Table of contents
Cryptorchidism
Background
Overview
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.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of cryptorchidism are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2024), the American Academy of Family Physicians (AAFP 2023), the European Association of Urology (EAU/ESPU 2023), the European Thyroid Association (ETA 2018), the Canadian Urological Association (CUA 2017), and the American Urological Association ...
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Screening and diagnosis
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
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Evaluation for disorders of sex development
Hormone testing
Diagnostic imaging
Evaluation for central hypothyroidism
Medical management
Hormonal therapy
As per EAU/ESPU 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
Surgical interventions
Orchidopexy, pre-pubertal: as per EAU/ESPU 2023 guidelines, perform surgical orchidolysis and orchidopexy before the age of 12 months and by 18 months at the latest.
B
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Orchidopexy (post-pubertal)
Surgical or laparoscopic exploration
Orchiectomy