Materiały źródłowe

• #1 The Undescended Testicle: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/1101/p2037.html/1000

  A more recent article on cryptorchidism (undescended testicle) is available. […] Early diagnosis and management of the undescended testicle are needed to preserve fertility and improve early detection of testicular malignancy. […] By six months of age, patients with undescended testicles should be evaluated by a pediatric urologist or other qualified subspecialist who can assist with diagnosis and treatment. […] The rationale for treatment of the undescended testicle is the prevention of potential sequelae. […] Recognition of the condition, identification of associated syndromes, proper diagnostic evaluation and timely referral for urologic surgical therapy are important steps in preventing adverse consequences. […] Cryptorchidism, or undescended testicle, is usually diagnosed during the newborn examination.

• #2

  https://step1.medbullets.com/evidence/11087186

  Early diagnosis and management of the undescended testicle are needed to preserve fertility and improve early detection of testicular malignancy. […] Physical examination of the testicle can be difficult; consultation should be considered if a normal testis cannot be definitely identified. […] Observation is not recommended beyond one year of age because it delays treatment, lowers the rate of surgical success and probably impairs spermatogenesis. […] By six months of age, patients with undescended testicles should be evaluated by a pediatric urologist or other qualified subspecialist who can assist with diagnosis and treatment. […] Therapy for an undescended testicle should begin between six months and two years of age and may consist of hormone or surgical treatment. […] The success of either form of treatment depends on the position of the testicle at diagnosis.

• #2

  https://www.nhs.uk/conditions/undescended-testicles/

  Undescended testicles can usually be diagnosed after a physical examination. […] This will determine whether the testicles can be felt near the scrotum (palpable) or if they can’t be felt at all (impalpable). […] No further scans or tests are needed to locate the testicles if they can be felt by the doctor. […] If they can’t be felt, part of the initial surgical treatment may involve keyhole surgery (a diagnostic laparoscopy) to see if the testicles are inside the abdomen.

• #3 Undescended testicle – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/undescended-testicle/symptoms-causes/syc-20351995

  Not seeing or feeling a testicle in the scrotum is the main symptom of an undescended testicle. […] An undescended testicle often is found during an exam done shortly after birth. If your baby has an undescended testicle, ask how often exams will need to be done. If the testicle hasn’t moved into the scrotum by 3 to 4 months of age, the condition likely won’t correct itself. […] Treating an undescended testicle when your child is still a baby might lower the risk of health problems later in life. […] The exact cause of an undescended testicle isn’t known. […] The testicles need to be slightly cooler than regular body temperature to develop and work well. […] Men who’ve had an undescended testicle have a higher risk of testicular cancer. […] Surgery to correct an undescended testicle might lower the risk of testicular cancer. […] Fertility problems make it harder to get a partner pregnant. They’re more likely to happen in men who’ve had an undescended testicle.

• #4 Cryptorchidism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/741

  Cryptorchidism diagnosis is made on physical exam when one or both testes are not present within the dependent portion of the scrotal sac. […] Approximately 70% of cryptorchid testes are palpable within the upper portion of the scrotum or inguinal canal, whereas the other 30% are not palpable, suggesting either an intra-abdominal location, testicular nubbin, or anorchia. […] Referral to a specialist should be made by 6 months corrected gestational age and surgical correction should be performed within the next year. Testes that remain undescended by 6 months are unlikely to descend spontaneously. […] Patients with bilateral cryptorchidism should be referred immediately for an evaluation with karyotype and biochemical workup for a difference of sex development (DSD). […] Key diagnostic factors include malpositioned or absent testis, palpable cryptorchid testis, and nonpalpable testis.

• #5 Cryptorchidism: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/438378-overview

  In cryptorchidism, the most useful determination is whether the testes are palpable upon physical examination. […] Approximately 80% of undescended testes are palpable and 20% are nonpalpable. […] Indications for hormonal or surgical correction of cryptorchidism are described below. […] Early reposition of the testis into the scrotum has been a mainstay of treatment to reduce the risk of infertility; however, even with successful orchiopexy at age 6-12 months, 20-25% of boys with nonsyndromic cryptorchidism have compromised fertility potential. […] Males with undescended testis are 40 times as likely to develop testicular cancer as males without undescended testis. […] Prepubertal orchiopexy reduces this risk. […] 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.

