Niezstąpione jądra – Epidemiologia

Niezstąpione jądra
Epidemiologia

Niezstąpione jądra (kryptorchizm) to najczęstsza wrodzona anomalia układu moczowo-płciowego u chłopców, z częstością występowania u noworodków donoszonych wynoszącą 1-5,9% (najczęściej 3-4%). U wcześniaków ryzyko jest znacznie wyższe, sięgając 30-45%, a u noworodków o masie urodzeniowej poniżej 907 g niemal 100%. Spontaniczne zstąpienie jąder następuje głównie w pierwszych 6-9 miesiącach życia, po czym jest mało prawdopodobne. Jednostronne przypadki stanowią około 80-90% wszystkich, a jądra niewyczuwalne palpacyjnie to około 20% przypadków. Czynniki ryzyka obejmują wcześniactwo, niską masę urodzeniową, ciążę bliźniaczą, ekspozycję na estrogeny, nadciśnienie i cukrzycę matki, palenie tytoniu oraz otyłość matki. Kryptorchizm wykazuje istotny komponent genetyczny, z wyższym ryzykiem u bliźniąt i krewnych pierwszego stopnia, co sugeruje udział dziedziczenia sprzężonego z chromosomem X lub kombinacji czynników genetycznych i środowiskowych.

Epidemiologia niezstąpionych jąder

Niezstąpione jądra (wnętrostwo, kryptorchizm) stanowią najczęstszą wrodzoną anomalię układu moczowo-płciowego u chłopców i najczęstszą anomalię narządów płciowych stwierdzaną po urodzeniu. Częstość występowania tego schorzenia różni się w zależności od wieku pacjenta, czasu trwania ciąży oraz masy urodzeniowej.¹²³

Częstotliwość występowania w różnych grupach wiekowych

U noworodków urodzonych o czasie, częstość występowania niezstąpionych jąder waha się od 1% do 5,9%, przy czym najczęściej podawane wartości to 3-4%.¹²³ W Stanach Zjednoczonych częstość występowania kryptorchizmu wynosi od około 3,7% przy urodzeniu do 1,1% w wieku od 1 roku do dorosłości.¹ W skali globalnej częstość występowania waha się od 4,3-4,9% przy urodzeniu do 1-1,5% w wieku 3 miesięcy i dalej spada do 0,8-2,5% w wieku 9 miesięcy.¹

Większość niezstąpionych jąder może samoistnie zstąpić w ciągu pierwszych miesięcy życia. W wieku 3 miesięcy występuje u około 1-1,2% chłopców, a w wieku 1 roku częstość ta spada do około 0,8-1%.¹²³ Po ukończeniu 6-9 miesięcy życia spontaniczne zstąpienie jądra jest już mało prawdopodobne.¹²

Częstotliwość występowania u wcześniaków

Częstość występowania niezstąpionych jąder jest znacznie wyższa u wcześniaków i wynosi od 30% do 45%.¹²³⁴ W niektórych badaniach podawane są nawet wartości dochodzące do 48% u dzieci z niską masą urodzeniową lub wcześniactwem.¹

Według badania przeprowadzonego w Estonii na grupie 5014 chłopców urodzonych w jednym szpitalu, 2,1% miało jedno lub oba jądra niezstąpione po urodzeniu. Częstość występowania kryptorchizmu przy urodzeniu różniła się w zależności od następujących czynników:¹

Przedwczesny poród: 11,9%
Niska masa urodzeniowa: 16,7%
Mała masa w stosunku do wieku ciążowego: 14%
Poród o czasie: 1,1%

Inne źródło podaje, że około 17% męskich noworodków o masie urodzeniowej poniżej 2,3 kg ma niezstąpione jądra. Im niższa masa urodzeniowa, tym wyższe ryzyko – prawie 100% męskich noworodków o masie poniżej 907 g rodzi się z tym schorzeniem.¹

Inne czynniki epidemiologiczne

Jednostronne niezstąpione jądro występuje około 4 razy częściej niż obustronne.¹ Według różnych źródeł, obustronne niezstąpienie jąder występuje w 10-20% przypadków kryptorchizmu.¹²³ Niezstąpione jądra, które nie są wyczuwalne palpacyjnie (non-palpable), stanowią około 20% wszystkich przypadków niezstąpionych jąder.¹

Występowanie nabytego kryptorchizmu

Oprócz wrodzonego kryptorchizmu wyróżnia się również nabyty kryptorchizm (wtórne wzniesienie jądra, ang. acquired undescended testes, aUDT), który występuje u chłopców z początkowo prawidłowo zstąpionym jądrem, które następnie przemieszcza się w górę, poza mosznę.¹² Według niektórych badań, nabyty kryptorchizm występuje około 3 razy częściej niż wrodzony kryptorchizm.¹

U chłopców, którzy byli leczeni z powodu niezstąpionego jądra jako niemowlęta, do 50% może rozwinąć wtórne wzniesienie jądra w późniejszym dzieciństwie.¹ Istnieją dwa szczyty wykrywania niezstąpionych jąder: przy urodzeniu i w wieku 5-7 lat, przy czym ta druga grupa prawdopodobnie reprezentuje pacjentów z jądrami położonymi nisko, które stają się widoczne wraz ze wzrostem liniowym.¹

Czynniki genetyczne i rodzinne

Istnieją wyraźne dowody na rodzinne występowanie niezstąpionych jąder, co sugeruje możliwy udział czynników genetycznych w etiologii tego schorzenia.¹²

Ryzyko w rodzinie

Kryptorchizm występuje u około 1,5-4% ojców i 6-7% braci pacjentów z tym schorzeniem.¹²³ Dziedziczność u krewnych płci męskiej pierwszego stopnia szacuje się na 0,5-1%.¹

Ryzyko wystąpienia niezstąpionych jąder jest:¹²

10,1 razy wyższe u bliźniąt płci męskiej, jeśli jest obecne u jednego z nich
3,5 razy wyższe u chłopców z bratem z niezstąpionym jądrem
2,3 razy wyższe u chłopców z ojcem z tym schorzeniem

¹²

Współczynnik zgodności występowania wynosi 7% dla braci, 17% dla bliźniąt dwujajowych i 27% dla bliźniąt jednojajowych.¹ Te dane sugerują, że wkład matczyny jest większy niż ojcowski, co wskazuje albo na dziedziczenie sprzężone z chromosomem X, albo na kombinację czynników genetycznych i środowiska matczynego.¹

Czynniki ryzyka i predyspozycje

Oprócz wcześniactwa i niskiej masy urodzeniowej, które są najsilniejszymi czynnikami ryzyka, zidentyfikowano szereg innych czynników predysponujących do wystąpienia niezstąpionych jąder.¹²

Czynniki związane z ciążą i porodem

Mała masa w stosunku do wieku ciążowego¹
Ciąża bliźniacza¹²
Ekspozycja matki na estrogeny w pierwszym trymestrze ciąży¹
Nadciśnienie tętnicze u matki (przedciążowe, ciążowe, stan przedrzucawkowy)¹²
Cukrzyca przedciążowa i ciążowa¹
Infekcje podczas ciąży¹
Palenie tytoniu przez matkę w czasie ciąży (zwiększa ryzyko o 13%)¹²
Otyłość matki przed ciążą (zwiększa ryzyko o 32% przy BMI ≥30 kg/m²)¹

Badacze zaobserwowali cykliczność występowania przypadków niezstąpionych jąder przy urodzeniu, z najwyższą częstością w marcu i najniższą we wrześniu.¹ Może to sugerować wpływ sezonowych czynników środowiskowych.

