Treatment Options for Undescended Testis (Cryptorchidism)
Orchiopexy (surgical repositioning of the testis) is the standard treatment for undescended testis, while hormonal therapy is not recommended as primary treatment for cryptorchidism. 1
Evaluation and Timing of Treatment
- Infants with cryptorchidism detected at birth who do not have spontaneous testicular descent by 6 months (corrected for gestational age) should be referred to an appropriate surgical specialist 2
- Boys with newly diagnosed cryptorchidism after 6 months of age should also be promptly referred to a surgical specialist 2
- Imaging studies (ultrasound or other modalities) are not recommended prior to referral as they rarely assist in decision making 2
- For phenotypic male newborns with bilateral nonpalpable testes, immediate specialist consultation is required to evaluate for possible disorders of sex development 2
Surgical Treatment Options
1. Orchiopexy (Standard Treatment)
- Success rates: >95% for inguinal testes and >85-90% for abdominal testes 3
- Timing: Surgery within the first year of life is safe and recommended to prevent ongoing testicular degenerative changes 3
- Approaches based on testicular position:
a) Scrotal Approach
- Appropriate for "low" palpable testes that can be manipulated to the scrotum 4
- Advantages: shorter operative time (25 min vs 40 min for inguinal approach), cosmetically appealing single incision, possibly less pain 5, 4
- Success rate of 98% with minimal complications 4
b) Inguinal Approach
- Traditional approach for "high" palpable testes that cannot be manipulated to the scrotum 4
- May have higher rates of testicular atrophy and hypotrophy compared to scrotal approach (when comparing different types of undescended testes) 4
c) Laparoscopic Approach
- Primarily used for non-palpable testes 1
- Can also be used for high palpable testes with good short-term results and minimal morbidity 6
- Allows visualization of intra-abdominal testes and testicular vessels
2. Scrotal Fixation
- Alternative surgical technique for testes located near the pubic tubercle 7
- Involves scrotal incision extending to tunica vaginalis, mobilizing the cord from below, and placing the testis in an extra-dartos pouch 7
Rationale for Treatment
- Early surgical intervention reduces the risk of impaired fertility potential 2
- Testes that remain undescended by 6 months are unlikely to descend spontaneously 2
- Continued damage may occur to testes that remain in a non-scrotal location 2
- Treatment addresses increased risks of:
- Impaired fertility potential
- Testicular malignancy
- Testicular torsion
- Associated inguinal hernia 1
Important Considerations
- Successful scrotal repositioning of the testis may reduce but does not completely prevent the potential long-term risks of infertility and testicular cancer 1
- Hormonal therapy (hCG) alone is not recommended as primary treatment for cryptorchidism 2
- For bilateral nonpalpable testes in a phenotypic male newborn, immediate specialist consultation is required to rule out disorders of sex development 2
- A newborn with bilateral nonpalpable gonads should not be circumcised until after workup is complete 2
- When cryptorchidism is present with phallic anomalies (hypospadias or micropenis), evaluation for disorders of sex development should be considered 2