Materiały źródłowe

• #1 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: […] 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). It can be done through a small cut in the groin, the scrotum or both. […] 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. Earlier treatment is better. Experts often recommend that surgery take place before the child is 18 months old. […] The timing for when your baby gets surgery will depend on many factors. These include the baby’s health and how hard the procedure might be to do. Your surgeon will likely suggest doing the surgery when your baby is somewhere between 6 and 18 months old. Early treatment with surgery seems to lower the risk of later health problems.

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

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

  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. Surgery with two undescended testicles brings less of an improvement. Surgery also might lower the risk of testicular cancer, but it doesn’t get rid of the risk. […] With hormone treatment, your child is given shots of a hormone called human chorionic gonadotropin. This could cause the testicle to move to the scrotum. But hormone treatment often is not recommended, because it’s much less effective than surgery.

• #2

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

  Undescended testicles will usually move down into the scrotum naturally by the time your child is 3 to 6 months old. […] If the testicles don’t descend by 6 months, it’s very unlikely they will without treatment. […] In this case, a surgical procedure called an orchidopexy will be recommended to reposition one or both testicles. […] The operation should ideally be carried out before your child’s 12 months old. […] This is because waiting longer than this may increase a boy’s risk of developing fertility problems (infertility) or testicular cancer later in life. […] In most cases, if the testicle can be felt in the groin, a simple orchidopexy can be performed. […] This involves first making a cut (incision) in the groin to locate the undescended testicle. […] The testicle is then moved downwards and repositioned in the scrotum through a second incision.

• #2

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

  If the testicle is thought to be higher in the tummy (abdomen), a type of keyhole surgery known as a laparoscopy is sometimes carried out to locate it before it’s repositioned. […] 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. […] When the procedure is complete, the incisions are usually closed with dissolvable stitches that don’t need to be removed. […] 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.

• #2

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

  The success rate for treating palpable testicles located near the scrotum is estimated to be higher than 90%. […] 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.

• #3 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. […] Observation is not recommended beyond one year of age because it delays treatment, lowers the rate of surgical success and probably impairs spermatogenesis. […] Therapy for an undescended testicle should begin between six months and two years of age and may consist of hormone or surgical treatment. […] Recent improvements in surgical technique, including laparoscopic approaches to diagnosis and treatment, hold the promise of improved outcomes. […] The rationale for treatment of the undescended testicle is the prevention of potential sequelae. […] Treatment for cryptorchidism can be hormonal, surgical or a combination of the two.

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

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

  Administration of systemic testosterone is minimally effective in achieving testicular descent because the process depends on a paracrine effecthigh local levels of testosterone that cannot be achieved systemically. […] In the United States, the only hormone labeled for the treatment of cryptorchidism is hCG, which is administered intramuscularly. […] Studies suggest that gonadotropin-releasing hormone (GnRH) is more effective than hCG in achieving testicular descent. […] The inguinal orchiopexy is a well-established operation for the palpable undescended testicle. […] The most significant complication of orchiopexy is testicular atrophy. […] Orchiopexy should be performed by urologists who are well versed in the surgical procedure and the management of complications. […] Surgery for the nonpalpable testicle is diagnostic and potentially therapeutic. […] The two initial surgical approaches to the nonpalpable testis are the open inguinal and diagnostic laparoscopic techniques.

• #4 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. […] 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. Theyll also make a small incision in your childs scrotum and create pockets to hold the testicles in place. If they discover the undescended testicles dont work, they may remove them. […] 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.

