When is treatment of cryptorchidism indicated?

Updated: Dec 17, 2020
  • Author: Joel M Sumfest, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Indications for hormonal or surgical correction of cryptorchidism include the following:

To increase the likelihood of fertility

  • Impairment of germ cell maturation is a well-recognized consequence of cryptorchidism.

  • Early reposition of the testis into the scrotum has been a mainstay of treatment to reduce the risk of infertility; however, recent studies have cast some doubt on this. [28, 29, 28]

  • Abnormal germ cell maturation correlates with abnormal spermiogram findings in adulthood.

  • Biopsy findings in children with unilateral undescended testis demonstrated reduced total germ cell counts due to failure of the two critical prepubertal steps involved in maturation and proliferation of germ cells: (1) transformation of the fetal stem cell pool (gonocytes) into adult stem cell pool (type Ad spermatogonia) at age 2-3 months and (2) transformation of type Ad spermatogonia into primary spermatocytes at age 4-5 years. [30]

  • Hadziselimovic and Herzog (2001) found a negative association between age and germ cell count by age 6 months in children undergoing orchiopexy. [31]

  • Lee (1995) postulated that paternity itself is a better index than sperm count. Compared with controls, paternity was significantly compromised in men with bilateral, but not unilateral, undescended testes. [32] This finding was supported by two subsequent studies in which up to 90% men with unilateral undescended testis had fathered children, as opposed to only 33-65% with bilateral undescended testes. [33, 34]

Facilitation of testicular self-examination for testicular cancer

  • Males with undescended testis are 40 times as likely to develop testicular cancer as males without undescended testis. [35] Ten percent of testicular cancer cases involve patients with undescended testis. [36, 37]

  • Prepubertal orchiopexy reduces this risk. [38, 39]

  • The ability for patients to perform testicular self-examination with the testes in the scrotum is a clear benefit of surgery.

  • The location of the undescended testis affects the relative risk of testicular cancer. Up to 50% of malignant testicular tumors associated with cryptorchidism involve intra-abdominal testes. [40, 41]

  • Seminoma is the most common malignant tumor type associated with cryptorchidism. [42]

  • Correction of associated hernia: A patent processus vaginalis is found in more than 90% of patients with undescended testis. [26, 22]

Additional indications

  • Prevention of testicular torsion

  • Prevention of injury against pubic bone

  • Psychological effects of an empty scrotum


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