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For further information, see CMDT Part 26-28: Cryptorchism

Key Features

  • One or both testes absent from the scrotum at birth

  • Must be distinguished from retractile testes, which require no treatment

Clinical Findings

  • Found in 1–2% of males after 1 year of age

  • Underlying hypogonadism, including hypogonadotropic hypogonadism, may be present

  • Infertility or subfertility occurs in up to 75% of men with bilateral cryptorchism and in 50% of men with unilateral cryptorchism

Diagnosis

  • For a testis that is not palpable, it is important to locate the testis and bring it into the scrotum or prove its absence

  • About one-third on nonpalpable testes are located within the inguinal canal, one-third are intra-abdominal, and one-third absent

  • Ultrasound can detect an inguinal testis

  • If ultrasound is negative, MRI is performed to locate the testis

  • MRI is more reliable than ultrasound for locating cryptorchid testes

Treatment

  • Human chorionic gonadotropin (hCG)

    • 1500 units intramuscularly daily for 3 days, causes a significant rise in testosterone if the testes are present

    • Results in a testicular descent rate of about 25%

  • Surgical correction (orchiopexy)

    • Should be performed by age 12–24 months and is generally successful

    • Decreases the risk of neoplasia when performed before 10 years of age

  • Orchiectomy after puberty is an option for intra-abdominal testes

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