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Urology (Expert Forum)
Re: ascending testicle in children
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Re: ascending testicle in children
by HFHS M.D.-MS, Jan 01, 1995 12:00AM
Posted By HFHS M.D.-MS on February 20, 1998 at 17:40:43:
In Reply to: ascending testicle in children posted by Michele on February 11, 1998 at 18:38:21:
: My six year old son was just diagnosed with an undecended testicle. His pediatrician insists, as records show, that in previous well visits this testicle had been in the scrotum but now is not. The urologist we have gone to says that the testicle never dropped and surgery is necessary. Is it possible that the testicle had been in the scrotum before and not now? Is it just a difference in medical opinion - ascending vs. decending testicle?
--------------------------------------------------------------------------------
Dear Michele;
Thanks for your question.
There have been reported cases in the literature of testicular ascent after once being descended. This condition is reportedly rare and is documented by these two abstracts I found on Medline( database 1987-1993). Both articles can be found in their entirety in a medical library.
Belman AB .
Acquired undescended (ascended) testis: effects of human chorionic
gonadotropin.
Journal of Urology. 140(5 Pt 2):1189-90, 1988 Nov.
A total of 7 boys 4 to 10 years old was evaluated for undescended
testes. All patients had been seen previously by a pediatric urologist
and diagnosed as having a retractile testis. In fact 4 boys had
undergone surgical correction of a contralateral undescended testis at
an earlier date at which time the testis in question could be
manipulated into the scrotum. Another boy was examined under anesthesia
and the operation was canceled because the testis could be brought into
the scrotum. Subsequently, on followup evaluation 2 to 8 years later the
ipsilateral testis could not be manipulated into the scrotum. Of the
boys 6 then were treated with a short course of human chorionic
gonadotropin. Four patients had a positive response but in 3 the testis
was undescended again at examination 6 months later. Of the boys 6
ultimately underwent orchiopexy. Boys with highly retractile testes
require periodic examination until puberty to ensure that those testes
do not ascend secondarily.
Schiffer KA. Kogan SJ. Reda EF. Levitt SB .
Acquired undescended testes.
American Journal of Diseases of Children. 141(1):106-7, 1987 Jan.
Three cases of reascent of a previously unequivocally documented
descended testis have been encountered. Chorionic gonadotropin treatment
was initially attempted in each child and was successful in causing
descent of the involved testis in one. The testes of the other two boys
were successfully brought down surgically. Possible causes for
testicular reascent are presented and the pertinent literature is
reviewed. These cases illustrate the need for continued diligence and
interval examination of the pediatric scrotum throughout childhood.
Please take note of Douglas Banks (2/18) response which does address the real issue.Drs. S.Liroff, R.Gonzalez, and E.Kass at our institution have experience in evaluating and treating problems such as you describe. If you would like to make an appointment for another opinion, please call us at (1-800-653-6568). We can also arrange local accommodations through this number if this is your need.
Sincerely,
HFHS M.D.-MS
* Keyword: Ascending Testes
In Reply to: ascending testicle in children posted by Michele on February 11, 1998 at 18:38:21:
: My six year old son was just diagnosed with an undecended testicle. His pediatrician insists, as records show, that in previous well visits this testicle had been in the scrotum but now is not. The urologist we have gone to says that the testicle never dropped and surgery is necessary. Is it possible that the testicle had been in the scrotum before and not now? Is it just a difference in medical opinion - ascending vs. decending testicle?
--------------------------------------------------------------------------------
Dear Michele;
Thanks for your question.
There have been reported cases in the literature of testicular ascent after once being descended. This condition is reportedly rare and is documented by these two abstracts I found on Medline( database 1987-1993). Both articles can be found in their entirety in a medical library.
Belman AB .
Acquired undescended (ascended) testis: effects of human chorionic
gonadotropin.
Journal of Urology. 140(5 Pt 2):1189-90, 1988 Nov.
A total of 7 boys 4 to 10 years old was evaluated for undescended
testes. All patients had been seen previously by a pediatric urologist
and diagnosed as having a retractile testis. In fact 4 boys had
undergone surgical correction of a contralateral undescended testis at
an earlier date at which time the testis in question could be
manipulated into the scrotum. Another boy was examined under anesthesia
and the operation was canceled because the testis could be brought into
the scrotum. Subsequently, on followup evaluation 2 to 8 years later the
ipsilateral testis could not be manipulated into the scrotum. Of the
boys 6 then were treated with a short course of human chorionic
gonadotropin. Four patients had a positive response but in 3 the testis
was undescended again at examination 6 months later. Of the boys 6
ultimately underwent orchiopexy. Boys with highly retractile testes
require periodic examination until puberty to ensure that those testes
do not ascend secondarily.
Schiffer KA. Kogan SJ. Reda EF. Levitt SB .
Acquired undescended testes.
American Journal of Diseases of Children. 141(1):106-7, 1987 Jan.
Three cases of reascent of a previously unequivocally documented
descended testis have been encountered. Chorionic gonadotropin treatment
was initially attempted in each child and was successful in causing
descent of the involved testis in one. The testes of the other two boys
were successfully brought down surgically. Possible causes for
testicular reascent are presented and the pertinent literature is
reviewed. These cases illustrate the need for continued diligence and
interval examination of the pediatric scrotum throughout childhood.
Please take note of Douglas Banks (2/18) response which does address the real issue.Drs. S.Liroff, R.Gonzalez, and E.Kass at our institution have experience in evaluating and treating problems such as you describe. If you would like to make an appointment for another opinion, please call us at (1-800-653-6568). We can also arrange local accommodations through this number if this is your need.
Sincerely,
HFHS M.D.-MS
* Keyword: Ascending Testes