Czynniki środowiskowe

Istnieje znaczące potencjalne zagrożenie związane z substancjami chemicznymi zaburzającymi funkcje endokrynne, które mogą być związane z anomaliami męskiego układu rozrodczego o wspólnej etiologii, w tym z kryptorchizmem (czasami określanym jako „zespół dysgenezji jąder”).¹ Ekspozycja na paracetamol i dietylstilbestrol w okresie płodowym również została zidentyfikowana jako czynnik ryzyka.¹

Współistnienie innych wad wrodzonych

Niezstąpione jądra mogą być związane z innymi wadami wrodzonymi. W badaniu przeprowadzonym w Teheranie wykazano istotny związek między wadami wrodzonymi a niezstąpionym jądrem – 33,3% niemowląt urodzonych z kryptorchizmem miało inne wady wrodzone.¹² Kryptorchizm często współistnieje z przepukliną pachwinową, która występuje w około 90% przypadków.¹²

Kryptorchizm może również być związany z zaburzeniami chromosomalnymi i genetycznymi, takimi jak:¹

Zaburzenia różnicowania płci (DSD)
Wrodzony przerost nadnerczy (CAH)
Zespół Klinefeltera
Zespół Pradera-Williego

Nadzór i monitorowanie

Znaczenie wczesnego rozpoznania

Wczesne rozpoznanie niezstąpionych jąder ma kluczowe znaczenie dla skutecznego leczenia i zmniejszenia długoterminowych powikłań.¹ Diagnoza stawiana jest na podstawie badania fizykalnego.¹² Podczas każdej wizyty kontrolnej lekarz powinien przeprowadzić badanie narządów płciowych w celu sprawdzenia lokalizacji jąder.¹

Mimo że badanie fizykalne jest podstawowym narzędziem diagnostycznym, istnieje problem opóźnień w kierowaniu pacjentów do specjalistów. W ankiecie przeprowadzonej wśród pediatrów w Stanach Zjednoczonych, 67% respondentów zgłosiło zlecanie badań obrazowych podczas przedoperacyjnej oceny chłopców z kryptorchizmem.¹ Jest to niezgodne z wytycznymi wielu organizacji zawodowych, które konsekwentnie zalecają, aby nie wykonywać rutynowo badań obrazowych w diagnostyce niezstąpionych jąder przed interwencją chirurgiczną, ponieważ nie dostarczają one klinicznie istotnych informacji uzupełniających badanie fizykalne.¹

Zalecenia dotyczące kierowania do leczenia

Podstawowi opiekunowie, w tym pediatrzy ogólni, powinni rozważyć skierowanie do specjalisty chirurgii w następujących przypadkach:¹²

Jądro nie zstąpiło do moszny do 6 miesiąca życia
Nowo zdiagnozowane niezstąpione jądro po 6 miesiącu życia
Podejrzenie skrętu jądra

¹²

Zgodnie z wytycznymi EAU (European Association of Urology), AUA (American Urological Association) i Nordyckiego Konsensusu, wczesna interwencja jest zalecana w przypadku niezstąpionych jąder w wieku od 6 do 18 miesięcy.¹ Preferowanym leczeniem jest orchidopeksja (operacyjne umieszczenie jądra w mosznie), którą należy wykonać między 6 a 12 miesiącem życia.¹²³

Opóźnienia w leczeniu

Mimo jasnych zaleceń dotyczących wczesnego leczenia, w wielu krajach obserwuje się opóźnienia w kierowaniu pacjentów do leczenia chirurgicznego. W badaniu przeprowadzonym w Niemczech tylko 16% orchidopeksji było wykonywanych przed pierwszymi urodzinami, zgodnie z zaleceniami wytycznych.¹ Opóźnienia w skierowaniu do leczenia są związane z:¹

Opóźnieniami ze strony lekarzy/personelu medycznego, którzy nie podjęli dalszych działań
Niewiedzą na temat ryzyka związanego z opóźnianiem operacji
Nierozpoznaniem niezstąpionego jądra przez rodziców/świadczeniodawców

Czynniki, które odegrały znaczącą rolę w opóźnianiu zabiegów operacyjnych w leczeniu niezstąpionych jąder, to opóźnienia w skierowaniu od lekarzy (p≤0,025) (lekarzy podstawowej opieki zdrowotnej i pediatrów) oraz nierozpoznane stany niezstąpionego jądra u pacjentów (p≤0,005).¹

Implikacje zdrowotne i nadzór długoterminowy

Ryzyko nowotworu jąder

Niezstąpione jądra są związane ze zwiększonym ryzykiem rozwoju nowotworu jądra w późniejszym życiu.¹²³ Ryzyko to jest 3-48 razy wyższe u pacjentów z niezstąpionym jądrem w porównaniu z populacją ogólną.¹²³⁴ Ryzyko złośliwego zwyrodnienia wynosi 3-18% u tych pacjentów.¹²

Niezstąpione jądro wiąże się szczególnie z nasieniaka jądra, z względnym ryzykiem wynoszącym 7,3.¹ Guzy te zazwyczaj rozwijają się u młodych dorosłych, gdy komórki rozrodcze szybko namnażają się po okresie dojrzewania.¹ Niektóre badania wykazały zwiększone ryzyko złośliwości w przeciwległym jądrze w jednostronnym niezstąpionym jądrze.¹

Ryzyko złośliwości jest wyższe, im wyżej położone jest jądro.¹ Szacunkowe ryzyko raka jądra u osób urodzonych z jednym lub dwoma niezstąpionymi jądrami wynosi około 1 na 500, co stanowi od czterodo czterdziestokrotny wzrost ryzyka.¹

Ryzyko niepłodności

Niezstąpione jądra są związane z obniżoną płodnością, szczególnie w przypadkach obustronnego niezstąpienia jąder.¹²³ Pacjenci z jednostronnym niezstąpionym jądrem mają wskaźnik niepłodności do 10%.¹ Wskaźnik ten jest jeszcze wyższy u pacjentów z obustronnym niezstąpieniem jąder, z niezstąpionym jądrem wewnątrzbrzusznym lub u tych, którzy przeszli opóźnioną orchidopeksję.¹

Zmniejszenie płodności po orchidopeksji z powodu obustronnego kryptorchizmu jest bardziej wyraźne, około 38%, czyli sześciokrotnie wyższe niż w populacji ogólnej.¹ Z drugiej strony, 87% nieleczonych mężczyzn z jednostronnym kryptorchizmem ma dzieci, ale tylko 33% mężczyzn z obustronnym kryptorchizmem.¹

Inne powikłania

Niezstąpione jądra są związane również z innymi powikłaniami:¹²³

Skręt jądra – ryzyko jest wyższe u dorosłych pacjentów z niezstąpionym jądrem w porównaniu z populacją ogólną¹²
Przepuklina pachwinowa – występuje w około 90% przypadków¹²
Zaburzenia psychologiczne u dorosłych¹

Nadzór po leczeniu

Rutynowa długoterminowa obserwacja pacjentów po orchidopeksji nie jest konieczna, ale zaleca się badania przesiewowe i samobadanie jąder po okresie dojrzewania, aby ułatwić wczesne wykrycie nowotworu.¹²³ Orchidopeksja ułatwia młodym mężczyznom łatwe i rutynowe badanie jąder w celu wykrycia ewentualnych nieprawidłowości, takich jak rak jądra.¹

Pacjent powinien być zaplanowany na rutynową ocenę około trzech miesięcy po operacji orchidopeksji. Pozwala to na wystarczający czas na ustąpienie obrzęku i przebarwień miejsca operacji.¹ Istnieje ryzyko skręcenia jądra lub ponownego wzniesienia się jądra nawet po zakończeniu operacji orchidopeksji.¹

Podsumowanie danych epidemiologicznych

Niezstąpione jądra stanowią istotny problem zdrowia publicznego ze względu na wysoką częstość występowania i potencjalne długoterminowe konsekwencje zdrowotne. Główne dane epidemiologiczne można podsumować w następujący sposób:

Grupa	Częstość występowania	Uwagi
Noworodki donoszone	1-5,9%	Najczęściej podawane wartości: 3-4%
Noworodki przedwcześnie urodzone	30-45%	Im niższa masa urodzeniowa, tym wyższe ryzyko
Wiek 3 miesięcy	1-1,5%	Spontaniczne zstąpienie jądra w pierwszych miesiącach życia
Wiek 1 roku i powyżej	0,8-1,2%	Po 6-9 miesiącach życia spontaniczne zstąpienie jest mało prawdopodobne
Przypadki jednostronne	~80-90% wszystkich przypadków	4 razy częstsze niż obustronne
Przypadki obustronne	10-20% wszystkich przypadków	Wyższe ryzyko niepłodności
Jądra niewyczuwalne palpacyjnie	~20% wszystkich przypadków	40% wewnątrzbrzuszne, 40% pachwinowe, 20% zanikowe lub nieobecne

