What is the recommended treatment for a child diagnosed with cryptorchidism?

Treatment of Cryptorchidism in Children

Surgical orchiopexy is the recommended treatment for cryptorchidism and should be performed between 6 and 12 months of age to optimize fertility potential and reduce the risk of testicular cancer. 1

Diagnosis and Referral Timeline

• Infants with cryptorchidism detected at birth who do not have spontaneous testicular descent by six months (corrected for gestational age) should be referred to an appropriate surgical specialist for timely evaluation 2
• Boys with newly diagnosed (acquired) cryptorchidism after six months should also be promptly referred to a surgical specialist 2
• No imaging studies (including ultrasound) should be performed prior to specialist referral 1

Treatment Algorithm

1. Initial Assessment:

   • Distinguish true cryptorchidism from retractile testes through careful physical examination
   • Retractile testes do not require surgical intervention but should be monitored annually until puberty 1, 3

2. Surgical Management:

   • Orchiopexy is the standard treatment and should be performed between 6-12 months of age 1
   • Surgical approaches include trans-scrotal incision or traditional inguinal incision orchiopexy, both with high success rates (94-98%) 4
   • For non-palpable testes, diagnostic laparoscopy is the standard approach, which can be combined with one or two-stage orchiopexy 5

3. Special Considerations:

   • Phenotypic male newborns with bilateral, nonpalpable testes require immediate specialist consultation to evaluate for possible disorders of sex development 2
   • In boys with bilateral nonpalpable testes without congenital adrenal hyperplasia, measurement of müllerian inhibiting substance/anti-müllerian hormone should be considered 2

Hormonal Treatment

• Hormonal therapy with human chorionic gonadotropin (HCG) is not recommended as primary treatment for cryptorchidism due to low success rates 1, 6
• HCG may be used in selected cases to help predict whether orchiopexy will be needed, but the response is usually temporary 7
• Caution: HCG can induce precocious puberty in pediatric patients treated for cryptorchidism; therapy should be discontinued if signs of precocious puberty occur 7

Follow-Up and Long-Term Management

• Lifelong surveillance is necessary for patients with a history of cryptorchidism due to the persistent risk of testicular cancer 1, 3
• Annual clinical examination until puberty is recommended 1, 3
• Patient education regarding self-examination techniques for early detection of testicular cancer is essential 1, 3

Clinical Pearls and Pitfalls

• Early intervention is critical: Delaying orchiopexy beyond 12 months of age can lead to progressive germ cell loss and impaired fertility potential 1, 6
• Avoid unnecessary imaging: Physical examination by an experienced clinician is the most reliable diagnostic method 1
• Beware of misdiagnosis: A newborn with male phallus and bilateral nonpalpable gonads could potentially be a genetic female (46 XX) with congenital adrenal hyperplasia 2
• Monitor retractile testes: These require annual follow-up until puberty as they may ascend and become truly undescended 3