From the Guidelines
Adult cryptorchidism requires prompt urological referral for surgical management, with orchiectomy being the preferred treatment due to the increased risk of testicular cancer. The undescended testicle should be removed rather than repositioned in adults, as the malignancy risk is significantly higher in cryptorchid testes compared to normally descended ones 1. This approach prioritizes reducing the risk of testicular cancer, which is a major concern in adults with cryptorchidism.
Prior to surgery, the patient should undergo testicular ultrasound to evaluate both testes and hormonal assessment, including testosterone, LH, and FSH, to evaluate fertility potential 1. Patients should also be counseled about potential fertility issues, as cryptorchidism is associated with reduced sperm production even in the normally positioned testicle. Key points to consider in the management of adult cryptorchidism include:
- The increased risk of testicular cancer, which necessitates prompt surgical intervention
- The potential impact on fertility, with bilaterally cryptorchid men having greatly reduced fertility compared to unilaterally cryptorchid men or the general male population 1
- The importance of counseling patients about potential long-term risks, including infertility and cancer risk 1
After orchiectomy, patients should be taught testicular self-examination for the remaining testicle and may require long-term follow-up to monitor for malignancy development. If the patient desires fertility, sperm banking before surgery should be discussed, and some may benefit from testosterone replacement therapy if the removed testicle was still producing hormones. The goal of management is to minimize the risk of testicular cancer while also addressing potential fertility concerns and optimizing quality of life.
From the Research
Clinical Characteristics of Adult Cryptorchidism
- Adult cryptorchidism is a rare presentation, often found incidentally, with a higher risk of infertility and malignancy 2, 3
- The location of the undescended testis can vary, with some cases being palpable in the inguinal area, while others may be located in the abdominal cavity 3, 4
- Patients with adult cryptorchidism may present with nonspecific symptoms, such as abdominal or suprapubic pain 2
Treatment Options for Adult Cryptorchidism
- Orchiopexy and orchiectomy are two possible treatment options for adult cryptorchidism, with the choice of treatment depending on the individual patient's circumstances 2, 3
- Orchiectomy may be considered in patients with a high risk of malignancy or in those who are not interested in preserving fertility 4, 5
- Orchiopexy with regular scrotal examination may be a suitable treatment option for patients who wish to preserve fertility, despite the potential for abnormal histology and semen analysis 3
Risk of Testicular Cancer in Adult Cryptorchidism
- The risk of testicular cancer is increased in patients with cryptorchidism, with a relative risk of 2.75 to 8 5
- Prepubertal orchiopexy may decrease the risk of testicular cancer, with a nearly 6 times lower risk compared to delayed or no orchiopexy 6
- The type of testicular cancer that develops may depend on the location of the undescended testis, with persistently cryptorchid testes being at higher risk for seminoma 5