Dane te podkreślają znaczenie wczesnej diagnozy i leczenia niezstąpionych jąder w celu zminimalizowania długoterminowych powikłań. Opóźnienia w skierowaniu do specjalistów i leczeniu chirurgicznym pozostają istotnym problemem w wielu krajach, mimo jasnych zaleceń dotyczących wczesnej interwencji.¹²

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Materiały źródłowe

#1 Cryptorchidism – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470270/
Cryptorchidism is observed in 3% of full-term newborn infants, with this prevalence decreasing to 1% in infants aged 6 months to 1 year. […] In the US, cryptorchidism ranges from approximately 3% at birth to 1% from 1 year to adulthood. […] Globally, the prevalence varies, starting at around 4% to 5% at birth, decreasing to about 1% to 1.5% at age 3 months, and further decreasing to 1% to 2.5% at 9 months. […] The prevalence of cryptorchidism is 30% in premature male neonates. […] Cryptorchidism affects approximately 1.5% to 4% of fathers and 6% of brothers of individuals with cryptorchidism. […] The heritability in first-degree male relatives is estimated to be around 0.5% to 1%. […] Additionally, 7% of siblings of boys with undescended testes also experience cryptorchidism, emphasizing its potential genetic predisposition within families.
#1 Cryptorchidism: Practice Essentials, History of the Procedure, Problem
https://emedicine.medscape.com/article/438378-overview
In the United States, the prevalence of cryptorchidism ranges from 3.7% at birth to 1.1% from age 1 year to adulthood. Internationally, prevalence ranges from 4.3-4.9% at birth to 1-1.5% at age 3 months to 0.8-2.5% at age 9 months. […] Cryptorchidism is identified in 1.5-4% of fathers and 6.2% of brothers of patients with cryptorchidism. Heritability in first-degree male relatives is estimated to be 0.67. The prevalence of cryptorchidism is 30% in premature male neonates. Other factors that predispose include low birth weight, small size for gestational age, twinning, and maternal exposure to estrogen during the first trimester. […] In a study of 5014 boys born at a single hospital in Estonia, 2.1% had one or both testicles undescended at birth. Cryptorchidism rates at birth varied according to the following factors: Preterm birth: 11.9%, Low birth weight: 16.7%, Small for gestational age: 14%, Full-term birth: 1.1%. […] An undescended testis may descend spontaneously during the first few months of life but is unlikely to do so after 6 months (corrected for gestational age). Cryptorchidism may also be acquired, with an initially descended testis ascending out of the scrotum.
#1 Pediatric Cryptorchidism Surgery: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/1017420-overview
A palpable undescended testis is found in 3-5% of newborns, and bilateral undescended testis is found in 15% of newborns with cryptorchidism. […] Most undescended palpable testes later spontaneously descend within the first 4 months of life; only 0.7-1% of 1-year-old infants have a persistent undescended testis. […] Studies have shown that spontaneous descent does not occur after age 9 months. […] The incidence does not change between age 1 year and adulthood. […] However, some testes that were descended in early childhood may ascend later in life. […] Nonpalpable testes account for approximately 20% of all undescended testes. […] Approximately 40% of the nonpalpable testes are intra-abdominal, 40% are inguinal, and 20% are atrophic or absent (vanishing testis syndrome). […] Cryptorchidism is found in 30% of babies born prematurely.
#1
https://link.springer.com/article/10.1007/s00345-024-05095-x
The prevalence in normal weight born males is between 1.8 up to 8.4% and may increase up to 48% in males with low birth weight or prematurity status. […] An untreated UDT is related with subfertility and an increased risk for testicular malignancy. […] Accordingly, the German, American, and European guidelines changed their recommendation regarding timing of treatment in the second decade of the twenty-first century. […] Our results support our hypothesis, that age at surgery decreases for patients with UDT. […] Furthermore, we found an increase in surgeries within the first year of life with a main increase from 2006 to 2011. […] Several studies have shown that the therapy for UDT should be completed between the 12th and 18th month of living. […] The German guideline states that the therapy of cryptorchidism should be completed within the first year of life.
#1 Undescended testicles | Better Health Channel
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/undescended-testicles
About five per cent of boys are born with undescended testicles. […] Premature and low birth weight babies are at increased risk. […] Undescended testicles are linked to a range of health problems and conditions, including hernia, testicular cancer and infertility. […] Undescended testes occur in around 1 in 100 to 1 in 20 newborn babies born at full term. In preterm babies, undescended testes can occur in up to half of all newborns. […] Premature babies are at increased risk of undescended testicles because the migration of the testicles hasnt had time to occur during development in the womb. Low birth weight babies also have a higher rate of undescended testicles. […] Around 17 per cent of male newborns that weigh under 2.3 kg have undescended testicles. The lower the birth weight, the higher the risk; nearly 100 per cent of male babies weighing under 907 g are born with the condition.
#1 Undescended Testes (Maldescended and Retractile Testes)
https://patient.info/doctor/undescended-and-maldescended-testes
Undescended testis is the most common birth defect among boys. […] Undescended testes affect 1-6% of males. […] There is a higher incidence in premature babies (up to 30%). […] Unilateral cryptorchidism is four times more likely than bilateral.
#1 Undescended Testicle
https://mobile.fpnotebook.com/Uro/Peds/UndscndTstcl.htm
Incidence: Preterm Newborn: 30 to 45% Incidence […] Term Newborn: 2.7 to 5.9% Incidence […] Age 6 months: 0.8% persistent Undescended Testicle […] Unilateral in 90% of cases […] Bilateral Undescended Testes in 10-20% of cases.
#1
https://journals.lww.com/md-journal/fulltext/2024/07050/diagnoses_and_treatment_of_acquired_undescended.20.aspx
Acquired undescended testes were once considered a sporadic disease. In recent years, reports suggest that they are not uncommon, with an incidence rate about 3 times that of congenital undescended testes. […] The etiology of acquired undescended testes remains inconclusive, clinical diagnostic standards are unclear, and treatment approaches are still controversial. […] Acquired undescended testes may increase the risk of testicular cancer, but this is still debated. […] aUDT is far more common than previously thought, occurring about 3 times more often than cUDT, and needs to be better recognized in clinical practice. […] The risk of testicular cancer with aUDT is still in dispute. […] The top choice of treatment for aUDT remains a controversial issue. […] Despite its sound instant effects, no studies have proved that early ORP treatment can improve patients fertility.
#1 Undescended testicles | Better Health Channel
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/undescended-testicles
Undescended testicles are linked to a range of health problems and conditions, including: […] the risk of testicular cancer is five to 10 times higher for males with undescended testicles than for the general male population. This risk may remain even after corrective surgery, particularly if surgery is delayed to later in childhood. Testicular cancer usually occurs between the ages of 25 and 40 years. […] Acquired undescended testicles may also occur in boys who were treated for undescended testis at birth. Up to 50 per cent of boys who are treated for undescended testis as a small infant, will develop acquired undescended testis later in childhood. […] Surgery is the best treatment for undescended testicles. […] Research suggests that future sperm quality in the affected testicle is compromised if the condition is corrected after the child is two years old. […] About 10 per cent of males who undergo surgical correction experience reduced fertility later in life.
#1 Cryptorchidism | 5-Minute Pediatric Consult
https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617321/2.1/Cryptorchidism
Cryptorchidism is a condition characterized by one or both testes being undescended. […] 3% of full-term newborn boys have cryptorchidism. […] This percentage falls to 1% by 3 months of age. […] There are two peaks for detection of undescended testes: at birth and at 5 to 7 years of age. The latter group probably represents those patients with low undescended testes that become apparent with linear growth. […] Bilateral undescended testes occur in 10% of patients with undescended testicles. […] Unilateral anorchia is found in 5% of patients with cryptorchidism.
#1 Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment?
https://pmc.ncbi.nlm.nih.gov/articles/PMC3701924/
The risk of undescended testes is 10.1 fold higher in male twins if present in one of them, 3.5 fold higher in males with a brother with undescended testes, and 2.3 fold higher in males with a father with the condition. […] The risk for cancer is 35 to 48 times higher in patients with undescended testes compared to the overall population. […] The risk for malignant degeneration is 3-18% in these patients. […] The risk for torsion is higher in adult patients with undescended testes compared to overall population. […] The success rate of surgery is defined as presence of testes in the scrotum without testicular atrophy and/or any recurrence for 1 year. […] According to the 2007 Consensus Report of Nordic countries, it is recommended that surgery should be the first-line treatment modality and should be performed at age 6-12 months.
