In the infant, the main attention should be addressed to the confirmation that both testicles are descended into the scrotum. A delayed descend can occur during the first 12 months and only in 1.8-2% of cases there is a true retention (cryptorchidism).
A pathological testicular retention (palpable or non-palpable) should aways be defined and adequately treated in order to guarantee a normal gonadal development and to prevent potential further problems (funicular torsion, infertility, testicular neoplasm).
It is fundamental to correctly differentiate between the physiologic testicular mobility, secondary to the contraction of a muscle over the spermatic cord (cremasteric reflex) and a true retention : the retractile testis (mobile) does not need infact any treatment.
Variations in the size of the scrotal pouch, which may occur intermittently, are mainly related to a pathological condition in the inguinal canal. In these cases the reason may be an inguinal hernia, a funicular cyst or a communicating hydrocele.
In the first case the only solution is surgical, while in the other two, an initial conservative attitude may lead to a spontaneous resolution.
During the subsequent growth of the genitalia the Parents should be aware of a few conditions and do not under-estimate their consequences.
A sudden and important acute testicular pain, most commonly associated to a significant swelling and/or redness of the scrotal pouch (with no past history of a trauma) MUST ALWAYS alert and requires an immediate and urgent specialistic evaluation. This scenario (also known as “acute scrotum”) may be related to different conditions, some of which will require an immediate surgical treatment to prevent an irreversible testicular damage (even in only few hours !) with a subsequent atrophy.
The spermatic cord torsion or the Morgagni’s hydatid torsion (ie a testicular appendix) almost always will require an immediate surgical exploration to eliminate the testicular vascular problem (the arterial blood flow will stop while the venous blood will congest) and in an attempt to salvage the gonad. Other inflammatory conditions are the epididymitis or the orchytis which will need a medical (antibiotic and anti-inflammatory) rather than a surgical treatment.
The penile growth will gradually occur over the years but mostly starting at the pubertal development (ie the highest growth of the organ) a penile shaft deviation, not present or poorly noticeable before, may become evident. The explanation is due to a congenital asymmetry of one of the two corpora cavernosa (the main pillars of the penis) and the correct evaluation of the true entity of this altered development will become possible only at completion of penile development.
The most common situation is represented by a ventral shaft curvature (foreward) rather than lateral (side). This finding, often not known by the Parents, can generate embarrassment and anxiety in the adolescent, unable to interpret it and frequently keeping this secret… Only with major deviations, which may interfere or limit a normal sexual life, it is necessary a surgical correction (corporoplasy) to solve the problem.
Finally it is important to recognize in the scrotal pouch (almost exclusively on the left side) the presence of a dilatation of the spermatic veins defined varicocele. This condition is extremely unusual before the age of 10 years and mostly will occur with the start of the pubertal development. Occasionally it can present with pain or testicular harassment (only 2-8% of cases) and/or a reduced size of the gonad compared to the contra-lateral.
The importance of a correct diagnosis and of an adequate monitoring is relevant because of the potential varicocele consequences over the future fertility (developed only in 15-25% of all adolescents).