Timing of Orchiopexy for Non-Palpable Undescended Testis
Orchiopexy should be performed between 6-18 months of age, with surgery ideally completed by 18 months to preserve fertility potential and reduce testicular cancer risk. 1
Immediate Action Required
- Refer to a pediatric urologist or surgical specialist now (by 6 months of corrected age at the latest), as spontaneous descent after 6 months is highly unlikely and continued delay causes progressive testicular damage 2, 3
- Do not wait for spontaneous descent beyond 6 months—the probability is negligible after this age 2, 3
- Do not order additional imaging studies (ultrasound has already confirmed the diagnosis); imaging should not delay surgical referral 2, 3
Rationale for Early Surgery (Before 18 Months)
Fertility Preservation
- The majority of cryptorchid boys have normal germ cell counts during the first 6 months of life 1
- After 15-18 months of age, cryptorchid boys begin losing germ cells in the testes 1
- By 8-11 years of age, approximately 40% of bilateral cryptorchid boys have no germ cells remaining in testicular biopsies 1
- Recent evidence shows that orchiopexy performed before 1 year of age results in significantly better testicular growth (growth percentage ratio of 2.02) compared to surgery performed between 1-2 years (1.25) or after 2 years (1.24) 4
Cancer Risk Reduction
- Cryptorchidism increases testicular cancer risk by 2.75-8 fold 1
- Prepubertal orchiopexy reduces this relative risk by 2-6 fold compared to postpubertal surgery 1
- Earlier intervention provides better cancer risk reduction 5
Surgical Approach for Non-Palpable Testis
- The surgical specialist will perform exploration to identify the testicular vessels and determine the next course of action 1
- Laparoscopic orchiopexy is often indicated for non-palpable testes, allowing both diagnosis and treatment in the same procedure 5
- Overall success rates exceed 96%, with testicular atrophy occurring in less than 2% of cases 1
Common Pitfalls to Avoid
- Delaying referral beyond 6 months—this is the most critical error, as real-world data shows that 67-70% of orchiopexies in the United States are performed after the recommended age, often at 4-5 years 6, 7
- Ordering unnecessary imaging before referral 2, 3
- Attempting hormonal therapy—this has low response rates (6-38% in controlled studies) and lacks long-term efficacy 1
- Waiting for "spontaneous descent" after 6 months of age 2, 3
Special Consideration: Bilateral Non-Palpable Testes
- If both testes were non-palpable (not applicable in this case), this would constitute a medical emergency requiring immediate specialist consultation to rule out disorders of sex development or congenital adrenal hyperplasia 2, 3
Long-Term Counseling
- Parents should be counseled about the increased risks of infertility and testicular cancer associated with cryptorchidism, even after successful surgery 2, 5
- Regular monitoring of testicular position and development is necessary throughout childhood, as acquired cryptorchidism can occur later (peak around 8 years of age) 3