#1 Cryptorchidism – Undescended Testicle
https://www.urology-textbook.com/cryptorchidism.html
Cryptorchidism is the absence of one testis or both testes from the scrotum, caused by a deficient or irregular testicular descent EAU Guidelines Paediatric Urology, AUA cryptorchidism guideline. […] 1% of one-year old boys […] 3% of the boys at birth (normal pregnancy) […] 930% in premature infants. […] The concordance rate is 7% for brothers, 17% for dizygotic twins, and 27% for monozygotic twins. […] Monorchidism (lack of one testis) is the underlying cause for 520% of patients with real (nonpalpable) cryptorchidism. […] Cryptorchidism is a risk factor for male infertility: 87% of untreated men with unilateral cryptorchidism have children, but only 33% of men with bilateral cryptorchidism. […] Cryptorchidism results in testicular damage with impaired germ cell development: persistence of fetal gonocytes and the lack of development of the adult dark spermatogonia (see pathology).
#1 Evaluation and Treatment of Cryptorchidism (2018) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline
Pre-gestational hypertension, gestational hypertension, moderate pre-eclampsia, severe pre-eclampsia and HELLP syndrome were associated with a greater likelihood of cryptorchidism. […] Both pre-gestational and gestational diabetes were found to be associated with an increased risk of cryptorchidism. […] Overall, mothers who reported smoking during pregnancy were 13% more likely to have a child with cryptorchidism. […] The authors caution about the complex nature of both the components of the exposure and the pathogenic mechanisms involving multifactorial origin and potential trans-generation effects. […] The authors concluded that the maternal contribution is greater than the paternal one, suggesting either an X-linked mode of inheritance or a combination of genetic factors and maternal environment. […] The increased incidence of malignancy in cryptorchid testes varies from 49/100,000 (0.05%) to 12/1,075 (1%). […] There are two major long-term concerns for patients with a history of cryptorchidism: an increased incidence of developing testicular cancer and a heightened risk of subfertility.
#1 Prevalence of Undescended Testis in Tehran and the Main Risk Factors: A Cross-sectional Multicenter Study
https://brieflands.com/articles/amhsr-111132
Undescended testis (UDT) is the most common abnormality of the male genital system. To date, no study has been carried out to determine the prevalence of UDT and its risk factors in Tehran. This study aimed to determine the frequency of cryptorchidism and its risk factors in male infants who were born at three university hospitals in Tehran. […] A total of 1,350 boys were evaluated. Eleven (0.81%) boys had UDT. There were statistically significant associations between UDT and maternal hypertension, presence of other congenital anomalies, infection during pregnancy, fetal presentation, and type of delivery. […] The prevalence of UDT in Tehran was much lower than in previously reported rates in other areas. Factor analysis showed that cryptorchidism was associated with the markers of poor fetal development.
#1 Lifestyle in pregnancy and cryptorchidism in sons: a study within two | CLEP
https://www.dovepress.com/lifestyle-in-pregnancy-and-cryptorchidism-in-sons-a-study-within-two-l-peer-reviewed-fulltext-article-CLEP
In this large population-based study; maternal tobacco smoking during pregnancy and prepregnancy overweight and obesity were associated with a higher occurrence of cryptorchidism in sons. Our results indicated no associations between weekly alcohol consumption or caffeine intake during pregnancy and cryptorchidism at the levels consumed in these cohorts. […] We observed higher HR for cryptorchidism with higher exposure to maternal tobacco smoking during pregnancy, and compared to the unexposed, boys of mothers who smoked 10-14 cigarettes/day had the highest HRs for cryptorchidism (HR: 1.37; 95% CI: 1.06-1.76). Sons of obese mothers (BMI: 30 kg/m2) had the highest HR for cryptorchidism (HR: 1.32; 95% CI: 1.06-1.65).
#1 Evaluation and Treatment of Cryptorchidism (2018) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline
In a systematic review estimating the prevalence of cryptorchidism by different ages and birth weights, they identified 97 articles, but only 49 remained eligible. […] The prevalence for boys three years and older is again rather stable between null and 6.6%. […] The possibility that environmental chemicals alter normal reproductive tract development has been debated in the recent literature. There is significant potential concern that endocrine-disrupting chemicals may be linked to male reproductive tract anomalies that may have a common etiology, including cryptorchidism (sometimes termed 'testicular dysgenesis syndrome’). […] The incidence of cases at birth was cyclic with a peak in March and a trough in September. […] The authors discuss three potential mechanisms relating maternal obesity to the risk of cryptorchidism and hypospadias.
#1 Cryptorchidism | Concise Medical Knowledge
https://www.lecturio.com/concepts/cryptorchidism/
Cryptorchidism is one of the most common congenital anomalies in young boys. […] Prevalence at birth about 3% overall: Full-term infants: 2%-5%, Premature infants: 30%. […] Risk factors: Maternal smoking and alcohol exposure, Fetal exposure to paracetamol and diethylstilbestrol, Prematurity and low birth weight. […] Cryptorchidism is usually an isolated condition, but there are related disorders: Disorders of sexual differentiation (DSD), Congenital adrenal hyperplasia (CAH), Genetic disorders such as Klinefelter syndrome and Prader-Willi syndrome.
#1 Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment?
https://pmc.ncbi.nlm.nih.gov/articles/PMC3701924/
Genetic, hormonal, and anatomical factors are believed to be involved in the etiology of undescended testes. Due to increased risk of infertility, testicular cancer, torsion and/or accompanying inguinal hernia (90%) as well as cosmetic concerns, all these patients require treatment. […] Undescended testis is present in about 1-4.5% of newborns with a higher incidence in preterms (30-45%). […] Patients with undescended testes should be treated because of increased risk of infertility, testicular cancer, torsion and/or accompanying inguinal hernia (90%), as well as because of cosmetic concerns. […] According to the 2007 Consensus Report of Nordic countries, it is recommended that surgery is the first-line treatment modality in undescended testes and that it should be performed by pediatric surgeons and urologists at the age of 6-12 months.
#1 Frontiers | Surgical treatment of cryptorchidism: current insights and future directions
https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1327957/full
Cryptorchidism presents with an incidence of 1-5% with potential long-term implications on future fertility and overall health. […] Early diagnosis by clinical examination enables timely treatment. […] Following guidelines, orchidopexy is recommended between 6-12 months of age for congenital cryptorchidism. […] Current surgical options range from open to laparoscopic techniques, with the choice largely determined by the location and accessibility of the undescended testicle. […] The EAU, AUA and Nordic Consensus guidelines uniformly recommend early intervention for undescended testes between the ages of 6 to 18 months. […] The AUA guidelines advocate the standard inguinal approach as the primary treatment for palpable undescended testes, whereas both the EAU and Nordic Consensus guidelines also acknowledge a scrotal approach for selected cases.
#1 Undescended testes: What general practitioners need to know
https://www1.racgp.org.au/ajgp/2019/january%E2%80%93february/undescended-testes
Undescended testis (UDT) is a common condition, and parents often primarily present to general practitioners. […] Management in a timely fashion may reduce the risk of malignancy and infertility. […] Undescended testis (UDT) is the second most common paediatric surgical condition after inguinal hernias. […] Five per cent of boys have a UDT at birth, 12% at three months and 1% at one year; hence, it is uncommon for testes to descend after three months. […] Emerging evidence suggests that UDT represents a disruption in the hormonally controlled testicular descent in fetal life and is probably secondary to a disturbance of intrauterine hormonal function. […] The prevalence in premature boys is up to 30.1%. […] Current guidelines recommend referral at 36 months for unilateral UDT, and orchidopexy between six and 12 months.
#1
https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Undescended-Testicles.aspx
Undescended testicles is the most common genital abnormality found at birth. About 1-3% of full-term boys have the condition at birth. But the rate is much higher in boys born preterm. About 30% of boys with a low birthweight (less than 5 pounds, 4 ounces) are born with undescended testicles. Those with a very low birthweight (less than 3 pounds, 4 ounces) have a near 100% chance of being born with undescended testicles. […] Undescended testicles are diagnosed through physical examination. At every well-child visit, the doctor will do a genital examination to check the location of the testicles. […] If your child’s testicle has not come down into the scrotum on its own by 6 months of age, they will likely need treatment. It is relatively rare for undescended testicles to fall into proper position after 6 months of age. So, there is usually little value to waiting.