• #5 Current Management of Undescended Testes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4856300/

  Hormonal therapy is not recommended for treatment of UDTs due to its low success rate, the incidence of secondary re-ascent, and the possible detrimental effects on spermatogenesis. […] The rationale for the treatment of cryptorchidism is to reduce the risk of its long term sequelae, including progressive subfertility/infertility, testicular neoplasms, torsion and cosmetic concerns. […] Orchiopexy has been the mainstay of treatment for cryptorchidism in the US. […] Primary hormonal therapy is another treatment modality that has been used to induce testicular descent, although this has been more widely practiced outside of the United States. […] Success rates from hormonal therapy are extremely variable. […] Therefore, the recent AUA guidelines as well as the Nordic consensus panel recommend against the use of hormonal therapy to facilitate testicular descent. […] Recommendations for the age at which orchiopexy should be performed have decreased over time. […] Therefore, referral to a surgical specialist for congenital cryptorchidism should occur at 6 months (corrected for gestational age), to facilitate correction within the next year.

• #5 Current Management of Undescended Testes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4856300/

  Undescended testes (UDTs) are a relatively common finding in newborn males, especially in those born prematurely. […] Patients with UDTs diagnosed after 6 months of age should be referred to a specialist for correction so that surgery may be performed within 1 year thereafter. […] The surgical approach is often dependent on the location of the testis on physical exam. […] Most orchiopexies for palpable testes are performed through an inguinal incision, although a scrotal approach can be safely utilized depending on the testis position. […] 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.

• #6 Cryptorchidism Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Cryptorchidism should be treated when the patient is approximately 6 months old. This age recommendation has been pushed up over recent decades and is based on (1) the rarity of spontaneous descent after age 6 months and (2) the possible improvements in fertility that early intervention may confer. The choice of initial treatment is a reflection of the preference of both physician and the patient or the patients caretaker(s). […] Regular re-examination of successful descent is necessary, as re-ascent can occur in up to 25% of treated children; however, a Swedish study of children treated for undescended testis with orchidopexy reported a 6% rate of re-ascent and an atrophy rate of 0.15%. […] American Urological Association guidelines recommend against the use of hormonal therapy to induce testicular descent, due to low response rates and lack of evidence for long-term efficacy.

• #6 Cryptorchidism Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  The success rates by surgical approach were as follows: Inguinal orchiopexy: 89%, Microvascular orchiopexy: 84%, Transabdominal orchiopexy: 81%, Staged Fowler-Stephens orchiopexy: 77%, Standard Fowler-Stephens orchiopexy: 67%. […] The success rate of 56% with GnRH was increased to 65% with the addition of hCG. […] A systematic review and meta-analysis found that atrophy and complication rates do not appear different between orchiopexy performed before or after 1 year of age, but fertility potential may be better with early orchidopexy.

• #6 Cryptorchidism Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  In summary, hormonal treatment yields an overall efficacy rate of less than 20% for undescended testes. The decision to use hormonal treatment depends on the pretreatment location of the testis. […] Treatment with GnRH has also been used as an adjunct to orchiopexy, to increase fertility. […] Successful surgical placement of the testis in the scrotum is based on the principles originally described by Bevan in 1899. […] According to a study of 51 formerly cryptorchid subjects who had undergone surgery in the first 2 years of life, sperm count and motility were normal in more than 95% at 18-26 years of age, with even better fertility prognosis if orchiopexy was performed during the first year of life (96.3% for both normal sperm count and sperm motility). […] Definitive surgical therapy should be performed between ages 6 and 12 months.

• #7 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. 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. […] Providers should not use hormonal therapy to induce testicular descent as evidence shows low response rates and lack of evidence for long-term efficacy. In the absence of spontaneous testicular descent by six months (corrected for gestational age), specialists should perform surgery within the next year. In prepubertal boys with palpable, cryptorchid testes, surgical specialists should perform scrotal or inguinal orchidopexy. In prepubertal boys with nonpalpable testes, surgical specialists should perform examination under anesthesia to reassess for palpability of testes. If nonpalpable, surgical exploration and, if indicated, abdominal orchidopexy should be performed. […] 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.

