From the Guidelines
A 6-year-old boy with bilateral undescended testicles should undergo surgical correction, specifically orchiopexy, as soon as possible to minimize potential damage to sperm production and reduce the risk of testicular cancer. This recommendation is based on the American Urological Association (AUA) guideline, which states that hormonal therapy is not recommended due to low response rates and lack of evidence for long-term efficacy 1. The guideline emphasizes that orchiopexy is the most successful therapy to relocate the testis into the scrotum 1.
Key Points to Consider
- The AUA guideline recommends against using hormonal therapy to induce testicular descent due to its limited effectiveness and potential risks 1.
- Orchiopexy should be performed promptly to preserve fertility potential, as the total number of germ cells in cryptorchid boys decreases significantly after 15-18 months of age 1.
- Surgical correction is typically done as an outpatient procedure and has a high success rate.
- Follow-up appointments are necessary to ensure proper healing and to monitor that the testicles remain in the correct position.
Importance of Prompt Treatment
Treatment is crucial because undescended testicles can lead to fertility problems and carry an increased risk of testicular cancer if left untreated 1. The longer the testicles remain undescended, the greater the potential damage to sperm production. Therefore, it is essential to refer the boy to a pediatric urologist promptly for evaluation and treatment.
From the FDA Drug Label
Prepubertal cryptorchidism not due to anatomical obstruction. In general, HCG is thought to induce testicular descent in situations when descent would have occurred at puberty. HCG thus may help predict whether or not orchiopexy will be needed in the future. Although, in some cases, descent following HCG administration is permanent, in most cases, the response is temporary Therapy is usually instituted in children between the ages of 4 and 9.
For a child with bilateral testicles not fully descended at age 6, therapy with human chorionic gonadotropin (HCG) may be considered. The goal of this treatment is to induce testicular descent, which may be temporary in most cases. Treatment is usually started between the ages of 4 and 9, and it may help predict if surgical intervention (orchiopexy) will be needed in the future 2.
From the Research
Bilateral Undescended Testicles at Age 6
- At age 6, if bilateral testicles are not fully descended, it is considered a case of cryptorchidism or undescended testis 3.
- The probability of spontaneous descent after 6 months of age is low, and the risk of infertility and testicular cancer increases if left untreated 3, 4.
- International guidelines recommend surgical specialist referral if descent does not occur by 6 months, and orchiopexy is recommended between 6 and 18 months to protect fertility potential and decrease the risk of malignant changes 3, 5.
Risks Associated with Undescended Testis
- Undescended testis is associated with a risk of low semen quality and an increased risk of testicular germ cell tumors 6.
- The risk of malignancy is 10 to 40 times higher in men with cryptorchidism than in normal men, and is highest in men who have had an intra-abdominal testis and in certain intersex conditions 4.
- Patients with bilateral undescended testes have a higher infertility rate, up to 10%, compared to those with unilateral undescended testis 3.
Treatment Options
- Orchiopexy is the standard treatment for undescended testis, and should be performed between 6 and 18 months of age to prevent degenerative changes and reduce the risk of infertility and testicular cancer 4, 3, 5.
- Hormonal therapy using human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) has low success rates and is not recommended by current guidelines for management of cryptorchidism 6.
- Early referral to a surgical specialist and timely surgical correction are the most important factors for decreasing infertility and testicular cancer rates 3, 5.