#1 Unnecessary diagnostic imaging: a review of the literature on preoperative imaging for boys with undescended testes – Hartigan – Translational Andrology and Urology
https://tau.amegroups.org/article/view/5174/html
Cryptorchidism (undescended testis) is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. Cryptorchidism occurs in 1% to 3% of full-term and up to 45% of preterm male neonates (1). […] The purpose of this article is to review the clinical utility of diagnostic imaging in the preoperative evaluation of boys with cryptorchidism, with respect to its benefits, limitations, and cost. […] In a national cross-sectional survey of pediatricians practicing in the United States conducted by Tasian et al., 67% of respondents reported ordering imaging during the preoperative evaluation of boys with cryptorchidism (21). Of the respondents who ordered imaging, 86% reported doing so because they believe imaging reveals the presence or absence of a nonpalpable testis.
#1 Unnecessary diagnostic imaging: a review of the literature on preoperative imaging for boys with undescended testes – Hartigan – Translational Andrology and Urology
https://tau.amegroups.org/article/view/5174/html
Guidelines from multiple professional organizations consistently recommend that imaging not be routinely performed in the diagnosis of undescended testes prior to surgical intervention. US Department of Health and Human Services guidelines recommend against ultrasound, CT, and MRI for boys with cryptorchidism as these tests do not add clinically important information to the physical examination (18,22,26,36,37). […] Preoperative imaging does not change surgical management of non-palpable testes because a reliable imaging modality is not yet available that can be used in lieu of the gold standard of laparoscopy to correctly identify the presence and location of a non-palpable undescended testis.
#1 Undescended testis: importance of a timely referral to a surgical specialist
http://e-cep.org/journal/view.php?doi=10.3345/cep.2020.00115
Shin and Jeon published a review article entitled Diagnostic and treatment guidelines for undescended testis. This article describes the diagnosis, differential diagnosis, hormone therapy, fertility, risk of testicular cancer, and timing of surgical therapy of UDT based on international guidelines. […] Primary caregivers including general pediatricians should consider the following indications for referral: (1) the testis has not descended into the scrotum by 6 months of age, (2) newly diagnosed UDT after 6 months of age, or (3) suspected testicular torsion. […] Thus, orchiopexy is recommended between 6 and 18 months at the latest based on international guidelines. […] This review by Shin and Jeon describes the importance of a timely referral and indications for referral to a surgical specialist for UDT.
#1
https://link.springer.com/article/10.1007/s00345-024-05095-x
Our results show that only one of 6 orchidopexies (16%) in Germany is performed before the first birthday and hereby matches the guideline recommendation. […] However, a major part of surgeries is performed prior to fourth birthday and almost all surgeries performed before the ninth’s birthday. […] Our study helps to understand that a non-negligible number of patients may not receive surgery at an early timepoint. […] The goal of pediatrics, urologists and pediatric surgeons should be to increase the number of surgeries before the first birthday and to make effort to improve data about secondary ascension and its clinical impact.
#1 Open Access Macedonian Journal of Medical Sciences (OAMJMS).
https://oamjms.eu/index.php/mjms/article/view/8649
BACKGROUND: The rate of delay in the referral of patients with undescended testis (UDT) to health facilities in Indonesia is still relatively high due to delays in the handling of urological surgery. Hence, it requires rapid and appropriate identification and early detection of patients with UDT in the community. […] AIM: The study aims to analyze the factors of delay in referral in cases of UDT management. […] RESULTS: Delay by doctors/paramedics who were not followed up, ignorance of the risk of delaying surgery, and undiagnosed UDT by parents/health-care providers showed a significant difference where the percentage of patients who were delayed was greater on these factors. In addition, the reference source is also known to have a significant difference with a significant value (p 0.005). […] CONCLUSIONS: Factors that played a significant role in the delay in operative procedures for treating UDT were delays in referral from doctors (p 0.025) (primary care physicians and pediatricians) and undiagnosed UDT conditions in patients ( 0.005).
#1 Undescended testes: What general practitioners need to know
https://www1.racgp.org.au/ajgp/2019/january%E2%80%93february/undescended-testes
The literature has shown there may be an association between UDT and infertility, but it does not appear to be as great as once feared or as parents are often told, particularly for unilateral UDT. […] The risk of testicular cancer has been approximated at 2% in UDT; although this is four to five times the risk in the general population, parents can be reassured this is still relatively low. […] UDT is particularly associated with testicular seminoma, with a relative risk of 7.3. […] The tumours usually develop in young adults as germ cells rapidly multiply after puberty. […] Some studies have shown an increased risk of malignancy in the contralateral testis in unilateral UDT. […] UDT is a common disorder that affects 12% of boys and should be referred at three months of age. […] Investigations are not required prior to referral. […] Surgery remains the treatment of choice. […] Decreased fertility is largely a concern for bilateral UDT. Malignancy occurs at a higher rate but remains relatively low risk.
#1 Cryptorchidism – Undescended Testicle
https://www.urology-textbook.com/cryptorchidism.html
The reasons for the increased testicular cancer risk (1020 if untreated) are unclear. Testicular dysgenesis is a probable cause. The higher the testis position, the higher the risk of malignancy. […] 80% of undescended testes are palpable. […] An elevated FSH before puberty is a sign of bilateral missing testes. […] An HCG stimulation test is indicated for bilateral nonpalpable testes: serum testosterone is measured before and 32 h after administration of 5000 IU HCG. An increase in testosterone proves the existence of dystopic testicle(s).
#1 Cryptorchidism – Wikipedia
https://en.wikipedia.org/wiki/Cryptorchidism
One of the strongest arguments for early orchiopexy is reducing the risk of testicular cancer. About one in 500 men born with one or both testes undescended develops testicular cancer, roughly a four- to 40-fold increased risk. […] The risk of malignancy in the undescended testis is 4 to 10 ten times higher than that in the general population and is about one in 80 with a unilateral undescended testis and one in 40 to one in 50 for bilateral undescended testes.
#1 Cryptorchidism – Wikipedia
https://en.wikipedia.org/wiki/Cryptorchidism
Cryptorchidism, also known as undescended testis, is the failure of one or both testes to descend into the scrotum. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis. However, about 80% of cryptorchid testes descend by the first year of life, making the true incidence of cryptorchidism around 1% overall. Undescended testes are associated with reduced fertility, increased risk of testicular germ-cell tumors, and psychological problems when fully-grown. Without intervention, an undescended testicle will usually descend during the first year of life, but to reduce these risks, undescended testes can be brought into the scrotum in infancy by a surgical procedure called an orchiopexy. […] The fertility reduction after orchiopexy for bilateral cryptorchidism is more marked, about 38%, or six times that of the general population.
#1 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. About 1%2% of boys older than 6 months have undescended testes after their early postnatal descent. 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. Routine hormonal therapy is not recommended for undescended testis due to a lack of evidence. 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.
#1 Undescended testis: importance of a timely referral to a surgical specialist
http://e-cep.org/journal/view.php?doi=10.3345/cep.2020.00115
Undescended testes (UDT) is the most common congenital genitourinary abnormality in male infants and associated with decreased fertility and a higher future malignancy risk, especially in cases of delayed orchiopexy after puberty. […] UDT is diagnosed at birth in 1%5% of full-term infants and up to 30%45% of premature infants. […] UDT are also associated with decreased fertility and a higher future malignancy risk despite surgical correction, especially in cases of delayed orchiopexy after puberty. […] Routine long-term follow-up of patients with orchiopexy is not needed, but screening and self-examination of the testes after puberty is recommended to aid in early cancer detection. […] UDT is almost always managed surgically, which is clearly proven beneficial for increasing fertility and decreasing cancer risk.