• #8 Undescended Testicle | Children’s Hospital Pittsburgh

  https://www.chp.edu/our-services/urology/conditions/undescended-testicle

  Treatment for the undescended testicle depends on the location of the testis. […] The usual recommendation is for an operation called anorchidopexy or orchidopexy. […] Recovery is generally very rapid and success can be expected to be good. […] An alternative is hormonal treatment with HCG. […] It is important to know that not all undescended testes are the same. […] Many of these testicles can be approached with a single incision through the scrotum, hopefully resulting in less post-operative discomfort as well as one less surgical scar. […] If the testicle cannot be felt by the doctor, it is called an „impalpable” testis. […] Generally, surgery is required to make that determination. […] The operation that is most accurate in locating these testicles is called a laparoscopy.

• #8 Undescended Testicle | Children’s Hospital Pittsburgh

  https://www.chp.edu/our-services/urology/conditions/undescended-testicle

  There are several reasons that we recommend treatment for persistently undescended testicles. […] First, it is well known that testicles are in the scrotum because this is a cooler location than other places in the body. […] Bringing the testicle into the scrotum early might preserve these cells and, therefore, improve chances for fertility in the future. […] Second, testicles that are undescended have a higher risk of developing testicular cancer than those that descended spontaneously. […] Bringing the testis into the scrotum allows more accurate examination-both by doctors and by the young man himself-and, therefore, will result in earlier detection of these tumors if they should occur. […] A third reason to fix undescended testicles is because of the hernia that is often associated with them.

• #9 Undescended Testicle Causes and Treatment | UPMC

  https://www.upmc.com/services/urology/conditions/undescended-testicle

  There are several reasons that UPMC pediatric urologists recommend treatment for persistently undescended testicles: […] Treatment for the undescended testicle depends on the location of the testis. […] For testes that can be felt in the groin area, the usual recommendation is an operation called anorchiopexy or orchidopexy. This literally means „fixing the testis.” […] An alternative is hormonal treatment with HCG, a series of injections that stimulate the testicles to make hormones. […] If the testicle cannot be felt by the doctor, it is called an „impalpable” testis (which simply means „cannot be felt”). […] Unfortunately, there is no reliable x-ray that can tell us whether a testis is in the abdomen. Generally, surgery is required to make that determination. […] The most accurate operation to locate these testicles is a laparoscopy, a procedure in which a telescope is placed into the abdomen through a small incision near the navel. […] Options are different for adults with an undescended testicle. Bringing the testicle down to the scrotum will probably not affect fertility and, therefore, an undescended testicle might simply be removed.

• #10 Undescended Testis | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/u/undescended-testis

  There are several possible procedures to correct this condition depending upon the location of the testicle and the distance to the scrotal sac. An orchidopexy is an outpatient procedure which requires general anesthesia. This is performed when the surgeon can feel the testicle in the groin. A small incision is made in the groin; the testicle is located, freed from restrictive tissues, positioned and anchored in the scrotum. The passage way is then stitched closed to prevent re-ascent. A laparoscopic orchidopexy procedure is frequently performed when you cannot feel the testicle on physical exam. Sometimes, the testicle is too malformed to be saved. It may have twisted sometime prior to the child’s birth and lost its blood supply. During surgery, the remaining non-functional tissue is removed. The other testicle is secured in its scrotal sac to prevent testicular torsion of that testicle. If the malformed testicle is removed, a prosthesis (an artificial replacement) can be placed in the scrotum after puberty. A testicular auto-transplant is indicated when the testicle is located very high in the abdomen and the blood vessels and other necessary structures are neither ample nor elastic enough to be stretched to the scrotum. The testicle must be „auto-transplanted” into the scrotum with all the necessary blood vessels and structures first cut and then reconnected.

• #11 Surgery for Undescended Testicles | NYU Langone Health

  https://nyulangone.org/conditions/undescended-testicles-in-children/treatments/surgery-for-undescended-testicles

  Many infants with undescended testicles, which is also referred to as cryptorchidism, do not need treatment, because the testicles move to the scrotum within the first few months of life. But if a boys testicles have not descended by age 6 to 12 months, NYU Langone pediatric urologists recommend surgery to move them into the scrotum. […] If a boys undescended testicles are palpable, or able to be felt by a doctor, a pediatric urologic surgeon may perform a surgical procedure called an orchiopexy to reposition them. An orchiopexy is an outpatient procedure that takes place in the hospital and requires general anesthesia. […] Most boys only need one surgery to correct this condition. […] Complications of orchiopexy are rare but may include bleeding and infection. […] NYU Langone doctors typically recommend a follow-up visit 10 to 14 days after surgery. During this appointment, they determine if your child is feeling better and healing well.