• #6 The Undescended Testicle: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/1101/p2037.html/1000

  Differentiation of a retractile testis from a true undescended testis is sometimes difficult; consultation with a urologist may be valuable. […] If a testis cannot be palpated in the inguinal canal or the scrotum, or in ectopic sites such as the femoral region or perineum, evaluation for a nonpalpable testis must be initiated. […] A phenotypically male newborn with bilateral nonpalpable testicles should be considered to be a genetic female with congenital adrenal hyperplasia until proved otherwise. […] Treatment for cryptorchidism can be hormonal, surgical or a combination of the two. […] The inguinal orchiopexy is a well-established operation for the palpable undescended testicle. […] Surgery for the nonpalpable testicle is diagnostic and potentially therapeutic.

• #7 Undescended Testicle: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/parenting/baby/what-is-an-undescended-testicle

  In most cases, your doctor finds the problem as part of a regular check-up soon after birth. […] If your doctor thinks theres a problem, they may try to rule out other causes, such as: […] Your doctor can check for this as part of a physical exam. […] Your doctor will see if they can gently move the testicle into the scrotum with their hand. If they can do that, then its a retractile testicle.

• #8 Evaluation and Treatment of Cryptorchidism (2018) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline

  Providers should obtain gestational history at initial evaluation of boys with suspected cryptorchidism. (Standard; Evidence Strength: Grade B) […] Primary care providers should palpate testes for quality and position at each recommended well-child visit. (Standard; Evidence Strength: Grade B) […] Providers should refer infants with a history of cryptorchidism (detected at birth) who do not have spontaneous testicular descent by six months (corrected for gestational age) to an appropriate surgical specialist for timely evaluation. (Standard; Evidence Strength: Grade B) […] Providers should not perform ultrasound (US) or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral as these studies rarely assist in decision making. (Standard; Evidence Strength: Grade B)

• #9 Diagnostic Imaging in Cryptorchidism: Utility, Indications, and Effectiveness

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3712862/

  Cryptorchidism (undescended testis) is the most common genitourinary anomaly in male infants. […] We reviewed the available literature on the diagnostic performance of ultrasound, CT, and MRI in localizing undescended testes. […] Ultrasound is the most heavily utilized imaging modality to evaluate undescended testes. […] Given the poor ability to localize non-palpable testes, ultrasound has no role in the routine evaluation of boys with cryptorchidism. […] Diagnostic imaging has been utilized to determine the anatomic location of non-palpable testes. […] Current US Department of Health and Human Services guidelines state that ultrasound, CT, or MRI do not provide additional information to the physical examination. […] We review the utility of ultrasound, CT, and MRI in the evaluation of boys with undescended testes and also address clinical scenarios in which the presence of associated abnormalities merits the use of diagnostic imaging.

• #10 Cryptorchidism | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cryptorchidism?lang=us

  Cryptorchidism refers to an absence of a testis (or testes) in the scrotal sac. It may refer to an undescended testis, ectopic testis, or an atrophic or absent testis. Correct localization of the testes is essential because surgical management varies on location. […] Ultrasound has 45% sensitivity, 78% specificity, and 88% accuracy for localization of undescended testis and is more accurate than clinical examination. […] MRI is the best cross-sectional modality to assess crypto-orchidism (replacing CT). It has a higher sensitivity than ultrasound (~90%) and a higher specificity (100%). […] Orchiopexy is the preferred mode of management in case of viable testes high-up in the scrotum or within inguinal canal/abdomen. It is performed after 1 year of age since the testes may descend without intervention.

• #11 Diagnostic Imaging in Cryptorchidism: Utility, Indications, and Effectiveness

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3712862/

  Diagnostic imaging has no role in the routine evaluation of boys with undescended testes. […] We recommend against routinely using ultrasound to evaluate children with cryptorchidism and propose that the diagnostic algorithm for the evaluation of a boy with cryptorchidism consist of physical exam and surgical evaluation. […] Ultrasound is an appropriate screening evaluation for children with ambiguous genitalia or hypospadias and cryptorchidism. […] Future studies should examine whether pre-operative MRI has utility in re-operative orchiopexy.

