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Undescended Testes
Undescended testes is the most common pediatric urological congenital condition. It occurs in 1 to 3 percent of boys, and up to 30 percent of prematurely born boys. Typically, at one year old, if the testis has not descended into the scrotum, a surgical procedure called orchidopexy is done to position the testis into the scrotum.

This procedure is done for two primary reasons:

  1. The testis must be located within the scrotum during adult life in order to produce sperm.
  2. Undescended testis carries a slightly higher risk of forming a tumor; therefore, the testis should be in a position for the long term where it can be examined regularly by both your child, as he gets older, and his primary care doctor.
The Urology Department has been particularly interested in the laparoscopic approach to abdominal undescended testes. And recently, robotic surgery has been applied to managing the intra-abdominal testis. These new approaches have revolutionized the management of this condition and improved success rates considerably.
Testicular Torsion
Testicular torsion is an emergency situation where the twisting of the spermatic cord cuts off the blood supply to the testicle and surrounding structures within the scrotum. Testicular torsion can occur in both newborns and adolescents, as well as in adults. It is managed often at Children's and at our affiliated neonatal nurseries at Brigham and Women's Hospital and Beth Israel Deaconess Medical Center.

One recent study on neonatal testicular torsion done at Children's demonstrated the potential value of scrotal ultrasounds with doppler imaging, in order to rule out scrotal hematoma as a mimicker of torsion.

Varicocele
A varicocele is mass of enlarged and dilated veins in the testicle that is typically not harmful or painful. Varicocele is becoming recognized as an exceedingly common disease, occurring in 15 percent of boys. The long term concerns associated with varicocele include fertility and proper growth of the affected testis.

Children's has established the first prospective adolescent varicocele study in the country. The goal of our study is to determine which boys may benefit from surgery for varicocele and which boys may do well with only observation. Our database of more than 300 boys has been a resource for our ongoing clinical research on varicocele.

Currently, when surgery is recommended for varicocele management, the approaches used in the department include:

  • Standard open surgery techniques
  • Laparoscopic surgery
  • Microscopic sublinguinal surgery
For patients who take an observational approach, the support of an interested and skilled ultrasound department has been invaluable to properly follow testicular growth and varicocele size.

More recently, we have advocated semen analysis for some older boys and have partnered with the Reproductive Laboratory at the Brigham and Women's Hospital, which is very skilled in this area.

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