• #12

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zy1328

  After surgery, your child may feel tired. […] Your child may also have pain, swelling, or bruises in the groin area. Medicines can help with pain. […] Your child should be able to go back to school or daycare in 2 or 3 days. […] Your doctor will tell you if and when your child can restart his or her medicines. […] Have your child take medicines exactly as prescribed. […] If your doctor prescribed antibiotics, be sure your child takes them as directed. Your child should not stop taking them just because he feels better. Your child needs to take the full course of antibiotics. […] Follow-up care is a key part of your child’s treatment and safety. […] Call your doctor or nurse advice line now or seek immediate medical care if: Your child has pain that does not get better after he takes pain medicine. […] Watch closely for changes in your child’s health, and be sure to contact your doctor or nurse advice line if your child has any problems.

• #13 Surgery for an Undescended Testicle | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/surgery-undescended-testicle

  If your child’s testicle doesnt descend on its own, it should be treated to prevent future problems. Surgery is done to bring an undescended testicle into the normal position within the scrotum. […] The testicle is brought down into the scrotum during surgery. […] Your child will most likely go home a few hours after surgery. They should be feeling better in 2 to 3 days. […] Most children will have one incision in the groin and a second incision in the scrotum. These are closed with skin glue. […] It’s normal for the scrotum to appear swollen and bruised around the scrotal incision. This will all resolve with time and usually appear much better in a week. […] Light activity is fine, but your child should not participate in strenuous activities like sports for 3 to 4 weeks after surgery, or as directed by your child’s healthcare provider.

• #14 Orchiopexy: Purpose, Surgery, Risks & Recovery

  https://my.clevelandclinic.org/health/treatments/17297-orchiopexy

  Orchiopexy is surgery to treat undescended testicles. A surgeon performs it when your baby is between six and 24 months old if their testicles haven’t moved into their scrotum yet. Healthcare providers use orchiopexy to treat undescended testicles and testicular torsion. An orchiopexy is surgery to move undescended testicles or to treat testicular torsion. To treat undescended testicles, a surgeon moves them from inside your child’s belly (abdomen) or groin area and attaches them inside the scrotum (the pouch of skin below your penis). If your child’s testicles don’t descend on their own by the time they’re about 6 months old, healthcare providers recommend orchiopexy between 6 and 24 months of age. An orchiopexy corrects two conditions: Undescended testicles. This is when a fetus or baby’s testicles don’t drop (descend) from inside their belly into their scrotum before birth or in the first few months of life. The surgeon may also need to repair hernias or put in an artificial testicle (testicular prosthesis) during surgery. An orchiopexy takes about an hour in most cases. After orchiopexy, providers will move you or your child to a recovery room. Orchiopexy is an outpatient procedure. So most of the time, you don’t have to stay at the hospital overnight. Advantages of orchiopexy include: Health benefits. An orchiopexy may help prevent infertility. It also helps you check yourself for testicular cancer when you’re older. Most adults and kids older than a year can resume normal activities about two or three days after an orchiopexy. But someone who’s had an orchiopexy shouldn’t participate in sports or rough physical activity for at least two weeks. If you’ve had an orchiopexy, you’ll probably have pain or discomfort for a few days to a week. The stitches should dissolve in about two weeks. Schedule a follow-up appointment with your pediatrician or surgeon two weeks after an orchiopexy. You may need to schedule another follow-up two to three months later.

