determine if the right testicle was just retractile or if it had ascended up and out of the normal position, requiring surgical intervention.
The American Pediatric Surgical Association notes that an empty scrotum can be due to a retractile testicle, which tends to bounce up and away from the scrotum. This is a normal condition that usually resolves by early adolescence. In other cases, an empty scrotum can indicate a testicle which is truly undescended (89 percent of cases), malformed (5 percent), abnormally positioned (3 percent) or actually absent (3 percent).
Undescended testes are most often seen in babies, and experts at the University of Virginia report that this cryptorchidism or "hidden testes" is most common in premature infant boys. Twenty-one percent of premature males are affected, while only 3 percent to 4 percent of full-term boys have an undescended testicle. In 30 percent of these little patients, both testes are found to be undescended.
The Virginia team explains that if testes have not descended on their own by about 6 months of age, they are then much less likely to do so on their own. Surgical repair, known as orchiopexy, involves finding and securing the testicle into the scrotal sac. The procedure is usually done between the ages of 6 months and 18 months, with a success rate of 98 percent if performed at this stage of life. Early repair is advised to decrease the risk of future infertility, hernia and torsion, or twisting of the testicle. Some specialists recommend that surgery take place by the patient's first birthday.
Finally, University of Michigan specialists point out that even after surgical correction, boys with a history of undescended testes have been shown to be at higher risk for future testicular cancer. Though most boys with repaired undescended testes will not develop cancer, when cancer does occur, it's important to know that it can involve either the undescended or the normally descended side. Affected males need to be particularly vigilant as they grow, learning how to do monthly self-exams starting in adolescence, with annual checkups performed by their physicians throughout adulthood.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.