• #12 Cryptorchidism | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cryptorchidism?lang=us

  Cryptorchidism refers to an absence of a testis (or testes) in the scrotal sac. It may refer to an undescended testis, ectopic testis, or an atrophic or absent testis. Correct localization of the testes is essential because surgical management varies on location. […] Ultrasound has 45% sensitivity, 78% specificity, and 88% accuracy for localization of undescended testis and is more accurate than clinical examination. […] MRI is the best cross-sectional modality to assess crypto-orchidism (replacing CT). It has a higher sensitivity than ultrasound (~90%) and a higher specificity (100%). […] Orchiopexy is the preferred mode of management in case of viable testes high-up in the scrotum or within inguinal canal/abdomen. It is performed after 1 year of age since the testes may descend without intervention.

• #13 Diagnostic Imaging in Cryptorchidism: Utility, Indications, and Effectiveness

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3712862/

  Cryptorchidism (undescended testis) is the most common genitourinary anomaly in male infants. […] We reviewed the available literature on the diagnostic performance of ultrasound, CT, and MRI in localizing undescended testes. […] Ultrasound is the most heavily utilized imaging modality to evaluate undescended testes. […] Given the poor ability to localize non-palpable testes, ultrasound has no role in the routine evaluation of boys with cryptorchidism. […] Diagnostic imaging has been utilized to determine the anatomic location of non-palpable testes. […] Current US Department of Health and Human Services guidelines state that ultrasound, CT, or MRI do not provide additional information to the physical examination. […] We review the utility of ultrasound, CT, and MRI in the evaluation of boys with undescended testes and also address clinical scenarios in which the presence of associated abnormalities merits the use of diagnostic imaging.

• #14 Pathology Outlines – Cryptorchidism

  https://www.pathologyoutlines.com/topic/testiscryptorchidism.html

  Absence of one or both testes in the scrotum. […] Most common congenital abnormality of the genitourinary tract (Transl Pediatr 2016;5:233). […] Associated with infertility and subfertility, testicular germ cell tumor, testicular torsion and inguinal hernia. […] Absence of one or both testes in the scrotum most commonly due to failure of descent into the scrotum during fetal development. […] Increased risk of reduced fertility and testicular germ cell tumor. […] Laparoscopy is gold standard in diagnosing a nonpalpable testis. […] Ultrasound and other radiologic imaging are not sensitive in diagnosing a nonpalpable testis (Pediatrics 2011;127:119, Pediatrics 2013;131:e1908). […] Must exclude retractile testis, a testis that has descended into the scrotum but has been pulled superiorly by cremaster muscle.

• #15

  https://www.nhs.uk/conditions/undescended-testicles/treatment/

  A testicle found inside the abdomen can occasionally be brought down to the scrotum in a single operation, but sometimes this has to be done in 2 separate stages. […] In cases where the testicle is in the abdomen (impalpable), there’s a small possibility that there’s no testicle at all on that side. […] This would be confirmed during the laparoscopy. […] Orchidopexies and laparoscopies are performed under a general anaesthetic, which means your child will be asleep during the procedure and won’t feel any pain while it’s carried out. […] The operation normally takes about 1 hour and is usually performed as day surgery, which means your child will be able to return home on the same day. […] The success rate for treating palpable testicles located near the scrotum is estimated to be higher than 90%.

• #16 Undescended testicle (cryptorchidism) Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/undescended-testicle-cryptorchidism.html

  During a physical examination, the doctor will be able to see that one or both testicles is absent from the scrotum. […] In the majority of cases, the doctor can feel the testicle above the scrotum. […] If the doctor cannot find and feel the testicle, a specialist needs to determine its position using a procedure called diagnostic laparoscopy. […] In this procedure, a specially designed video camera is inserted through a small incision to look at an area inside the body directly.

• #17 The Undescended Testicle: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/1101/p2037.html/1000

  Differentiation of a retractile testis from a true undescended testis is sometimes difficult; consultation with a urologist may be valuable. […] If a testis cannot be palpated in the inguinal canal or the scrotum, or in ectopic sites such as the femoral region or perineum, evaluation for a nonpalpable testis must be initiated. […] A phenotypically male newborn with bilateral nonpalpable testicles should be considered to be a genetic female with congenital adrenal hyperplasia until proved otherwise. […] Treatment for cryptorchidism can be hormonal, surgical or a combination of the two. […] The inguinal orchiopexy is a well-established operation for the palpable undescended testicle. […] Surgery for the nonpalpable testicle is diagnostic and potentially therapeutic.

