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Ultrasound of child showed no evidence of scrotal sac. What does it mean?

4 years old male child was sent for an ultrasound exam to rule out undescended testicles (non palpable testicles). During examination only penis was identified and no evidence of the scrotal sac. Child s mother was assisting to move testicles down with her fingers for it to be examined ( in the groin area ). What does it mean?
Asked On : Tue, 26 Mar 2013
Answers:  3 Views:  57
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Pediatrician 's  Response

Thanks for your query.
Boy’s testicles normally descend from within the abdomen into the scrotum before birth. Around 3% of boys are born with their testicles undescended (not within the scrotum).
At six months of age and beyond only about 0.8% of boys have undescended testicles. That means in other about 2.2 % the testicles descend down into scrotum by 6 months.
Sometimes a testicle may move back and forth between the scrotum and the groin and when so called retractile testicle is residing in the groin, it may be easily guided by hand into its proper position in the scrotum during a physical examination.
For most boys, the problem of a retractile testicle goes away sometime before or during puberty, the time when an out-of-place testicle moves to its correct location in the scrotum and stays there permanently.
Ultrasound and MRI are not generally helpful in determining whether testes are retractile or not. It is in fact only by clinical examination similar to how his mum was asked to assist.
The definitive treatment of truly undescended testes is by surgery ideally around one year of age.
Hope you find the information helpful.
Answered: Wed, 27 Mar 2013
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General & Family Physician Dr. Jay Patel's  Response

Well the undescended testis with out scrotal sac and the age of child is 4 years old leaves very few viable alternatives.

Normally such issues are first check and identified by the pediatrician who is present at the birth and the child will be asked to undergo surgery in the first 6 months and they will create the sac using the child skin and will pull the testis and get it out of the inguinal canal, testis has germ cell which are very temperature sensitive and will get damage and reduces the chances of sperm production if kept at body temperature, normally the testis has 2 degree lower temperature then normal body temperature. The testis looses half of the viable / alive germs cell by age of 1year if kept at higher / body temperature, but in our case the child is 4 years old , so the viability of germ cell which give rise to sperms is very questionable .

1) Mostly all the surgeon will advice to remove the testis as higher chances of getting cancer if nonfunctional testis are not removed from the abdomen.

2) Sorry to say that but the child will not be able to reproduce.

3) Will need the hormone replacement to keep normal physical growth (the hormone is normally made by testis if present)

Hope it helps.
Answered: Wed, 27 Mar 2013
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General & Family Physician Dr. Sunil 's  Response
Thanks for your query.
As you mentioned your child's testicles are non palpable and no evidence of scrotal sac. This condition is called cryptorchidism or undescended testis. It is more common in infants born premature but may affect healthy infant,in these usually testicles descend in 3rd month of life, some descend later and some children needs to be surgically treated as undescended testicles are at risk of torsion and cancer development.
Very few cases are reported with congenital absence of scrotal sac. Some sex hormone abnormalities are also associated but in rare cases.
I advise you to consult a urologist and pediatrician to promptly cure cryptorchidism. After surgery most of boys have retained their fertility and live healthy life.
Hope it helps.
Take Care!
Answered: Wed, 27 Mar 2013
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