Testicular problems in boys: When is surgery necessary?
Testicular problems can be a source of alarm for parents of boys, but they’re actually quite common. Here, Dr. Erin McNamara, a pediatric urologist in the Department of Urology at Boston Children’s Hospital, explains testicular abnormalities and shares when to consider surgery.
Before a baby boy is born, his testicles form in his abdomen. During the third trimester of pregnancy, the testicles travel from the abdomen and into the scrotum. An undescended testicle doesn’t complete this process of descent.
What to look for: The best time to examine your son is while he soaks in a warm bath. If you’re unable to see or feel both testicles, make an appointment with a pediatric urologist.
What next: If your son is diagnosed with an undescended testicle, his clinicians will usually observe him until he turns 6 months old. If the testicle still hasn’t descended on its own by then, they will perform a type of day surgery called an orchiopexy. This procedure releases the testicle from the attachments hindering its descent and tacks it down in the scrotum so it can develop appropriately.
Testicular pain can occur at any time and is usually either caused by torsion or epididymitis. Common in pre-pubertal boys, testicular torsion occurs when a testicle is not attached well to the scrotum. If your son complains of testicular pain but doesn’t have torsion, he will most likely have a type of inflammation called epididymitis.
What to look for: If your son complains of a swollen scrotum and sharp pain, either with or without nausea and vomiting, take him to your local emergency department immediately.
What next: If a physical exam and ultrasound reveal that your son has testicular torsion, a pediatric urologist will perform a simple surgery to untwist the testicle and sew both testicles in place so they can’t turn again in the future. In rare cases, the testicle may need to be removed if the blood supply is completely cut off for a long period of time. If epididymitis is the source of pain, over-the-counter pain relievers, elevation, icing, and rest can help relieve symptoms until they resolve.
A swollen scrotum can be a sign of either a hydrocele or an inguinal hernia. A hydrocele occurs when fluid moves from the abdomen into the scrotum and surrounds the testicle. This occurs when the inguinal canal (the passage from a boy’s abdomen to his genitalia) doesn’t close as it should at birth. When intestinal segments come down through an open inguinal canal, they can cause a bulge in the scrotum called a hernia.
What to look for: If your child has a bulge on one side of his groin and is uncomfortable, call your pediatrician. Try pushing gently on the bulge when your son is calm and lying down, and you will likely see the bulge get smaller or go back into the abdomen. However, if the bulge is red or very hard, it can be a sign that blood flow has been cut off, which requires urgent attention. In that case, you should take your son immediately to your local emergency department.
What next: Clinicians typically wait to surgically repair a hydrocele until the child is a year old, in case the issue resolves on its own. Because the risk of reoccurrence is high for hernias, that your son will likely need to undergo surgery within a few weeks of being diagnosed.
Learn about the Department of Urology.
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