From the Guidelines
The recommended treatment for undescended testes (cryptorchidism) is orchiopexy, a surgical procedure to move the undescended testis into the scrotum, which should be performed between 6-18 months of age, with many experts now advocating for surgery closer to 6 months to preserve fertility potential and reduce malignancy risk 1.
Key Considerations
- The surgical approach varies based on testicular location: standard inguinal orchiopexy for palpable testes and laparoscopic exploration for non-palpable testes.
- Early treatment is crucial as undescended testes have increased risks of infertility, testicular cancer, torsion, and hernia.
- Regular follow-up after surgery is important to monitor testicular position and development, especially during puberty.
- Patients with a history of cryptorchidism should be educated about testicular self-examination beginning in adolescence due to their increased lifetime risk of testicular cancer.
Rationale
- The American Urological Association (AUA) guidelines recommend orchiopexy as the most successful therapy to relocate the testis into the scrotum, while hormonal therapy is not recommended 1.
- The guidelines also emphasize the importance of referral to a surgical specialist by 6 months of age, as testes that remain undescended by this age are unlikely to descend spontaneously 1.
- Successful scrotal repositioning of the testis may reduce but does not prevent the potential long-term issues of infertility and testis cancer, highlighting the need for appropriate counseling and follow-up 1.
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 between the ages four and nine. The recommended treatment for a patient with undescended testes (cryptorchidism) is human chorionic gonadotropin (HCG), which may induce testicular descent, especially in cases where descent would have occurred at puberty. The therapy is usually started between the ages of four and nine. It is essential to note that the response to HCG is often temporary, and in some cases, orchiopexy may still be needed in the future 2.
From the Research
Treatment Options for Undescended Testes
The recommended treatment for a patient with undescended testes (cryptorchidism) includes:
- Surgical treatment, specifically orchiopexy, which is considered the standard treatment 3, 4
- Hormonal therapy with human chorionic gonadotropin (hCG) may be used in some cases, particularly if the clinician suspects a retractile testis 3, 5
- The use of hCG has shown variable degrees of success, with some studies reporting a low success rate of 7% 6
- The American Academy of Pediatrics recommends that orchiopexy be performed between 6 and 12 months of age to prevent degenerative changes and reduce the risk of complications such as infertility and testicular cancer 7
Factors Affecting Treatment Success
Several factors can affect the success of treatment for undescended testes, including:
- Anatomical abnormalities, such as abnormal attachment of the gubernaculum, short testicular vessels, and closed internal ring 6
- Age of the patient, with younger patients showing a lower response to hCG therapy 5
- Location of the testis, with high scrotal testes showing a higher response to hCG therapy than those in the inguinal canal or superficial pouch 5
Risks and Benefits of Treatment
The treatment of undescended testes carries several risks and benefits, including:
- Increased risk of infertility and testicular cancer if left untreated 3, 7
- Potential adverse effects of hormonal therapy, such as penile growth, painful erection, and behavioral changes 7
- Benefits of early surgical treatment, including reduced risk of complications and improved fertility outcomes 3, 7