• #18 The Undescended Testicle: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/1101/p2037.html/1000

  Differentiation of a retractile testis from a true undescended testis is sometimes difficult; consultation with a urologist may be valuable. […] If a testis cannot be palpated in the inguinal canal or the scrotum, or in ectopic sites such as the femoral region or perineum, evaluation for a nonpalpable testis must be initiated. […] A phenotypically male newborn with bilateral nonpalpable testicles should be considered to be a genetic female with congenital adrenal hyperplasia until proved otherwise. […] Treatment for cryptorchidism can be hormonal, surgical or a combination of the two. […] The inguinal orchiopexy is a well-established operation for the palpable undescended testicle. […] Surgery for the nonpalpable testicle is diagnostic and potentially therapeutic.

• #19 Cryptorchidism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/741

  Cryptorchidism diagnosis is made on physical exam when one or both testes are not present within the dependent portion of the scrotal sac. […] Approximately 70% of cryptorchid testes are palpable within the upper portion of the scrotum or inguinal canal, whereas the other 30% are not palpable, suggesting either an intra-abdominal location, testicular nubbin, or anorchia. […] Referral to a specialist should be made by 6 months corrected gestational age and surgical correction should be performed within the next year. Testes that remain undescended by 6 months are unlikely to descend spontaneously. […] Patients with bilateral cryptorchidism should be referred immediately for an evaluation with karyotype and biochemical workup for a difference of sex development (DSD). […] Key diagnostic factors include malpositioned or absent testis, palpable cryptorchid testis, and nonpalpable testis.

• #20 Evaluation and Treatment of Cryptorchidism (2018) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline

  In boys with bilateral, nonpalpable testes who do not have congenital adrenal hyperplasia (CAH), providers should measure Mllerian Inhibiting Substance (MIS or Anti- Mllerian Hormone [AMH]) level, and consider additional hormone testing, to evaluate for anorchia. (Option; Evidence Strength: Grade C) […] In the absence of spontaneous testicular descent by six months (corrected for gestational age), specialists should perform surgery within the next year. (Standard; Evidence Strength: Grade B) […] In prepubertal boys with palpable, cryptorchid testes, surgical specialists should perform scrotal or inguinal orchidopexy. (Standard; Evidence Strength: Grade B) […] Providers should counsel boys with a history of cryptorchidism and/or monorchidism and their parents regarding potential long-term risks and provide education on infertility and cancer risk. (Clinical Principle)

• #21 Cryptorchidism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/741

  1st investigations to order include clinical diagnosis. […] Investigations to consider include ultrasound, magnetic resonance imaging (MRI), hormonal evaluation with human chorionic gonadotropin (hCG) stimulation test, hormonal evaluation with Mullerian inhibiting substance (MIS), inhibin B, and follicle-stimulating hormone (FSH), and karyotyping.

• #22 Pathology Outlines – Cryptorchidism

  https://www.pathologyoutlines.com/topic/testiscryptorchidism.html

  In bilateral cryptorchidism, must exclude congenital adrenal hyperplasia and persistent Müllerian duct syndrome. […] In cases of bilateral undescended testicles, hormonal studies (LH, FSH, Müllerian inhibiting substance [MIS] and testosterone) may support diagnosis of gonadal dysgenesis with abnormal hCG stimulation test (Am Fam Physician 2000;62:2037). […] Delayed repair reduces fertility, which is worse with bilateral cryptorchidism. […] Relative risk for testicular germ cell tumor is 2.2x with prepubertal repair versus 5.4x with postpubertal repair (N Engl J Med 2007;356:1835).

• #23 The Undescended Testicle: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/1101/p2037.html/1000

  A more recent article on cryptorchidism (undescended testicle) is available. […] Early diagnosis and management of the undescended testicle are needed to preserve fertility and improve early detection of testicular malignancy. […] By six months of age, patients with undescended testicles should be evaluated by a pediatric urologist or other qualified subspecialist who can assist with diagnosis and treatment. […] The rationale for treatment of the undescended testicle is the prevention of potential sequelae. […] Recognition of the condition, identification of associated syndromes, proper diagnostic evaluation and timely referral for urologic surgical therapy are important steps in preventing adverse consequences. […] Cryptorchidism, or undescended testicle, is usually diagnosed during the newborn examination.