#1 Undescended Testicles (Cryptorchidism) | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/undescended-testes-cryptorchidism
Parents should know that cases of cancer related to undescended testicles are rare. Having the surgery is important in that the testicle is located where a young man can palpate a mass if it should develop. […] Some undescended testicles will eventually move into their proper position without any sort of treatment within the first six months of a baby’s life; those that do not will need to be moved surgically. […] Orchiopexy also makes it possible for young men to easily and routinely examine their testes to detect any abnormalities such as testicular cancer. […] Boys born with undescended testicles are slightly more prone to testicular cancer, even after corrective surgery, and at a rate of less than 1 percent. However, recent studies suggest that surgical repositioning may help in early detection of a testicular mass prior to the spread of disease, which may reduce the rate of malignancies.
#1 Undescended testicles and treatment
https://www.aboutkidshealth.ca/undescended-testicle
An undescended testicle also cannot be easily felt or palpated. As children get older, this means they may be unable to self-examine for testicular masses or cancer. […] Your child will be scheduled for routine assessment approximately three months after orchidopexy surgery. This allows enough time for the swelling and discoloration of the surgical site to resolve. […] There is a risk of the testes twisting or rising back up even after orchidopexy surgery is completed.
#2 Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment?
https://pmc.ncbi.nlm.nih.gov/articles/PMC3701924/
Genetic, hormonal, and anatomical factors are believed to be involved in the etiology of undescended testes. Due to increased risk of infertility, testicular cancer, torsion and/or accompanying inguinal hernia (90%) as well as cosmetic concerns, all these patients require treatment. […] Undescended testis is present in about 1-4.5% of newborns with a higher incidence in preterms (30-45%). […] Patients with undescended testes should be treated because of increased risk of infertility, testicular cancer, torsion and/or accompanying inguinal hernia (90%), as well as because of cosmetic concerns. […] According to the 2007 Consensus Report of Nordic countries, it is recommended that surgery is the first-line treatment modality in undescended testes and that it should be performed by pediatric surgeons and urologists at the age of 6-12 months.
#2 Cryptorchidism: Practice Essentials, History of the Procedure, Problem
https://emedicine.medscape.com/article/438378-overview
In the United States, the prevalence of cryptorchidism ranges from 3.7% at birth to 1.1% from age 1 year to adulthood. Internationally, prevalence ranges from 4.3-4.9% at birth to 1-1.5% at age 3 months to 0.8-2.5% at age 9 months. […] Cryptorchidism is identified in 1.5-4% of fathers and 6.2% of brothers of patients with cryptorchidism. Heritability in first-degree male relatives is estimated to be 0.67. The prevalence of cryptorchidism is 30% in premature male neonates. Other factors that predispose include low birth weight, small size for gestational age, twinning, and maternal exposure to estrogen during the first trimester. […] In a study of 5014 boys born at a single hospital in Estonia, 2.1% had one or both testicles undescended at birth. Cryptorchidism rates at birth varied according to the following factors: Preterm birth: 11.9%, Low birth weight: 16.7%, Small for gestational age: 14%, Full-term birth: 1.1%. […] An undescended testis may descend spontaneously during the first few months of life but is unlikely to do so after 6 months (corrected for gestational age). Cryptorchidism may also be acquired, with an initially descended testis ascending out of the scrotum.
#2 Undescended testes: What general practitioners need to know
https://www1.racgp.org.au/ajgp/2019/january%E2%80%93february/undescended-testes
Undescended testis (UDT) is a common condition, and parents often primarily present to general practitioners. […] Management in a timely fashion may reduce the risk of malignancy and infertility. […] Undescended testis (UDT) is the second most common paediatric surgical condition after inguinal hernias. […] Five per cent of boys have a UDT at birth, 12% at three months and 1% at one year; hence, it is uncommon for testes to descend after three months. […] Emerging evidence suggests that UDT represents a disruption in the hormonally controlled testicular descent in fetal life and is probably secondary to a disturbance of intrauterine hormonal function. […] The prevalence in premature boys is up to 30.1%. […] Current guidelines recommend referral at 36 months for unilateral UDT, and orchidopexy between six and 12 months.
#2 Cryptorchidism | 5-Minute Pediatric Consult
https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617321/2.1/Cryptorchidism
Cryptorchidism is a condition characterized by one or both testes being undescended. […] 3% of full-term newborn boys have cryptorchidism. […] This percentage falls to 1% by 3 months of age. […] There are two peaks for detection of undescended testes: at birth and at 5 to 7 years of age. The latter group probably represents those patients with low undescended testes that become apparent with linear growth. […] Bilateral undescended testes occur in 10% of patients with undescended testicles. […] Unilateral anorchia is found in 5% of patients with cryptorchidism.
#2 Evaluation and Treatment of Cryptorchidism (2018) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline
The primary source of evidence for this guideline was the systematic review conducted as part of the Agency for Healthcare Research and Quality (AHRQ) Comparative Effectiveness Review titled Evaluation and Treatment of Cryptorchidism (2012). […] Although delayed diagnosis or treatment of cryptorchidism beyond the neonatal period is well-documented, the relative proportion of cases of true testicular ascent v. congenital cases that were not identified and/or referred early for care remains unclear. However, the preponderance of data strongly supports the existence of acquired cryptorchidism as a real phenomenon whose prevalence may be similar to that of congenital cryptorchidism. […] In a large population-based study of 819,111 non-syndromic boys in Denmark, Jensen and colleagues analyzed associations between birth weight, prematurity and cryptorchidism, which occurred in 14.1 cases out of 1000 boys.
#2 Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment?
https://pmc.ncbi.nlm.nih.gov/articles/PMC3701924/
The risk of undescended testes is 10.1 fold higher in male twins if present in one of them, 3.5 fold higher in males with a brother with undescended testes, and 2.3 fold higher in males with a father with the condition. […] The risk for cancer is 35 to 48 times higher in patients with undescended testes compared to the overall population. […] The risk for malignant degeneration is 3-18% in these patients. […] The risk for torsion is higher in adult patients with undescended testes compared to overall population. […] The success rate of surgery is defined as presence of testes in the scrotum without testicular atrophy and/or any recurrence for 1 year. […] According to the 2007 Consensus Report of Nordic countries, it is recommended that surgery should be the first-line treatment modality and should be performed at age 6-12 months.
#2 Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment? – Journal of Clinical Research in Pediatric Endocrinology
https://jcrpe.org/articles/epidemiology-classification-and-management-of-undescended-testes-does-medication-have-value-in-its-treatment/doi/Jcrpe.883
The risk of undescended testes is 10.1 fold higher in male twins if present in one of them, 3.5 fold higher in males with a brother with undescended testes, and 2.3 fold higher in males with a father with the condition (2). […] The risk for cancer is 35 to 48 times higher in patients with undescended testes compared to the overall population (5). The risk for malignant degeneration is 3-18% in these patients (28). […] The risk for torsion is higher in adult patients with undescended testes compared to overall population. A germ-cell tumor was reported to occur in 64% of such cases. It was also suggested that the risk for torsion was associated with the duration of the undescended testes (29).
#2 Pediatric Cryptorchidism Surgery: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/1017420-overview
Other predisposing factors include low birth weight, small size for gestational age, twin pregnancy, and maternal estrogen exposure. […] Cryptorchidism is found in 7% of siblings and in about 2% of fathers of babies with this condition. […] Cryptorchidism affects only males and has no reported racial predilection.
#2 Prevalence of Undescended Testis in Tehran and the Main Risk Factors: A Cross-sectional Multicenter Study
https://brieflands.com/articles/amhsr-111132
Undescended testis (UDT) is the most common abnormality of the male genital system. To date, no study has been carried out to determine the prevalence of UDT and its risk factors in Tehran. This study aimed to determine the frequency of cryptorchidism and its risk factors in male infants who were born at three university hospitals in Tehran. […] A total of 1,350 boys were evaluated. Eleven (0.81%) boys had UDT. There were statistically significant associations between UDT and maternal hypertension, presence of other congenital anomalies, infection during pregnancy, fetal presentation, and type of delivery. […] The prevalence of UDT in Tehran was much lower than in previously reported rates in other areas. Factor analysis showed that cryptorchidism was associated with the markers of poor fetal development.
