From the Guidelines
Diagnosis of bilateral undescended testes (cryptorchidism) should primarily involve clinical examination and laparoscopy as the gold standard diagnostic procedure, with karyotyping essential in bilateral cases to rule out disorders of sexual development, as recommended by the American Urological Association guideline 1.
Key Points for Diagnosis
- Initial evaluation includes a thorough physical examination in a warm environment with the patient relaxed, as testes may descend temporarily with cold or anxiety.
- Laparoscopy is considered the gold standard diagnostic procedure, allowing direct visualization of intra-abdominal testes or confirming their absence, and facilitates surgical correction if needed.
- Karyotyping is essential in bilateral cryptorchidism to rule out disorders of sexual development, particularly when gonads are non-palpable.
- Additional imaging such as MRI may be used in select cases, but ultrasound is not recommended prior to referral due to its limitations in identifying intra-abdominal testes 1.
- Hormonal testing including measurement of testosterone, LH, FSH, and AMH levels helps assess testicular function and may guide management.
Importance of Early Diagnosis
Early diagnosis is crucial as treatment before age 1-2 years improves fertility outcomes and reduces malignancy risk. The diagnostic approach should be comprehensive as bilateral undescended testes may indicate underlying endocrine or genetic disorders requiring multidisciplinary management. Providers should counsel boys with a history of cryptorchidism and/or monorchidism and their parents regarding potential long-term risks and provide education on infertility and cancer risk 1.
From the Research
Diagnosis of Bilateral Undescended Testis
To diagnose bilateral undescended testis, several methods can be employed, including:
- Laparoscopy: This is a minimally invasive surgical procedure that allows for the visualization of the internal organs, including the testes 2, 3, 4.
- Karyotyping: This is a genetic test that can help identify any chromosomal abnormalities that may be associated with undescended testes 5.
- Imaging studies: Such as ultrasound, computed tomography, and magnetic resonance imaging (MRI) can be used to localize the undescended testes, although their effectiveness varies 6, 3, 4.
Effectiveness of Laparoscopy
Laparoscopy has been shown to be a highly effective method for diagnosing and treating undescended testes, with a high success rate and low complication rate 2, 3, 4.
- A study published in the Journal of Endourology found that laparoscopy was successful in treating 192 out of 192 palpable undescended testes, with only one procedure being converted to open surgery 2.
- Another study published in the Journal of Pediatric Surgery found that laparoscopy had a sensitivity and specificity of nearly 100% for localizing nonpalpable testes 3.
Limitations of Imaging Studies
Imaging studies, such as ultrasound, have limited effectiveness in localizing undescended testes, especially nonpalpable testes 6, 3, 4.
- A study published in the Journal of Pediatric Surgery found that ultrasound had a sensitivity and specificity of only 45% and 78%, respectively, for localizing nonpalpable testes 3.
- Another study published in the British Journal of Urology found that ultrasonography was able to demonstrate the testes in only two out of 12 cases 4.