Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Cryptorchidism

Definition
Cryptorchidism, also known as undescended testis, is a common congenital abnormality among males that is characterized by the failure of one or both testes to permanently descend.
1
Pathophysiology
Cryptorchidism is caused due to a disruption in any phase of testicular descent triggered by hereditary, hormonal, anatomical, environmental, or social factors.
1
Disease course
The disruption in any phase of testicular descent results in cryptorchidism, which causes an increased chance of inguinal hernia, torsion, and trauma that leads to psychological distress in parents. It may also lead to reduced fertility and testicular cancer in adult males.
1
Prognosis and risk of recurrence
Orchiectomy for ASA 3 and ASA 4 is associated with 0.49% and 3.31% of mortality risk.
2
Key sources
The following summarized guidelines for the evaluation and management of cryptorchidism are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2023), the European Association of Urology (EAU/ESPU 2023), the European Association of Urology (EAU 2023), the European Thyroid Association (ETA 2018), the Canadian Urological Association (CUA 2017), and the American Urological Association (AUA 2014).
1
2
3
4
5
6
7
8

Guidelines

1.Screening and diagnosis

Indications for screening: palpate testes for quality and position at each recommended well-child visit.
B
Create free account

2.Diagnostic investigations

History and physical examination: as per AAFP 2023 guidelines, obtain serial examinations for the diagnosis of cryptorchidism because the testicle usually descends to the correct location by 6 months of age.
B

More topics in this section

  • Evaluation for disorders of sex development

  • Hormone testing

  • Diagnostic imaging

  • Evaluation for central hypothyroidism

3.Medical management

Hormonal therapy
As per EAU 2023 guidelines:
Do not offer hormonal therapy in patients with unilateral cryptorchidism, as it is of no benefit for future paternity.
D
Offer GnRH analogs at a typical dose of 1.2 mg/day in 3 divided doses for 4 weeks to preserve the fertility potential in patients with bilateral cryptorchidism.
B

4.Surgical interventions

Orchidopexy, pre-pubertal, ESPU/EAU: perform surgical orchidolysis and orchidopexy before the age of 12 months and by 18 months at the latest.
B
Show 2 more

More topics in this section

  • Orchidopexy (post-pubertal)

  • Surgical or laparoscopic exploration

  • Orchiectomy

5.Patient education

General counseling: as per AAFP 2023 guidelines, consider educating patients with a history of cryptorchidism on how to perform monthly self-examinations for early detection of testicular cancer.
C

6.Preventative measures

Prophylactic contralateral orchidopexy: decide on performing prophylactic orchidopexy based on informed discussion of options with the patient parents or legal guardian.
B

7.Follow-up and surveillance

Indications for specialist referral: as per AAFP 2023 guidelines, refer patients for surgical consultation by 6 months of age or at the time of diagnosis in older patients.
B

More topics in this section

  • Follow-up