#2 Lifestyle in pregnancy and cryptorchidism in sons: a study within two | CLEP
https://www.dovepress.com/lifestyle-in-pregnancy-and-cryptorchidism-in-sons-a-study-within-two-l-peer-reviewed-fulltext-article-CLEP
In this large population-based study; maternal tobacco smoking during pregnancy and prepregnancy overweight and obesity were associated with a higher occurrence of cryptorchidism in sons. Our results indicated no associations between weekly alcohol consumption or caffeine intake during pregnancy and cryptorchidism at the levels consumed in these cohorts. […] We observed higher HR for cryptorchidism with higher exposure to maternal tobacco smoking during pregnancy, and compared to the unexposed, boys of mothers who smoked 10-14 cigarettes/day had the highest HRs for cryptorchidism (HR: 1.37; 95% CI: 1.06-1.76). Sons of obese mothers (BMI: 30 kg/m2) had the highest HR for cryptorchidism (HR: 1.32; 95% CI: 1.06-1.65).
#2 Prevalence of Undescended Testis in Tehran and the Main Risk Factors: A Cross-sectional Multicenter Study
https://brieflands.com/articles/amhsr-111132
Among 1,350 male infants who were evaluated, the prevalence of UDT was 0.81% (11 patients). […] There was a significant relationship between congenital anomalies and UDT, so that 33.3% of infants born with cryptorchidism had congenital malformation (P 0.01). […] In our study, all infants with UDT had other congenital anomalies. Previous studies have reported a strong association between cryptorchidism and an increase in the prevalence of congenital anomalies. […] However, our study showed a significant association between hypertension and UDT, while no association was observed between gestational diabetes and UDT.
#2 Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment? – Journal of Clinical Research in Pediatric Endocrinology
https://jcrpe.org/articles/epidemiology-classification-and-management-of-undescended-testes-does-medication-have-value-in-its-treatment/doi/Jcrpe.883
Genetic, hormonal, and anatomical factors are believed to be involved in the etiology of undescended testes. Due to increased risk of infertility, testicular cancer, torsion and/or accompanying inguinal hernia (90%) as well as cosmetic concerns, all these patients require treatment. […] Patients with undescended testes should be treated because of increased risk of infertility, testicular cancer, torsion and/or accompanying inguinal hernia (90%), as well as because of cosmetic concerns (1,5,7). […] According to the 2007 Consensus Report of Nordic countries, it is recommended that surgery is the first-line treatment modality in undescended testes and that it should be performed by pediatric surgeons and urologists at the age of 6-12 months. […] Undescended testis is present in about 1-4.5% of newborns with a higher incidence in preterms (30-45%) (1,2).
#2
https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Undescended-Testicles.aspx
Undescended testicles is the most common genital abnormality found at birth. About 1-3% of full-term boys have the condition at birth. But the rate is much higher in boys born preterm. About 30% of boys with a low birthweight (less than 5 pounds, 4 ounces) are born with undescended testicles. Those with a very low birthweight (less than 3 pounds, 4 ounces) have a near 100% chance of being born with undescended testicles. […] Undescended testicles are diagnosed through physical examination. At every well-child visit, the doctor will do a genital examination to check the location of the testicles. […] If your child’s testicle has not come down into the scrotum on its own by 6 months of age, they will likely need treatment. It is relatively rare for undescended testicles to fall into proper position after 6 months of age. So, there is usually little value to waiting.
#2 Comparison of diagnostic and treatment guidelines for undescended testis
https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2019.01438
Timely referral to a surgical specialist and timely surgical correction may improve fertility and decrease malignancy rates related to undescended testis. Primary caregivers should consider surgical specialist referral of patients with undescended testis if no descent occurs by 6 months, undescended testis is newly diagnosed after 6 months of age, or testicular torsion is suspected. The use of ultrasonography and other diagnostic imaging techniques is not recommended because they cannot add diagnostic accuracy or change treatment. Orchiopexy is recommended between 6 and 18 months at the latest. The fertility rate is low in patients with bilateral undescended testes, although orchiopexy is successful. The risk of testicular cancer in patients with undescended testis is increased compared to that in the general population. The original location of the testes and the age at orchiopexy are predictive factors for fertility and malignancy later in life. Self-examination after puberty is recommended to facilitate early cancer detection.
#2 Undescended testes: What general practitioners need to know
https://www1.racgp.org.au/ajgp/2019/january%E2%80%93february/undescended-testes
The literature has shown there may be an association between UDT and infertility, but it does not appear to be as great as once feared or as parents are often told, particularly for unilateral UDT. […] The risk of testicular cancer has been approximated at 2% in UDT; although this is four to five times the risk in the general population, parents can be reassured this is still relatively low. […] UDT is particularly associated with testicular seminoma, with a relative risk of 7.3. […] The tumours usually develop in young adults as germ cells rapidly multiply after puberty. […] Some studies have shown an increased risk of malignancy in the contralateral testis in unilateral UDT. […] UDT is a common disorder that affects 12% of boys and should be referred at three months of age. […] Investigations are not required prior to referral. […] Surgery remains the treatment of choice. […] Decreased fertility is largely a concern for bilateral UDT. Malignancy occurs at a higher rate but remains relatively low risk.
#2 Undescended Testicles (Cryptorchidism) | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/undescended-testes-cryptorchidism
Boys born with undescended testicles are also slightly more prone to testicular cancer, even after corrective surgery. […] Surgery is highly recommended in order to reduce the risk of cancer or infertility, to improve your son’s body image through adolescence and adulthood, and to reduce long-term effects and the risk of cancer or infertility. […] Undescended testicles may increase the risk of infertility, especially if both testicles are affected. However, boys who have one undescended testicle tend to father children at the same rate as those who are not affected by the condition at all. […] Boys who have two undescended testicles a much lower percentage of patients do have a significantly lower fertility rate. A child with undescended testicles is slightly more prone to develop testicular cancer, even after corrective surgery. However, surgery performed before puberty may reduce the risk of developing cancer.
#2 Management of cryptorchidism: a survey of clinical practice in Italy | BMC Pediatrics | Full Text
https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-12-4
Our study aim was to describe the clinical practice of cryptorchidism management in Italy before the publication of the Consensus by selecting a cohort of children born and treated before then, with the additional aim of divulgating the Consensus. […] Our results suggest that the spread of the Consensus guidelines on the management of cryptorchidism among all paediatricians is warranted in order to reduce age at orchidopexy and to have a more homogenous approach in the whole of Italy.
#3 Evaluation and Treatment of Cryptorchidism (2018) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline
Cryptorchidism or undescended testis (UDT) is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. The main reasons for treatment of cryptorchidism include increased risks of impairment of fertility potential, testicular malignancy, torsion and/or associated inguinal hernia. Cryptorchidism has evolved significantly over the past half century, with respect to both diagnosis and treatment. The current standard of therapy in the United States is orchidopexy (also referred to as orchiopexy in the literature), or surgical repositioning of the testis within the scrotal sac, while hormonal therapy has fewer advocates. Successful scrotal relocation of the testis, however, may reduce but does not prevent these potential long-term sequelae in susceptible individuals. The purpose of this guideline is to provide physicians and non-physician providers (primary care and specialists) with a consensus of principles and treatment plans for the management of cryptorchidism.
#3 Undescended testes: What general practitioners need to know
https://www1.racgp.org.au/ajgp/2019/january%E2%80%93february/undescended-testes
