From the Guidelines
An undescended testicle, or cryptorchidism, requires prompt medical attention, especially if it persists beyond 6 months of age, with surgical correction (orchiopexy) being the recommended approach, typically performed between 6-18 months of age 1.
Diagnosis and Treatment
The diagnosis of cryptorchidism involves obtaining gestational history and palpating testes for quality and position at each recommended well-child visit 1.
- Providers should refer infants with a history of cryptorchidism who do not have spontaneous testicular descent by six months (corrected for gestational age) to an appropriate surgical specialist for timely evaluation 1.
- Imaging for cryptorchidism is not recommended prior to referral, which should occur by 6 months of age 1.
Hormonal Therapy
Hormonal therapy with human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) is not recommended due to low response rates and lack of evidence for long-term efficacy 1.
Importance of Early Intervention
Early intervention is crucial as untreated cryptorchidism increases the risk of testicular cancer, infertility, and testicular torsion 1.
- Orchidopexy in the first 18 months of life is recommended to preserve available fertility potential 1.
- Parents should ensure regular follow-up with a pediatric urologist after treatment to monitor testicular development and position. The condition occurs because during fetal development, testicles form in the abdomen and normally descend into the scrotum before birth, affecting approximately 3-5% of full-term male infants and up to 30% of premature boys 1.
From the Research
Definition and Prevalence
- Undescended testis (UDT) is the most common disorder of sexual development in boys, affecting 3.5% of male newborns 2.
- Approximately half of newborn UDTs descend spontaneously, while some boys develop an ascending testis later in childhood 2.
Diagnosis and Treatment
- Early diagnosis and management of UDT are necessary to preserve fertility and improve early detection of testicular malignancy 3.
- Physical examination of the testicle can be difficult, and consultation with a pediatric urologist or other qualified subspecialist is recommended by six months of age 3.
- Treatment options include hormone therapy and surgery, with the success of treatment depending on the initial position of the testicle 3, 4.
- Surgical treatment, such as orchiopexy, is recommended between 6 months and 1 year of age to lower the risks of subfertility and testicular carcinoma 5.
Surgical Approaches
- For palpable testes, a standard inguinal approach is appropriate, while the prescrotal approach is often effective for low inguinal testes and reduces surgical time and patient discomfort 2.
- For nonpalpable testes, diagnostic laparoscopy is advised to determine whether the testis is abdominal, and treatment options include one-stage laparoscopic or open orchiopexy, two-stage Fowler-Stephens orchiopexy, or microvascular testicular autotransplantation 2.
- The Prentiss maneuver is a safe and efficient technique for improving distal scrotal positioning of the testis, even in younger age groups 6.
Long-term Consequences
- Reduced fertility is the main risk of primary cryptorchidism, even after timely treatment, due to histopathological changes such as Leydig cell hypoplasia 4.
- Treatment does not lessen the risk of malignancy, but it does facilitate early detection by enabling physical examination of the testicle 3, 4.
- Parents must be informed about the risk of testicular cancer and the importance of regular self-examination 4.