• #24 Evaluation and Treatment of Cryptorchidism (2018) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline

  Providers should obtain gestational history at initial evaluation of boys with suspected cryptorchidism. (Standard; Evidence Strength: Grade B) […] Primary care providers should palpate testes for quality and position at each recommended well-child visit. (Standard; Evidence Strength: Grade B) […] Providers should refer infants with a history of cryptorchidism (detected at birth) who do not have spontaneous testicular descent by six months (corrected for gestational age) to an appropriate surgical specialist for timely evaluation. (Standard; Evidence Strength: Grade B) […] Providers should not perform ultrasound (US) or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral as these studies rarely assist in decision making. (Standard; Evidence Strength: Grade B)

• #25

  https://www.ndcs.com.sg/patient-care/conditions-treatments/undescended-testicles

  The babys doctor will usually check for undescended testicles at birth and at the regular baby reviews. […] Some boys may need a referral to a paediatric surgeon if the testicles are not in position. […] This condition can usually be checked by a doctor during a physical examination alone. In general, scans are not required unless nothing can be felt.

• #26 Undescended testicle – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/undescended-testicle/diagnosis-treatment/drc-20352000

  The timing for when your baby gets surgery will depend on many factors. […] Early treatment with surgery seems to lower the risk of later health problems. […] Orchiopexy is the most common surgery to fix a single undescended testicle. It has a success rate of nearly 100%. Most of the time, the risk of fertility problems goes away after surgery for a single undescended testicle. […] If your baby’s testicle hasn’t moved down or can’t be found by about 6 months of age, you may need to see a specialist for more exams.

• #27 Undescended Testicle

  https://www.healthline.com/health/undescended-testicle

  Your childs doctor may be able to palpate, or feel, his undescended testicle in his abdomen. In other cases, the testicle cant be felt. In some cases, the testicle isnt present at all. […] An X-ray or ultrasound imaging test may help your childs doctor diagnose an undescended testicle. Imaging scans, including an MRI with contrast dye, can confirm the presence or absence of his testicle. […] Two conditions can mimic an undescended testicle. A retractile testicle is one that moves back and forth between your childs groin and his scrotum. This condition typically subsides as your child ages. An ascending testicle is one that returns to your childs groin and cant be easily guided back.

• #28 Cryptorchidism – Pathophysiology – Managment – TeachMePaediatrics

  https://teachmepaediatrics.com/surgery/urology/cryptorchidism/

  Cryptorchidism is a congenital absence of one or both testes in the scrotum due to a failure of the testes to descend during development. […] Cryptorchidism, or the failure of testicular descent into the scrotum, is a surgical condition found in 6% of newborns, but drops to 1.5-3.5% of males at 3 months. […] Initial inspection may reveal testis within the scrotum, therefore a diagnosis of retractile or normal descended testis can be made. If not, one should proceed to palpation to locate the testis. Around 80% of undescended testis are palpable, therefore should be found with a good examination. […] If DSD suspected, undescended testis associated with ambiguous genitalia or hypospadias, or bilateral undescended testis are found: urgent referral to senior paediatrician within 24 hours, ideally with access to paediatric endocrinology and urology services.

• #29 The Undescended Testicle: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/1101/p2037.html/1000

  Differentiation of a retractile testis from a true undescended testis is sometimes difficult; consultation with a urologist may be valuable. […] If a testis cannot be palpated in the inguinal canal or the scrotum, or in ectopic sites such as the femoral region or perineum, evaluation for a nonpalpable testis must be initiated. […] A phenotypically male newborn with bilateral nonpalpable testicles should be considered to be a genetic female with congenital adrenal hyperplasia until proved otherwise. […] Treatment for cryptorchidism can be hormonal, surgical or a combination of the two. […] The inguinal orchiopexy is a well-established operation for the palpable undescended testicle. […] Surgery for the nonpalpable testicle is diagnostic and potentially therapeutic.

• #30 Undescended testicle – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/undescended-testicle/symptoms-causes/syc-20351995

  Not seeing or feeling a testicle in the scrotum is the main symptom of an undescended testicle. […] An undescended testicle often is found during an exam done shortly after birth. If your baby has an undescended testicle, ask how often exams will need to be done. If the testicle hasn’t moved into the scrotum by 3 to 4 months of age, the condition likely won’t correct itself. […] Treating an undescended testicle when your child is still a baby might lower the risk of health problems later in life. […] The exact cause of an undescended testicle isn’t known. […] The testicles need to be slightly cooler than regular body temperature to develop and work well. […] Men who’ve had an undescended testicle have a higher risk of testicular cancer. […] Surgery to correct an undescended testicle might lower the risk of testicular cancer. […] Fertility problems make it harder to get a partner pregnant. They’re more likely to happen in men who’ve had an undescended testicle.