Undescended testis (UDT) is a common condition, and parents often primarily present to general practitioners. […] Management in a timely fashion may reduce the risk of malignancy and infertility. […] Undescended testis (UDT) is the second most common paediatric surgical condition after inguinal hernias. […] Five per cent of boys have a UDT at birth, 12% at three months and 1% at one year; hence, it is uncommon for testes to descend after three months. […] Emerging evidence suggests that UDT represents a disruption in the hormonally controlled testicular descent in fetal life and is probably secondary to a disturbance of intrauterine hormonal function. […] The prevalence in premature boys is up to 30.1%. […] Current guidelines recommend referral at 36 months for unilateral UDT, and orchidopexy between six and 12 months.
#3 Cryptorchidism – Wikipedia
https://en.wikipedia.org/wiki/Cryptorchidism
Cryptorchidism, also known as undescended testis, is the failure of one or both testes to descend into the scrotum. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis. However, about 80% of cryptorchid testes descend by the first year of life, making the true incidence of cryptorchidism around 1% overall. Undescended testes are associated with reduced fertility, increased risk of testicular germ-cell tumors, and psychological problems when fully-grown. Without intervention, an undescended testicle will usually descend during the first year of life, but to reduce these risks, undescended testes can be brought into the scrotum in infancy by a surgical procedure called an orchiopexy. […] The fertility reduction after orchiopexy for bilateral cryptorchidism is more marked, about 38%, or six times that of the general population.
#3 Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment? – Journal of Clinical Research in Pediatric Endocrinology
https://jcrpe.org/articles/epidemiology-classification-and-management-of-undescended-testes-does-medication-have-value-in-its-treatment/doi/Jcrpe.883
Genetic, hormonal, and anatomical factors are believed to be involved in the etiology of undescended testes. Due to increased risk of infertility, testicular cancer, torsion and/or accompanying inguinal hernia (90%) as well as cosmetic concerns, all these patients require treatment. […] Patients with undescended testes should be treated because of increased risk of infertility, testicular cancer, torsion and/or accompanying inguinal hernia (90%), as well as because of cosmetic concerns (1,5,7). […] According to the 2007 Consensus Report of Nordic countries, it is recommended that surgery is the first-line treatment modality in undescended testes and that it should be performed by pediatric surgeons and urologists at the age of 6-12 months. […] Undescended testis is present in about 1-4.5% of newborns with a higher incidence in preterms (30-45%) (1,2).
#3
https://step2.medbullets.com/pediatrics/120601/cryptorchidism
Most common disorder of sexual differentiation in boys […] incidence of 3-4% in full term infants […] more common in preterm infants […] bilateral in 10% of cases.
#3 Pediatric Cryptorchidism Surgery: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/1017420-overview
Other predisposing factors include low birth weight, small size for gestational age, twin pregnancy, and maternal estrogen exposure. […] Cryptorchidism is found in 7% of siblings and in about 2% of fathers of babies with this condition. […] Cryptorchidism affects only males and has no reported racial predilection.
#3 Undescended Testis | Pediatric Urology Book
https://pediatricurologybook.com/book/chapters/05-28_undescended-testis/
Undescended testis is one of the most common congenital anomalies of the male newborn child. The risk of undescended testes is 3.5 fold higher in males with a sibling with undescended testes, and 2.3 fold higher in males with a father with the condition. Incidence in the full-term neonates is reported to be 1.0-4.5% and unilateral cases are 2 times more common than bilateral cases. About 70% of cryptorchids descend at 3 mo of age under influence of mini puberty and the incidence of undescended testis decreases to 0.8-1.2% at 1 year of age. […] The goal of treatment for undescended testicles is to lower the risk of infertility by minimizing the histological degeneration of the testicles by placing the testicles into the scrotum at an early stage and to make it easier to detect testicular cancer, which has a higher incidence than normally descended one. In addition, the secondary goal is to correct the accompanying lesions, prevent complications such as testicular torsion, alleviate the psychological impact of the patient, and improve the cosmesis. Until now, it has been recognized that orchiopexy cannot prevent testicular cancer, but recently, it has been reported that early surgery can lower the risk of testicular cancer. The timing of treatment for undescended testicles is important. Orchiopexy should be performed after 6 months of age and within the subsequent year, and by age eighteen months at the latest.
#3 Undescended testes: What general practitioners need to know
https://www1.racgp.org.au/ajgp/2019/january%E2%80%93february/undescended-testes
The literature has shown there may be an association between UDT and infertility, but it does not appear to be as great as once feared or as parents are often told, particularly for unilateral UDT. […] The risk of testicular cancer has been approximated at 2% in UDT; although this is four to five times the risk in the general population, parents can be reassured this is still relatively low. […] UDT is particularly associated with testicular seminoma, with a relative risk of 7.3. […] The tumours usually develop in young adults as germ cells rapidly multiply after puberty. […] Some studies have shown an increased risk of malignancy in the contralateral testis in unilateral UDT. […] UDT is a common disorder that affects 12% of boys and should be referred at three months of age. […] Investigations are not required prior to referral. […] Surgery remains the treatment of choice. […] Decreased fertility is largely a concern for bilateral UDT. Malignancy occurs at a higher rate but remains relatively low risk.
#3 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. About 1%2% of boys older than 6 months have undescended testes after their early postnatal descent. 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. Routine hormonal therapy is not recommended for undescended testis due to a lack of evidence. 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.
#3 Cryptorchidism – Pathophysiology – Managment – TeachMePaediatrics
https://teachmepaediatrics.com/surgery/urology/cryptorchidism/
Around 20% of undescended testis are impalpable and are therefore: ectopic, intra-abdominal, absent, or impalpably small. […] Impaired fertility as testis are 2-3 C warmer if intra-abdominal, this can effect spermatogenesis. […] 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. […] Undescended testis are at higher risk of torsion.
#3 Comparison of diagnostic and treatment guidelines for undescended testis
https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2019.01438
Timely referral to a surgical specialist and timely surgical correction may improve fertility and decrease malignancy rates related to undescended testis. Primary caregivers should consider surgical specialist referral of patients with undescended testis if no descent occurs by 6 months, undescended testis is newly diagnosed after 6 months of age, or testicular torsion is suspected. The use of ultrasonography and other diagnostic imaging techniques is not recommended because they cannot add diagnostic accuracy or change treatment. Orchiopexy is recommended between 6 and 18 months at the latest. The fertility rate is low in patients with bilateral undescended testes, although orchiopexy is successful. The risk of testicular cancer in patients with undescended testis is increased compared to that in the general population. The original location of the testes and the age at orchiopexy are predictive factors for fertility and malignancy later in life. Self-examination after puberty is recommended to facilitate early cancer detection.
#4 Undescended testes: What general practitioners need to know
https://www1.racgp.org.au/ajgp/2019/january%E2%80%93february/undescended-testes
Undescended testis (UDT) is a common condition, and parents often primarily present to general practitioners. […] Management in a timely fashion may reduce the risk of malignancy and infertility. […] Undescended testis (UDT) is the second most common paediatric surgical condition after inguinal hernias. […] Five per cent of boys have a UDT at birth, 12% at three months and 1% at one year; hence, it is uncommon for testes to descend after three months. […] Emerging evidence suggests that UDT represents a disruption in the hormonally controlled testicular descent in fetal life and is probably secondary to a disturbance of intrauterine hormonal function. […] The prevalence in premature boys is up to 30.1%. […] Current guidelines recommend referral at 36 months for unilateral UDT, and orchidopexy between six and 12 months.
#4 Cryptorchidism – Wikipedia
https://en.wikipedia.org/wiki/Cryptorchidism
One of the strongest arguments for early orchiopexy is reducing the risk of testicular cancer. About one in 500 men born with one or both testes undescended develops testicular cancer, roughly a four- to 40-fold increased risk. […] The risk of malignancy in the undescended testis is 4 to 10 ten times higher than that in the general population and is about one in 80 with a unilateral undescended testis and one in 40 to one in 50 for bilateral undescended testes.