Updated: 12/25/2021

Cryptorchidism

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  • Snapshot
    • A one-year old child is brought to the pediatrician for his 12-month visit. The physician notes that the boy's testicles are inappreciable on exam. The medical record reports that the child's testicles had been examined at two previous visits. The mother is confused and asks if her son will need surgery.
  • Introduction
    • Undescended testicle(s)
    • Most testicles descend by the age of 9 months
    • Once a testicle is found in the scrotum, it is considered "descended" even if on later inspection it is inappreciable
    • Not to be confused with "retractile testicles" that are pulled upward by muscle contraction
  • Epidemiology
    • Most common disorder of sexual differentiation in boys
      • incidence of 3-4% in full term infants
      • more common in preterm infants
      • bilateral in 10% of cases
  • ETIOLOGY
    • Associated with infertility and testicular cancer in adulthood
  • Presentation
    • Symptoms
      • asymptomatic
    • Physical exam
      • no testicle(s) are appreciable in the scrotum
      • the testicle(s) may or may not be found in the abdominal wall above the scrotum
  • Evaluation
    • Diagnosis is based primarily on physical exam
    • Ultrasound
      • may be helpful in identifying undescended testicles in abdominal space
  • Differential
    • Absent testicle(s)
  • Treatment
    • Medical management
      • observation alone
        • indicated until 4 to 6 months at the latest
      • Beta-HCG / testosterone injections
        • indicated after 1yr of age to assist in testicular descension
        • not always successful
    • Surgical intervention
      • orchiopexy
        • indicated in cases where testicle(s) are not descended by 6 months
        • current recommendation is to correct as soon as possible after 4 months of age
        • early removal may prevent infertility and cancer
      • orchiectomy
        • indicated in cases when testicle is found in the abdominal space later in life
  • Complications
    • Decreased fertility and in some cases infertility
    • Malignancy
      • 4 to 10-fold increased risk of developing cancer in both testicles, if even one is undescended
      • peak age of malignancy is 15-45 years
      • seminoma is most common malignancy
      • orchiopexy does not decrease risk of cancer
        • improves prognosis by earlier detection
    • Torsion
    • Hernias
  • Prognosis
    • Very good to excellent in most cases
    • Most descend spontaneously by 1 year of age

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