• #31 Undescended Testicles (Cryptorchidism): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17594-undescended-testicles

  During pregnancy, testicles develop in the abdominal cavity. In most cases, they drop into the scrotum before birth. Undescended testicles dont drop before birth. If the testicles dont descend after six months, your child may need surgery or hormone therapy. […] Your childs healthcare provider can diagnose undescended testicles during a physical examination at birth or shortly after birth. If they cant feel the testicles (impalpable), your child may have undescended testicles. […] An orchiopexy is the gold-standard undescended testicle treatment. During an orchiopexy, a surgeon will make a small cut (incision) in your childs groin and locate the undescended testicles in the abdomen. […] If your childs testicles havent dropped by the time theyre 6 months old, talk to a healthcare provider about treatment. If your child needs an orchiopexy, providers recommend they get it between 12 and 24 months of age. […] Surgery to fix undescended testicles has a high success rate about 98% effective. In most cases, the testicles develop normally in the scrotum and produce healthy sperm later in life.

• #32 Cryptorchidism – Pathophysiology – Managment – TeachMePaediatrics

  https://teachmepaediatrics.com/surgery/urology/cryptorchidism/

  No imaging modality has been shown to be of benefit in the diagnosis of undescended testis. Both USS and MRI have been showed to have low sensitivity and be poor at locating the testis and therefore plays no role in the pre-operative management of these patients. […] The intervention is dependent on clinical findings and the suspected position of the undescended testis. If unable to find the testis on examination, it is important to identify if the testis is absent or intra-abdominal. Therefore, an examination under anaesthesia followed by laparoscopy remains the mainstay of intervention in order to locate an impalpable testis. […] Short term complications include infection, bleeding and wound dehiscence. Long term there is a small risk of testicular atrophy and testicular re-ascent. […] Impaired fertility as testis are 2-3 C warmer if intra-abdominal, this can effect spermatogenesis. Although fertility in unilateral undescended testis is around 90%, this has been reported to drop to around 53% if bilateral. Risk of infertility increases with delayed correction. […] Testicular cancer 2-3 times more common with a history of undescended testis (2-3%), and this risk double if correction is undertaken after puberty.

• #33 Cryptorchidism: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/438378-overview

  In cryptorchidism, the most useful determination is whether the testes are palpable upon physical examination. […] Approximately 80% of undescended testes are palpable and 20% are nonpalpable. […] Indications for hormonal or surgical correction of cryptorchidism are described below. […] Early reposition of the testis into the scrotum has been a mainstay of treatment to reduce the risk of infertility; however, even with successful orchiopexy at age 6-12 months, 20-25% of boys with nonsyndromic cryptorchidism have compromised fertility potential. […] Males with undescended testis are 40 times as likely to develop testicular cancer as males without undescended testis. […] Prepubertal orchiopexy reduces this risk. […] 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.

• #34 Undescended testicle – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/undescended-testicle/diagnosis-treatment/drc-20352000

  With an undescended testicle, surgery may be needed to find the problem and treat it. There are two main types of surgery: […] If a baby’s testicles can’t be found in the scrotum after birth, more tests may be needed. These tests can determine if the testicles are absent meaning not there at all rather than undescended. […] Imaging tests, such as an ultrasound and MRI, usually aren’t needed to find out if a baby has an undescended testicle. […] The goal of treatment is to move the undescended testicle to its proper place in the scrotum. Treatment before age 1 might lower the risk of health problems linked with an undescended testicle, such as infertility and testicular cancer. […] Most often, an undescended testicle is fixed with surgery. The surgeon moves the testicle into the scrotum and stitches it into place. This is called orchiopexy (OR-kee-o-pek-see).

