What is the management for an 8-year-old male with one undescended testicle (cryptorchidism)?

From the Guidelines

For an 8-year-old boy with an undescended testicle, you should consult a pediatric urologist promptly to discuss surgical correction (orchiopexy) as the primary treatment option. This condition, called cryptorchidism, typically requires surgical correction when it persists beyond infancy. The procedure is usually performed as outpatient surgery and involves bringing the testicle down into the scrotum and securing it there.

Key Considerations

• Surgery is recommended between ages 6-18 months, so at age 8, treatment should not be delayed further 1.
• Untreated undescended testicles have increased risks of fertility problems, testicular cancer, and testicular torsion.
• The surgery helps reduce these risks, though it cannot eliminate them completely.
• After surgery, follow-up appointments will be necessary to ensure proper healing and to monitor the testicle's position.
• While waiting for the specialist appointment, no special care is needed beyond normal hygiene, but avoid putting pressure on the groin area during physical activities.

Treatment Options

• Hormonal therapy is not recommended due to low response rates and lack of evidence for long-term efficacy 1.
• Orchidopexy in the first 18 months of life is recommended to preserve available fertility potential, but it is still beneficial to perform the surgery in prepubertal boys at the time of diagnosis 1.
• Prepubertal orchidopexy results in a two- to six-fold reduction in the relative risk of testicular cancer compared with postpubertal orchidopexy 1.

From the FDA Drug Label

Prepubertal cryptorchidism not due to anatomic obstruction. In general, HCG is thought to induce testicular descent in situations when descent would have occurred at puberty. HCG thus may help to 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 of 4 and 9.

The management for an 8-year-old male with one undescended testicle (cryptorchidism) may include human chorionic gonadotropin (HCG) therapy to induce testicular descent, as it is thought to be effective in situations where descent would have occurred at puberty 2.

• Therapy age: HCG therapy is usually instituted between the ages of 4 and 9.
• Predicting orchiopexy need: HCG may help predict whether orchiopexy will be needed in the future.
• Temporary response: In most cases, the response to HCG administration is temporary, although in some cases, descent may be permanent.

From the Research

Management of Undescended Testicle

The management of an 8-year-old male with one undescended testicle (cryptorchidism) involves surgical intervention.

• The mainstay of therapy for undescended testes is operative treatment, which should be performed within the first years of life to avoid ongoing testicular degenerative changes 3.
• For an 8-year-old, the treatment is likely to involve orchiopexy, a surgical procedure to move the undescended testicle into the scrotum, with a success rate of >95% for inguinal testes and >85-90% for abdominal testes 3.
• Hormonal therapy with hCG is effective in causing descent in only a small percent of children with cryptorchidism, and its use is generally not recommended for nonpalpable cryptorchid testes 4.
• The risk of testicular cancer is increased in men with a history of cryptorchidism, and early orchiopexy may reduce this risk 4, 5.
• Fertility is also impaired in men with cryptorchidism, and early treatment may improve fertility rates 4, 5.

Timing of Intervention

• The American Academy of Pediatrics recommends that all children with cryptorchid testes undergo treatment by the age of 1 or 2 years 4.
• However, in this case, the child is 8 years old, and the treatment should be performed as soon as possible to reduce the risk of testicular cancer and preserve fertility 5, 6, 7.
• After surgery, the patient will require lifelong surveillance and counseling regarding fertility implications and increased risk of testicular conditions 7.

Key Considerations

• The parents of children with a nonpalpable testis should be informed of the high rate of testicular absence 4.
• Patients with undescended testis have a threefold increased risk of testicular cancer later in life compared to the general population, and self-examination after puberty is recommended to facilitate early cancer detection 5.
• Annual clinical examination and self-examination techniques for early detection of testicular cancer should be taught to patients with a history of cryptorchidism 7.