Undescended Testicle

Aka: Undescended Testicle, Undescended Testes, Undescended Testis, Cryptorchidism

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II. Definition

  1. Cryptorchidism: "Hidden Testicle"

III. Epidemiology: Incidence

  1. Preterm Newborn: 30% Incidence
  2. Term Newborn: 2.7 to 5.9% Incidence
  3. Age 6 months: 0.8% persistent Undescended Testicle
  4. Bilateral Undescended Testes in 10-20% of cases

IV. Differential Diagnosis: Bilateral Undescended Testicle

  1. Congenital Adrenal Hyperplasia (female Virilization)

V. Diagnostics: Bilateral Crytorchidism

  1. Pelvic Ultrasound
  2. Karyotype

VI. Labs: Bilateral Crytorchidism

  1. Serum Testosterone
  2. Luteinizing Hormone (LH)
  3. Follicle Stimulating Hormone (FSH)
  4. Thyroid Stimulating Hormone
  5. 17-Hydroxyprogesterone
  6. Mullerian-Inhibiting Substance
  7. Serum Cortisol
  8. Thyroid Stimulating Hormone

VII. Management

  1. Initial Referral Indications
    1. Bilateral Undescended Testes
    2. Associated genitourinary abnormalities
  2. Unilateral retracted Testicle
    1. Testicle may be brought down into Scrotum
    2. Parents pull Testis into Scrotum per diaper change
    3. Follow-up examinations in the clinic
  3. Unilateral palpable ectopic or Undescended Testicle
    1. Observe for descent
    2. Surgical correction at 6 month to 1 year
  4. Unilateral nonpalpable Testicle (15% of cases)
    1. Laparoscopy at 6 months to 1 year for evaluation
    2. Testicle found on laparoscopy in 50% of cases
    3. Orchiopexy brings Testis into Scrotum (98% efficacy)

VIII. Complications: Untreated

  1. Testicular Cancer (Seminoma) at age 15 to 45 years
    1. Unilateral Undescended Testicle risk: 1 in 80
    2. Bilateral Undescended Testicle risk: 1 in 50
  2. Infertility
  3. Indirect Inguinal Hernia (often present)
  4. Testicular Torsion (of cryptorchid Testicle)

IX. Prognosis: Fertility

  1. Repaired unilateral Cryptorchidism: 50-65% fertile
  2. Repaired bilateral Cryptorchidism: 85% fertile

X. References

  1. Behrman (2000) Nelson Pediatrics, Saunders, p. 1650-1
  2. Docimo (2000) Am Fam Physician 62(9):2037-48 [PubMed]
  3. Fuloria (2002) Am Fam Physician 65(2):265-70 [PubMed]

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