• #35 Comparison of diagnostic and treatment guidelines for undescended testis

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2019.01438

  Cryptorchidism or undescended testis is the single most common genitourinary disease in male neonates. In most cases, the testes will descend spontaneously by 3 months of age. If the testes do not descend by 6 months of age, the probability of spontaneous descent thereafter is low. A surgical specialist referral is recommended if descent does not occur by 6 months, undescended testis is newly diagnosed after 6 months of age, or testicular torsion is suspected. International guidelines do not recommend ultrasonography or other diagnostic imaging because they cannot add diagnostic accuracy or change treatment. Orchiopexy is recommended between 6 and 18 months at the latest to protect the fertility potential and decrease the risk of malignant changes. Patients with unilateral undescended testis have an infertility rate of up to 10%. This rate is even higher in patients with bilateral undescended testes, with intra-abdominal undescended testis, or who underwent delayed orchiopexy. Patients with undescended testis have a threefold increased risk of testicular cancer later in life compared to the general population. A timely referral to a surgical specialist and timely surgical correction are the most important factors for decreasing infertility and testicular cancer rates.

• #36 Undescended Testicles (Cryptorchidism) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/undescended-testes-cryptorchidism

  How are undescended testicles diagnosed? A primary care doctor will first perform a full genital examination and will try to locate the testicle if it is not in the scrotum. If one can’t be felt, your son may be referred to a pediatric urologist or pediatric surgeon for a more complete examination and to rule out two related conditions etopic testicles and retractile testicles. […] If the testicle can be felt in the groin, orchiopexy will probably be done through a small incision in the groin. The surgeon will free the testicle from its location in the abdomen and maneuver it into the scrotum. […] If your child’s testicle does not descend on its own, his surgeon will most likely recommend surgery to move it down into the scrotum around your baby’s first birthday. The surgery, called orchiopexy, reduces long-term effects including risk of cancer or infertility, and will improve your son’s body image through adolescence and adulthood. […] Orchiopexy also makes it possible for young men to easily and routinely examine their testes to detect any abnormalities such as testicular cancer.

• #37

  https://www.nhs.uk/conditions/undescended-testicles/treatment/

  A testicle found inside the abdomen can occasionally be brought down to the scrotum in a single operation, but sometimes this has to be done in 2 separate stages. […] In cases where the testicle is in the abdomen (impalpable), there’s a small possibility that there’s no testicle at all on that side. […] This would be confirmed during the laparoscopy. […] Orchidopexies and laparoscopies are performed under a general anaesthetic, which means your child will be asleep during the procedure and won’t feel any pain while it’s carried out. […] The operation normally takes about 1 hour and is usually performed as day surgery, which means your child will be able to return home on the same day. […] The success rate for treating palpable testicles located near the scrotum is estimated to be higher than 90%.

• #38 Undescended Testicles (Cryptorchidism): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17594-undescended-testicles

  During pregnancy, testicles develop in the abdominal cavity. In most cases, they drop into the scrotum before birth. Undescended testicles dont drop before birth. If the testicles dont descend after six months, your child may need surgery or hormone therapy. […] Your childs healthcare provider can diagnose undescended testicles during a physical examination at birth or shortly after birth. If they cant feel the testicles (impalpable), your child may have undescended testicles. […] An orchiopexy is the gold-standard undescended testicle treatment. During an orchiopexy, a surgeon will make a small cut (incision) in your childs groin and locate the undescended testicles in the abdomen. […] If your childs testicles havent dropped by the time theyre 6 months old, talk to a healthcare provider about treatment. If your child needs an orchiopexy, providers recommend they get it between 12 and 24 months of age. […] Surgery to fix undescended testicles has a high success rate about 98% effective. In most cases, the testicles develop normally in the scrotum and produce healthy sperm later in life.

• #39 Undescended Testicle: Causes, Treatment and Surgery

  https://dreminozbek.com/en/undescended-testicle-causes-treatment-and-surgery/

  The success rate in orchiopexy surgery is high. It is successful around 95%, complications are extremely low, around 1%. […] In summary; Undescended testis is a common congenital developmental defect of the urogenital system. The most effective treatment is surgery. The success of the surgery is quite high. The surgery should be done within 6-12 months. If left untreated, it causes serious problems such as testicular cancer and infertility in the future.

