Johns Hopkins Division of Infectious Diseases
M E N S  H E A L T H  G U I D E
search:



Men's Health Sponsors About this site Site Map
Expert Questions & AnswersFeature Articles
HOME DISEASES
  Cryptorchidism
 
Author: Jonathan Jarow Last modified: March 19, 2002
DIAGNOSTIC CRITERIA

  EPIDEMIOLOGY

  • One of the most common congenital anomalies in man.
  • Incidence at birth is 3.4%.
  • Many of these testes will descend within the first year of life.
  • Incidence at 1 year of life is approximately 1%.

  RISK FACTORS

  • Kallmann syndrome.
  • Anencephaly or pituitary aplasia.
  • Steroidogenic enzyme deficiency.
  • 5-alpha reductase deficiency.
  • Androgen resistance.
  • Prune belly syndrome.

  SIGNS AND SYMPTOMS

  • Non-palpable testis.
  • Testis palpable in inguinal canal that cannot be brought down into the scrotum.
  • Testis palpable at an ectopic position; superficial inguinal pouch, suprapubic, contralateral scrotum, femoral or perineal.

  DIFFERENTIAL DIAGNOSIS

  • True undescended testis.
  • Retractile testis.
  • Testicular agenesis.
  • Neonatal testicular torsion.

  LABORATORY FINDINGS

  • Endocrine studies, basal FSH, may be performed to differentiate anorchia from bilateral cryptorchidism.
  • Radiologic imaging, ultrasonography, CT and angiography, are only 44% accurate in determing the presence and location of non-palpable testes.
  • Ultrasonography may be utilized to monitor undescended testes for testicular cancer.
  • Laparoscopy may be used to determine the presence and location of non-palpable testes (ie. blind ending vessels infer that the testis is absent).
 
TREATMENT
HORMONAL THERAPY
  • GnRH (1.2 mcg/day intranasal times 4 weeks) is utilized in cryptorchid children with low LH levels to reverse a pituitary defect such as Kallmann syndrome.
  • Hormonal therapy is only effective at inducing complete testicular descent is certain cryptorchid patients with endocrine abnormalities and patients with retractile testes.
  • hCG (100 IU/kg IM 3X weekly for 3 weeks)should be given to those patients with palpable undescended testes to differentiate between true cryptorchidism and retractile testes.
  • hCG (100 IU/kg IM 3X weekly for 3 weeks) may given prior to surgery to beef up the testicular vasculature.
SURGERY
  • Standard inguinal orchidopexy is performed for the vast majority of true undescended testes and ectopic testes.
  • Fowler-Stephens orchidopexy is utilized for high intra-abdominal testes and is based upon dividng the gonadal vessels and sparing the deferential vessels.
  • Microvascular autotransplantation is an option for the high intra-abdominal undescended testis.
  • Laparoscopic orchidopexy has been utilized as either a two stage approach whereby the gonadal vessels are ligated and an open Fowler-Stephens is subsequently performed or as a single stage procedure.
  • Orchiectomy is recommended for adults with untreated unilateral cryptorchidism because of the risk of neoplasia. However, the risks of surgery exceed the risk of neoplasia after age 32 years.
 
IMPORTANT POINTS/RECOMMENDATIONS
  • Retractile testes descend normally during puberty and have normal fertility potential.
  • There is a significant increased risk of testicular neoplasia of undescended testes regardless of treatment that requires lifetime monitoring.
  • There appears to be a deleterious effect of cryptorchidism, even unilateral, upon fertility regardless of age of treatment. However, follow up data on boys treated at approximately age 1 year has not
  • Syndromes associated with cryptorchidism include Klinefelter, Noonan, Prader-Willi and cystic fibrosis.
 
REFERENCES
  1. Jordan GH ;  Laparoscopic management of the undescended testicle ;  Urol Clin North Am 2001 Feb;28(1):23-9, vii-viii

  2. Wolf CK, Maizels M, Furness PD 3rd. ;  The undescended testicle. ;  Compr Ther 2001 Spring;27(1):11-7

  3. Callaghan P. ;  Undescended testis. ;  Pediatr Rev 2000 Nov;21(11):395

  4. Jennings RW. ;  Prune belly syndrome. ;  Semin Pediatr Surg 2000 Aug;9(3):115-20

  5. Dieckmann KP, Skakkebaek NE. ;  Carcinoma in situ of the testis: review of biological and clinical features ;  Int J Cancer 1999 Dec 10;83(6):815-22

  6. Nguyen HT, Coakley F, Hricak H ;  Cryptorchidism: strategies in detection ;  Eur Radiol 1999;9(2):336-43

  7. Toppari J, Skakkebaek NE ;  Sexual differentiation and environmental endocrine disrupters ;  Baillieres Clin Endocrinol Metab 1998 Apr;12(1):143-56

  8. Gill B, Kogan S ;  Cryptorchidism. Current concepts ;  Pediatr Clin North Am 1997 Oct;44(5):1211-27

  9. Jarow JP, Berkovitz GD, Migeon CJ, Gearhart JP, Walsh PC ;  Elevation of serum gonadotropins establishes the diagnosis of anorchism in prepubertal boys with bilateral cryptorchidism ;  J Urol 1986 Jul;136(1 Pt 2):277-9

Copyright © 2002 The Johns Hopkins University School of Medicine. All rights reserved.