• #15 Undescended testicle repair: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003002.htm

  Undescended testicle repair is surgery to correct testicles that have not dropped down into the correct position in the scrotum. […] Undescended testicle repair surgery is recommended for males whose testicles do not descend on their own. […] The surgery is done while the child is asleep (unconscious) and pain-free under general anesthesia. […] In some cases, the procedure can be done laparoscopically. This involves smaller surgical cuts. […] This surgery is recommended for infants older than 1 year whose testicles have not descended into the scrotum (cryptorchidism). […] Risks of this surgery include: Shrinkage of the testicle or failure of the testicle to grow to normal size. […] Undescended testicle repair is successful in most cases. A small percentage of men will have fertility problems. […] Men who have had undescended testicles should do monthly self-exams for the rest of their lives to look for possible tumors. […] The surgery may be done on an outpatient basis. Bed rest is recommended for the first 2 to 3 days. Avoid strenuous activity, including bicycling, for at least 1 month.

• #16 Evaluation and Treatment of Cryptorchidism | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/undescended-testicle/research

  We assessed the effectiveness of imaging for identifying and correctly locating testicles, the use of hormonal stimulation for treatment planning and hormones for achieving testicular descent, and choices among surgical treatments, including surgical approach (open vs. laparoscopic). […] Hormonal treatment is associated with testicular descent in some children, but rates generally do not exceed those seen with placebo by more than 10 percent. Surgical treatment for cryptorchidism is associated with success rates of testicular descent that range from 33 percent to 100 percent, depending on type of surgery. […] Hormonal stimulation testing may predict anorchia, but evidence is insufficient, with only two studies of fewer than 50 participants. Hormonal treatment is marginally effective relative to placebo, but it is successful in some children and has minimal side effects, suggesting that it may be an appropriate trial of care for some patients. Surgical options are effective, with high rates of testicular descent (moderate strength of evidence for Fowler-Stephens procedures, high for primary orchiopexy). Comparable outcomes occur with laparoscopic and open approaches.

• #17 Frontiers | Surgical treatment of cryptorchidism: current insights and future directions

  https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1327957/full

  Surgical treatment of cryptorchidism: current insights and future directions. Cryptorchidism presents with an incidence of 1-5% with potential long-term implications on future fertility and overall health. This review focuses on surgical treatment modalities, their impact on testicular development, and function while addressing the Nordic consensus statement as well as current European Association of Urology (EAU) and American Urological Association (AUA) guidelines. Early diagnosis by clinical examination enables timely treatment. Following guidelines, orchidopexy is recommended between 6-12 months of age for congenital cryptorchidism. Evidence increasingly suggests the benefits of early surgery for promoting testicular health and fertility potential. Current surgical options range from open to laparoscopic techniques, with the choice largely determined by the location and accessibility of the undescended testicle. More research is needed to explore both the potential and limitations of hormonal therapy, which is secondary to surgical treatment and can selectively have a role as adjunct to surgery. Long-term follow-up is imperative to evaluate fertility outcomes, risk of testicular malignancy, and psychological impact. Early recognition and surgical repair before 1 year of age remain the most important intervention to reduce the negative impact of both unilateral and bilateral cryptorchidism. Current evidence advocates for physical assessment as the primary investigative method. 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. The EAU, like the AUA guidelines, does not recommend hormonal therapy as the primary treatment for undescended testes. The Nordic Consensus guidelines aligns in highlighting its limited efficacy and potential adverse reactions during childhood. Orchidopexy remains a cornerstone in pediatric urologic surgery, constantly evolving in technique and approach. The role of hormonal therapy for cryptorchidism remains controversial. While hormonal therapy may offer some therapeutic benefit, potential risks like infertility and surgical delays cannot be ignored and warrant further investigation.

