Undescended Testis & Enuresis in Children: MSRA High-Yield Guide
- examiner mla
- Jul 9
- 3 min read
A 6-week-old boy is reviewed at his routine baby check. His left testis is not palpable in the scrotum, but no hypospadias is noted. What is the most appropriate next step?
Choose the correct answer
A) Urgent referral to paediatrics within 24 hours
B) Refer to paediatric surgery now
C) Re-examine at 4-5 months
D) Arrange urgent karyotyping
✅ Answer: C) Re-examine at 4-5 months
✔ Explanation:
If unilateral undescended testis at 6-8 week check → re-examine at 4-5 months.
If still undescended by 6 months → refer for orchidopexy.
Hormonal therapy is not recommended
A 2-month-old male infant has bilateral non-palpable testes and hypospadias. What is the next best step?
Choose the correct answer
A) Arrange orchidopexy at 12 months
B) Monitor until 6 months
C) Urgent referral to paediatrics within 24 hours
D) Start testosterone therapy
✅ Answer: C) Urgent referral to paediatrics within 24 hours
✔ Explanation:
Bilateral undescended testes or associated hypospadias → suspect DSD → urgent endocrine/genetic evaluation within 24 hours.
A 5-year-old boy presents with testicular pain and a non-retractile undescended testis. What is the most serious complication to consider?
Choose the correct answer
A) Infertility
B) Testicular torsion
C) Inguinal hernia
D) Testicular atrophy
✅ Answer: B) Testicular torsion
✔ Explanation:
While infertility and malignancy are long-term risks, torsion is an acute emergency with an increased risk in undescended testes.
Which of the following statements about cryptorchidism is FALSE?
Choose the correct answer
A) It increases the risk of testicular cancer
B) Orchidopexy reduces infertility risk
C) Hormonal therapy with hCG is first-line in the UK
D) It is more common in preterm infants
✅ Answer: C) Hormonal therapy with hCG is first-line in the UK
✔ Explanation:
Hormonal therapy is not recommended in the UK; surgical orchidopexy is the definitive treatment.
At what age should orchidopexy ideally be performed for an undescended testis?
Choose the correct answer
A) Before 3 months
B) Between 6-12 months
C) At 18 months
D) Between 2-4 years
✅ Answer: B) Between 6-12 months
✔ Explanation:
Best outcomes (fertility and cancer risk reduction) if done by 12 months, and no later than 18 months.
Which of the following is a risk factor for cryptorchidism?
Choose the correct answer
A) Large for gestational age
B) Hypertension in pregnancy
C) Prematurity
D) Maternal diabetes
✅ Answer: C) Prematurity
✔ Explanation:
Prematurity, low birth weight, small for gestational age, family history, genetic abnormalities (e.g. hypospadias) are risk factors.
A 6-year-old boy is brought to the GP due to bedwetting 4 nights a week. He has no daytime urinary symptoms. The parents want long-term treatment. What is the first-line management?
Choose the correct answer
A) Reassurance
B) Desmopressin
C) Enuresis alarm
D) Oxybutynin
✅ Answer: C) Enuresis alarm
✔ Explanation:
≥5 years + frequent bedwetting (>2x/week) + no daytime symptoms → Enuresis alarm (first-line for long-term control).
Desmopressin is for short-term control or >7 years if alarm unsuitable.
A 4-year-old girl wets the bed twice a week. There are no daytime symptoms. What is the next step?
Choose the correct answer
A) Start desmopressin
B) Start enuresis alarm
C) Refer to paediatrics
D) Reassure parents
✅ Answer: D) Reassure parents
✔ Explanation:
<5 years = reassurance only as continence may be achieved with age.
A 9-year-old boy develops new-onset bedwetting after being dry for 2 years. His mother reports he is drinking a lot and has lost weight recently. What is the most appropriate next step?
Choose the correct answer
A) Start enuresis alarm
B) Start desmopressin
C) Reassure
D) Check urine for glucose
✅ Answer: D) Check urine for glucose
✔ Explanation:
Secondary enuresis + polyuria + polydipsia + weight loss → suspect Diabetes Mellitus → urgent glucose check.
Which of the following is NOT a cause of secondary enuresis?
Choose the correct answer
A) Emotional upset
B) UTI
C) Constipation
D) Sleep arousal difficulty
✅ Answer: D) Sleep arousal difficulty
✔ Explanation:
Sleep arousal difficulty = mechanism for primary nocturnal enuresis, not a cause of secondary (which is due to new pathology or emotional stress after being dry for ≥6 months).
A 7-year-old girl with primary nocturnal enuresis wets the bed 5 nights a week. She is due to go on a school camp in 2 weeks. What is the most appropriate short-term treatment?
Choose the correct answer
A) Enuresis alarm
B) Desmopressin
C) Oxybutynin
D) Reassure
✅ Answer: B) Desmopressin
✔ Explanation:
Desmopressin is first-line for short-term control (e.g. sleepovers, camps) or if alarm is not acceptable.
After 2 complete courses of enuresis alarm and desmopressin, a 6-year-old boy still wets the bed nightly. There are no daytime symptoms. What is the next step?
Choose the correct answer
A) Continue alarm
B) Start oxybutynin
C) Reassure
D) Refer to secondary care
✅ Answer: D) Refer to secondary care
✔ Explanation:
Persistent enuresis despite two treatment courses → refer to secondary care (enuresis clinic or paediatrician).
🔑 Final MSRA Clinchers
✔ Prematurity = major risk factor
✔ Re-examine unilateral undescended testis at 4-5 months
✔ Refer if undescended by 6 months
✔ Bilateral undescended + hypospadias = urgent DSD evaluation
✔ No role for hormonal therapy (hCG) in UK
✔ Orchidopexy by 12 months ideally (max 18 months)
✔ Cancer risk remains increased post-orchidopexy
✔ Primary enuresis = never dry
✔ Secondary enuresis = dry ≥6 months then relapse
✔ First-line long-term = enuresis alarm
✔ First-line short-term / >7 years = desmopressin
✔ New enuresis + polydipsia + weight loss = check glucose urgently
✔ Constipation is a hidden cause
✔ Daytime symptoms = refer to secondary care
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