Cryptorchism

One or both testes absent from the scrotum at birth

Must be distinguished from retractile testes, which require no treatment

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

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

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

For bilateral undescended testes,

• Boys with early orchiopexy (before age 13 years) appear to have relatively normal fertility

• Boys with delayed orchiopexy may have reduced fertility

For unilateral undescended testis

• About 50% descend spontaneously

• Early orchiopexy does not improve fertility, so it is usually delayed until after puberty

For intra-abdominal testes, orchiectomy after puberty is usually the best option