From the Guidelines
The medical term for an undescended testicle is cryptorchidism. This condition occurs when one or both testicles fail to descend from the abdomen into the scrotum before birth or during early infancy, as defined in the evaluation and treatment of cryptorchidism guideline 1. The condition is also referred to as undescended testis, and it is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth.
Key Points
- Cryptorchidism is defined as failure of a testis to descend into a scrotal position, and it may also lead to identification of an absent testis, which is most commonly referred to as vanishing or vanished 1.
- The prevalence of cryptorchidism is higher in premature boys, with approximately 3% of full-term male infants and up to 30% of premature boys affected, as stated in the guideline 1.
- Treatment typically involves surgical correction called orchiopexy, ideally performed before the child reaches 18 months of age to preserve fertility and reduce the risk of testicular cancer.
- For infants under 6 months, doctors may initially observe as spontaneous descent can still occur, but referral to a surgical specialist is recommended if spontaneous descent does not occur by 6 months (corrected for gestational age) 1.
- Hormonal therapy with human chorionic gonadotropin (hCG) is sometimes used but has limited success rates, and imaging for cryptorchidism is not recommended prior to referral 1.
Diagnosis and Referral
- Providers should obtain gestational history at initial evaluation of boys with suspected cryptorchidism, and primary care providers should palpate testes for quality and position at each recommended well-child visit 1.
- Referral to an appropriate surgical specialist is recommended for infants with a history of cryptorchidism who do not have spontaneous testicular descent by six months (corrected for gestational age), as well as for boys with newly diagnosed acquired cryptorchidism after six months (corrected for gestational age) 1.
From the Research
Definition of Undescended Testicle
- The medical term for an undescended testicle is cryptorchidism, which indicates a testis that has failed to descend to the scrotum and is located at any point along the normal path of descent or at an ectopic site 2.
- Cryptorchidism is a common genitourinary malformation in male children, and it is diagnosed with history and physical examination findings 3.
- The term cryptorchidism refers to a testis that is not in its normal position in the scrotum, and it can be classified as palpable or impalpable 2.
Prevalence and Associated Risks
- Cryptorchidism is present in about 4.5% of newborns, with a higher incidence in preterms, and the incidence decreases to 1.2% by the first year 2.
- The condition is associated with a risk of low semen quality, an increased risk of testicular germ cell tumors, and impaired fertility 4, 5.
- Patients with cryptorchidism are at a higher risk of developing testicular cancer, and they require lifelong surveillance and counseling regarding fertility implications and increased risk of testicular conditions 3.
Diagnosis and Treatment
- A thorough clinical examination helps in arriving at the etiology of cryptorchidism, and a short hCG stimulation test can help to exclude anorchia 2.
- Laparoscopy has an important role in the diagnosis and management of undescended testis, and surgical intervention is recommended at six months of age or at the time of diagnosis if the child is older 3.
- Hormonal treatments using human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) have low success rates and are not recommended by current guidelines for management of cryptorchidism 4, 6.