• #18 Undescended testis and infertility—Is hormonal therapy indicated? – Hollowell – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/5173/html

  The purpose of this chapter is to review hormonal therapy in cryptorchidism in boys to improve fertility. […] Current data is insufficient to know if hormonal therapy is efficacious in bilateral UDT. […] Hormonal therapy should not be used in childhood to improve fertility in cases of unilateral cryptorchidism. […] More data are needed to answer whether hormonal therapy is beneficial in bilateral UDT. […] The AUA Guideline published in August 2014 noted that no studies on long term fertility outcomes following hormonal therapy alone were found. […] This guideline did not recommend hormonal treatment to improve fertility in boys with cryptorchidism. […] I believe there is adequate data to conclude that hormonal therapy is not useful in unilateral cryptorchidism. […] In bilateral cryptorchidism, there is a significant risk of infertility and a prospective randomized controlled trial to evaluate hormonal treatment or other treatment is needed.

• #19

  https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Undescended-Testicles.aspx

  Since the chances of the testicle coming down on its own is slim after 6 months old, your child should be referred for treatment once they’ve reached that age. Waiting beyond 2-3 years may hinder the testicle’s ability to grow and function normally. Ideally, orchiopexy should be done within the first 18 months of life. […] For teenagers with an undescended testicle that has never been fixed, your specialist may suggest biopsy of the testicle to look for cancerous cells.

• #20 Cryptorchidism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470270/

  Surgery is recommended promptly following diagnosis for acquired undescended testes (those identified as normal before diagnosis) and entrapped undescended testes (those occurring after hernia repair). […] For palpable undescended testes, performing an inguinal or scrotal orchiopexy is recommended. […] The selection of a surgical approach depends on the surgeon’s specific training, experience, skill level, and personal preference. […] If no testis is located during exploratory laparoscopy, it becomes crucial to ascertain the presence of either blind-ending vessels or a testicular nubbin to rule out a missing testis definitively. […] Patients with bilateral undescended testes who undergo orchidopexies as adults are almost invariably infertile and exhibit azoospermia.

• #21 Undescended Testicle in an Adult Male | United Urology

  https://www.unitedurology.com/conditions-treatments/for-men/undescended-testicle-in-an-adult-male/

  In adult males who have not been treated for an undescended testicle as children, reduced fertility, as well as a higher incidence of testicular cancer, is of increased concern. […] Most doctors agree that moving the testicle into the scrotum in an adult male under the age of 40 will not improve its ability to produce sperm and usually recommend that the testicle be surgically removed. […] After the age of 40, most doctors recommend that the testicle is left alone. […] Any adult male with an undescended testicle should consult a urologist to discuss the best course of action based on medical history.

• #22 Treatment for undescended testicle in adults

  https://thefertilitycentermexico.com/en/blog/cryptorchidism-male-fertility/

  Treatment for undescended testicles in adults has been a great source of research for the last decade. Current treatment regimens are based on research. […] Through intensive research, fertility experts have found that treating adult men with cryptorchidism doesn’t improve sperm production. Removal of the testicle, especially in men over forty, is often recommended. This is a very personal decision that you and your urologist should discuss in detail. […] It is currently recommended that all adult males with cryptorchidism do a monthly testicle exam to catch testicular cancer as early as possible.

• #22 Treatment for undescended testicle in adults

  https://thefertilitycentermexico.com/en/blog/cryptorchidism-male-fertility/

  If untreated, there is an increased chance of infertility by 30% if only one testicle is undescended and 65% in the case of both testicles being undescended. Untreated into adulthood, the chances of infertility jump to 90%! […] Cryptorchidism is treated for two reasons. The first is that the affected testicle may not produce sperm. Boys can lose their ability to produce sperm as young as twelve months old! The longer the testicle remains undescended, the increased chance of the condition worsening. […] The second is that the affected testicle has a greater chance of testicular cancer, which is usually found by men when they palpate their scrotum. […] One functioning testicle can create the amount of testosterone needed to maintain a male’s erection, ejaculation, sexual function, and sex drive. He will have enough sperm to fertilize an egg, but the quality of the semen produced may be lower. Men with an undescended testicle can still impregnate their partner. Unfortunately, their fertility is only 50%. Having the surgery as a child increases their fertility as if they never had the condition!

