Will my son need another ultrasound after an orchiopexy?
Patient's Query
Hello doctor,
My son had an orchiopexy two weeks and five days ago. He is 13 years old. His left testicle was undescended. He has had the surgery, but I am wondering if it is normal for the left testicle that had surgery to still be sitting higher in the scrotal sac and not as low as the right testicle. It is much higher.
I am worried because there is a small risk after orchiopexy of it ascending back up. If this does happen, what time frame does it usually occur in? We cannot have a review with the surgeon because we flew to a different state for the surgery.
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Will he need another ultrasound?
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Would we need to fly back to see the surgeon after a few months?
Kindly advise.
Hello,
Welcome to icliniq.com.
It is completely understandable to be worried, and this is a very common concern after orchiopexy. At less than three weeks after surgery, it is often normal for the operated testicle to sit slightly higher than the other side. The tissues are still healing, and the spermatic cord and surrounding tissues may feel tight early on. Over the next several weeks to a few months, the testicle often settles into a lower and more natural position.
A reassuring sign is that the testicle is still within the scrotum, even if it is sitting higher. This is uncommon. If it happens, it is more often noticed within the first three to six months after surgery. Greater concern arises if the testicle is no longer felt in the scrotum at all, rather than simply sitting a little higher.
Let me know whether the testicle can still be felt in the scrotum. or any pain, redness, swelling, or changes in size.
A follow-up with a local doctor at about six to eight weeks after surgery is usually reasonable. In many cases, a physical examination is enough. Ultrasound is generally only needed if the testicle is difficult to feel or there is concern about position or size.
I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.
Thank you.
Patient's Query
Hello doctor,
Thank you, Doctor, for your response. I just wanted to ask a few more questions.
As this left undescended testicle was not found until he was 13 years old, we feel terribly bad. During his baby check-ups, the nurses did examine him, but somehow it was not identified then.
I wanted to ask about the testicular cancer risk now. My son also has one testicle that is smaller than the right one, as mentioned on the ultrasound. Since it remained high in the groin and not in the scrotum for 13 years:
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Does this mean he now has a higher cancer risk?
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Do all children with undescended testes have some risk regardless of whether surgery is done before 18 months, or because my son had surgery later, is his risk even higher than the general population?
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Is this related to it not being in the cooler scrotal environment for so long?
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Will he require monitoring now?
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Will he need ultrasounds yearly or every few years, or regular testicular checks?
Another concern is that my son also had a circumcision at the same time because he had severe ballooning of the penis. When he urinated, the penis would balloon, and urine would leak out significantly, almost like a full accident. We were told this was likely severe phimosis. He could not retract the foreskin at all, and urine was getting trapped. Since circumcision, this problem has resolved.
However, during surgery, the surgeon found some ulcers under the foreskin and one on the tip. They healed after about two days and formed scabs after the operation. We were also using an ointment for healing. Are such ulcers common when urine gets trapped with severe phimosis?
We were worried because HSV testing was mentioned, although the doctor said this was routine protocol for ulcers and that the cause was more likely trapped urine or irritation.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I have read your query and understand your concern.
Undescended testicles can occasionally be missed, and the important thing is that it has now been identified and treated.
Regarding the undescended testicle, boys with this condition do have a higher risk of testicular cancer than the general population. This risk exists even when surgery is done early, but earlier orchiopexy (ideally before one to two years of age) may help reduce that risk.
Since your son had a correction at 13 years, his risk may be somewhat higher than if it had been corrected earlier, but the overall absolute risk still remains relatively low. One reason is that long-term location outside the cooler scrotal environment may affect normal testicular development.
A smaller testicle on the affected side is also common after long-standing undescended testis and often reflects reduced development rather than cancer. For long-term follow-up, routine yearly ultrasound is not usually required unless there are specific concerns.
Regular clinical examinations are important, and during adolescence, he should be taught monthly testicular self-examination so that any new lump, size change, or abnormality is noticed early.
Regarding the circumcision and ulcers, severe phimosis with trapped urine can commonly cause chronic irritation, inflammation, skin breakdown, and small ulcers under the foreskin. In this situation, ulcers may occur from irritation alone and are not uncommon. Quick healing after circumcision is reassuring.
Herpes simplex virus (HSV) testing is often done routinely when ulcers are present, even if infection is unlikely. Based on severe phimosis, urine trapping, and rapid healing, local irritation is often a more likely explanation than herpes infection.
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Cancer risk is increased compared with the general population, but is still relatively low.
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A smaller testicle can occur due to reduced growth from a long-term undescended position.
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Regular doctor follow-up and future self-examination are more important than frequent ultrasound.
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The penile ulcers were likely related to severe phimosis and trapped urine rather than a serious infection.
I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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