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

• 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