• #40

  https://www.nhs.uk/conditions/undescended-testicles/treatment/

  The operation is slightly less successful in treating impalpable testicles located in the abdomen. […] As with any type of surgery, an orchidopexy carries the risk of complications, some of which may need to be treated with further surgery. […] Possible side effects and complications of an orchidopexy include: bleeding, swelling or bruising where the incisions were made; the wound becoming infected; the testicle moving up into the groin again; the blood supply not being able to sustain the testicle in its new position, which causes it to wither away (testicular atrophy); damage to the tube connecting the testicle to the urethra (vas deferens), which can make it difficult for semen to pass through. […] In general, complication rates are low. The main risk is loss (atrophy) of the testicle.

• #41

  https://link.springer.com/article/10.1007/s40746-016-0039-7

  Diagnostic laparoscopy is most often used for non-palpable testes, as it not only allows for the identification of an atrophic or absent testicle, but it also provides an opportunity to perform an orchiopexy simultaneously should a viable testis be found. […] A physical exam should be performed to determine the position and morphology of the testicles. A UDT can be located in several locations along the path of descent (abdomen, inguinal canal, superficial inguinal pouch, or upper scrotum) or can be ectopic (perineum, contralateral scrotum, or femoral region). […] The management of a UDT should not include imaging. […] Surgical exploration, often using minimally invasive laparoscopy, is the gold standard for the diagnosis of a non-palpable testis. […] It is important for providers to discern retractile testes from UDTs.

• #42 Diagnostic Imaging in Cryptorchidism: Utility, Indications, and Effectiveness

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3712862/

  Diagnostic imaging has no role in the routine evaluation of boys with undescended testes. […] We recommend against routinely using ultrasound to evaluate children with cryptorchidism and propose that the diagnostic algorithm for the evaluation of a boy with cryptorchidism consist of physical exam and surgical evaluation. […] Ultrasound is an appropriate screening evaluation for children with ambiguous genitalia or hypospadias and cryptorchidism. […] Future studies should examine whether pre-operative MRI has utility in re-operative orchiopexy.

• #43 Evaluation and Treatment of Cryptorchidism (2018) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline

  Providers should obtain gestational history at initial evaluation of boys with suspected cryptorchidism. (Standard; Evidence Strength: Grade B) […] Primary care providers should palpate testes for quality and position at each recommended well-child visit. (Standard; Evidence Strength: Grade B) […] Providers should refer infants with a history of cryptorchidism (detected at birth) who do not have spontaneous testicular descent by six months (corrected for gestational age) to an appropriate surgical specialist for timely evaluation. (Standard; Evidence Strength: Grade B) […] Providers should not perform ultrasound (US) or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral as these studies rarely assist in decision making. (Standard; Evidence Strength: Grade B)

• #44 Comparison of diagnostic and treatment guidelines for undescended testis

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2019.01438

  The external genitalia must be inspected thoroughly, especially in patients whose bilateral testes are not palpable. Diagnostic exploratory laparoscopy is recommended to identify impalpable undescended testis, which is the gold standard with great sensitivity and specificity. […] The use of ultrasonography and other diagnostic imaging techniques is not recommended because they cannot add diagnostic accuracy or change treatment.

• #45

  https://step1.medbullets.com/evidence/11087186

  Early diagnosis and management of the undescended testicle are needed to preserve fertility and improve early detection of testicular malignancy. […] Physical examination of the testicle can be difficult; consultation should be considered if a normal testis cannot be definitely identified. […] Observation is not recommended beyond one year of age because it delays treatment, lowers the rate of surgical success and probably impairs spermatogenesis. […] By six months of age, patients with undescended testicles should be evaluated by a pediatric urologist or other qualified subspecialist who can assist with diagnosis and treatment. […] Therapy for an undescended testicle should begin between six months and two years of age and may consist of hormone or surgical treatment. […] The success of either form of treatment depends on the position of the testicle at diagnosis.

• #46 The undescended testicle: diagnosis and management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11087186/

  Early diagnosis and management of the undescended testicle are needed to preserve fertility and improve early detection of testicular malignancy. […] Physical examination of the testicle can be difficult; consultation should be considered if a normal testis cannot be definitely identified. […] By six months of age, patients with undescended testicles should be evaluated by a pediatric urologist or other qualified subspecialist who can assist with diagnosis and treatment. […] Therapy for an undescended testicle should begin between six months and two years of age and may consist of hormone or surgical treatment. […] The success of either form of treatment depends on the position of the testicle at diagnosis. […] Recent improvements in surgical technique, including laparoscopic approaches to diagnosis and treatment, hold the promise of improved outcomes.

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