• #23 Management of cryptorchidism in adolescent and adult males | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-020-00051-8

  The current AUA guidelines with reference to the post-pubertal patients are as follows: In the post-pubertal child with cryptorchidism, consideration should be given to performing an orchiectomy or biopsy. […] In boys with a normal contralateral testis, surgical specialists may perform an orchidectomy (removal of the undescended testis) if a boy has a normal contralateral testis and either very short testicular vessels and vas deferens, dysmorphic or very hypoplastic testis, or post-pubertal age. […] For the UDT in the post-pubertal patient who has a normal contralateral testis, discuss orchidectomy because of the theoretical risk of later malignancy. […] The apparent loss of function and malignant potential of the UDT have swayed many authors towards doing orchidectomy for the adult patient, rather than orchidopexy. […] With advances in medical care and improvement of patient compliance, there may be a case to be made for managing selected adult patients presenting with UDT, by means of orchidopexy rather than orchidectomy.

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

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

  Correction of associated hernia: A patent processus vaginalis is found in more than 90% of patients with undescended testis. […] Treatment recommendations for postpubertal men are as follows: Men younger than 32 years with a unilateral undescended testis and normal contralateral testis should undergo orchiectomy. […] Men older than 32 years with a unilateral undescended testis should receive close observation and physical examination. If examination is difficult, orchiopexy or orchiectomy should be considered; this recommendation is based on the relative risk of testicular cancer along with the risks associated with anesthesia.

• #25 Undescended Testicles – Treatment | familydoctor.org

  https://familydoctor.org/condition/undescended-testicles/

  Undescended testicle treatment […] There are several reasons to treat an undescended testicle. First, undescended testicles may not make sperm. Testicles are in the scrotum because the temperature is cooler there than it is inside the body. A cooler temperature helps the testicles make sperm. A baby boy with an undescended testicle can start to lose the ability to make sperm by 12 months of age. […] Second, an undescended testicle is more likely to develop a tumor. When the testicle is inside the scrotum, a doctor can feel it to check for a tumor. This leads to early detection and treatment of testicular cancer. […] Getting the testicle down into the scrotum early in life can lead to better outcomes. There are several treatment options for an undescended testicle. For babies who have retractile testes, the testicle will often descend on its own.

• #26 Undescended testicles | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/undescended-testicles/

  The method of treatment depends on the suspected cause. If the doctors suspect the testicles have not descended due to a hormone problem, they may suggest a short course of a hormone called human chorionic gonadotrophin (hCG). This is more likely to be suspected if neither testicle has descended. […] If the doctor does not suspect a hormone problem, or if the testicles remain in the abdomen after the hormone treatment, the child will need a short operation under general anaesthetic called an orchidopexy. […] Undescended testicles are best treated in early childhood, usually just before or around one year of age. The childs testicles will need treatment as they do not seem to mature properly if left in the abdomen. […] The amount of sperm and fertility levels seem lower in men who have had undescended testicles, and even lower if they were not treated early in childhood. This is because the testicles need to be a few degrees cooler than the rest of the body to produce sperm.

• #27 Recovery & Support for Undescended Testicles | NYU Langone Health

  https://nyulangone.org/conditions/undescended-testicles-in-children/support

  NYU Langone pediatric urologists offer guidance to the families of boys who have had surgery to correct undescended testicles. […] The success rate for surgery to correct undescended testicles is greater than 96 percent. Treatment before age 2 is recommended to help lower a boys risk of developing changes in the testicle that can possibly result in infertility. […] Although surgery may reduce the risk of testicular cancer, it does not eliminate it. […] Boys who have had surgery to correct two undescended testicles may experience infertility in adulthood, depending on the location of the testicles prior to surgery.

