Enlarged Testicle

Dear Lisa,

Why would a 3 year old have an enlarged testicle?

“Three year old with an enlarged testicle”

Dear “Three year old with an enlarged testicle”,

A child’s testicle could appear enlarged for a few reasons. A child with Cryptorchidism, can present with the appearance of one testicle being enlarged. Cryptorchidism is the absence of a testicle from the scrotal sac. Therefore the side of the sac that has a testicle would appear larger than the side of the sac without one. Cryptorchidism occurs when a boy has an Undescended testicle or Retractile testes.

An Undescended testicle occurs when the descent of the testicle from the abdomen to the scrotal sac does not occur. A delay in the descent of the testicle from the abdomen can occur in up to 4% of full term newborns and in up to 30 % of premature males. (1) Within the first few months of life about 80% of all undescended testes will be in the scrotum. (1) Spontaneous descent does not usually occur after one year of age. (2). If a testicle does not descend within this time frame medical intervention is indicated.

A testicle may not be able to descend because of a mechanical barrier such as a short spermatic cord or a narrow inguinal canal. Adhesions or fibrous bands may also prevent a testicle from descending. (1,2) In some cases the descent of the testes is diverted to another area in the perineum or femoral area.

Cryptorchidism can also occur due to Retractile testes. Retractile testes can be felt at any level along the line of decent and can be manipulated into the bottom of the scrotum. (1,2) These testes are usually descended, but are pulled back up due to a hyperactive cremasteric reflex. The testes are retracted into the upper part of the scrotum in response to cold, pain, fear or touch.

The appearance of an enlarged testicle may also be due to a Hydrocele or Inguinal hernia. A Hydrocele is a non-tender, fluid filled mass in the scrotal sac. (3) Before a baby is born the testes travel from the abdomen down into the scrotum. The testes descend through a special sac of peritoneal tissue called the processus vaginalis. Once the testes reach the scrotum this sac naturally closes. Freqeuntly at birth some residual peritoneal fluid is left in the scrotal sac after closure of the processus vaginalis. A Hydrocele is the accumulation of this peritoneal fluid in the scrotal sac. The fluid gradually absorbs during the first year of life.

A Hydrocele in a child with a closed processus vaginalis is called a Non-communicating Hydrocele. Non-communicating Hydroceles are full, fluctuant and tense. If a beam of light is directed from behind the scrotum in a dark room, the testicle will transilluminate. This means the light appears as a red glow with clear fluid. No blood or tissue should be seen. (4)

A Communicating Hydrocele occurs when the process vaginalis does not close. If this is the case, fluid in the scrotal sac is not noticed until some time after birth. In this type of Hydrocele, the scrotum appears flat in the morning and increases in size as the day goes on. (4) Since there is an opening between the scrotal cavity and the abdominal cavity communicating hydroceles are frequently associated with Inguinal Hernias. (4)

An Inguinal Hernia occurs when the abdominal contents descend down through the patent process vaginalis and into the scrotum. Inguinal Hernias occur most often during the first 10 months of life. (1) They are painless and tend to increase in size when a baby cries or coughs. (1)

On the other hand an acute onset of painful scrotal swelling may be a sign of a more serious health problem such as epididymitis, acute orchitis , torsion of the spermatic cord or a strangulated inguinal hernia. (3) These conditions require immediate medical attention. If a hernia becomes strangulated or incarcerated the child experiences colicky abdominal pain and the scrotal area becomes more swollen and reddened. When an incarcerated hernia occurs the hernia is not able to be reduced which means that the contents cannot easily slide out of the scrotum and back into the abdomen. (2)

If you notice that your three year old has an enlarged testicle, he should be evaluated by your Doctor so that the proper diagnosis and treatment plan be instituted. Signs such as redness, pain, abdominal pain, increased swelling or limp are concerning. If your son’s scrotal swelling is an acute problem, especially if it is associated with pain or an illness, you should visit your Doctor without delay in order to rule out a more serious condition.

References:
(1)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:828,790.
(2)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1520,1459.
(3)Bates B. A Guide to Physical Examination and History Taking. Fifth Ed. Philadelphia, PA:J.B.Lippincott Company. 1991:380, 376.
(4)Graham M, Uphold C. Clinical Guidelines in Child Health. Gainsville, Florida: Barmarrae Books. 1994:473-474.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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