• #28 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. […] Current evidence does not support the use of ultrasonography prior to referral. Hormone therapy has shown no significant benefit, and surgery remains the treatment of choice. […] Current guidelines recommend referral at 36 months for unilateral UDT, and orchidopexy between six and 12 months. […] Examination under anaesthesia and diagnostic laparoscopy is the treatment for impalpable testes. […] If the testis is palpable within the inguinal canal or at the deep inguinal ring under anaesthetic, a single-stage operation can be successful in up to 90% of cases. […] Hormonal treatment with gonadotrophin-releasing hormone or human chorionic gonadotropin has been investigated but has not proven efficacious in promoting testicular descent. […] 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. […] Surgery remains the treatment of choice.

• #29 Undescended testicles | healthdirect

  https://www.healthdirect.gov.au/undescended-testicles

  Undescended testicles are when one or both of a babys testes have not fully come down into their scrotum. […] If they dont descend by 6 months, its important to get treatment to prevent future health problems. […] If the testicles have not descended by 3 to 6 months, they are unlikely to come down by themselves. […] In most cases, surgery will be recommended if: the testes dont descend by themselves; your child develops an undescended testicle. […] The operation for undescended testicles is called orchidopexy. During the procedure, the surgeon gently stretches the spermatic cord and brings the testicle down into the scrotum. […] Your doctor will discuss with you the need for follow-up appointments and advise on regular testicular examinations. […] It’s important to treat undescended testes. Problems that can arise from undescended testicles include the following. […] An increased risk of testicular cancer (although this is uncommon, affecting fewer than 1 in 100 boys with undescended testes).

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

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

  If your son’s testicle does not descend on its own before his first birthday, his surgeon will most likely recommend a type of surgery called orchiopexy to move the testicle down into the scrotum. […] 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. In most cases, doctors are able to repair an undescended testicle with a single, simple operation at around 12 months of age. […] 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.

• #31 Undescended Testis – BetterKids

  https://betterkids.com.au/conditions/undescended-testis/

  An undescended testis, also known as cryptorchidism, is a condition where one or both of a male infant’s testicles do not descend into the scrotum before birth. […] The treatment for undescended testes is an operation called orchidopexy, which moves the undescended testis into the scrotum. […] Yes, in most cases. […] The main reasons for treatment include the following. […] The testicles need to be in the scrotum where it is cooler, which is important for producing healthy sperm. […] There is a slightly higher risk of testicular cancer in boys with undescended testes. […] An undescended testis has a higher risk of twisting, which cuts off its blood supply, a condition known as testicular torsion. […] There’s also a higher risk of developing an inguinal hernia, where part of the intestine bulges into the groin area.

• #32 Cryptorchidism | Patient Care

  https://weillcornell.org/services/urology/pediatric-urology/conditions-we-treat/cryptorchidism

  Laparoscopy can be used to localize nonpalpable, undescended testes. The laparoscopy is performed first to find out if the testicle is located in the abdomen or if it is congenitally absent. If the testis is low in the abdomen, an orchidopexy is performed laparoscopically. […] Long-term issues include infertility and tumorigenesis. After the initial post-operative visits, children should be seen 1 year after surgery to note the location and size of the testes.

• #33 Undescended Testicle Repair – UF Health

  https://ufhealth.org/conditions-and-treatments/undescended-testicle-repair

  Undescended testicle repair is surgery to correct testicles that have not dropped down into the correct position in the scrotum. […] Undescended testicle repair surgery is recommended for males whose testicles do not descend on their own. […] This surgery is recommended for infants older than 1 year whose testicles have not descended into the scrotum (cryptorchidism). […] Undescended testicle repair is successful in most cases. […] Men who have had undescended testicles should do monthly self-exams for the rest of their lives to look for possible tumors. […] Bringing the testicles down will make it easier to monitor for tumor growth in the future.

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

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

  If the testes do not descend at 6 months of age, the probability of spontaneous descent thereafter is low. International guidelines recommend surgical specialist referral from primary caregivers if descent does not occur by 6 months, or if undescended testis is newly diagnosed after 6 months of age. […] To protect fertility potential and decrease malignant changes, surgical exploration and orchiopexy are recommended between six and 18 months of age. Timely referral to a surgical specialist and timely surgical correction may improve fertility and decrease malignancy rates related to undescended testis.

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