Materiały źródłowe

• #1 Cryptorchidism – StatPearls – NCBI Bookshelf

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

  Cryptorchidism, the most prevalent congenital condition involving male genitalia, is characterized by the absence of at least one testicle from the scrotum; this often manifests unilaterally or bilaterally, with a higher frequency of involvement observed in the right testicle. […] Untreated cryptorchidism can lead to potential long-term complications such as fertility issues, testicular cancer, testicular torsion, inguinal hernias, and psychological impacts. […] If the testis has not descended by 6 months, surgical correction through orchiopexy is recommended to minimize risks and potential complications. […] Approximately 20% to 30% of undescended testes are nonpalpable. […] Spontaneous descent is unlikely if the testis has not descended by 6 months, and surgical correction should be considered.

• #1 Cryptorchidism – StatPearls – NCBI Bookshelf

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

  Experts believe that a combination of genetics, maternal factors, and environmental influences may disrupt the hormonal and physical processes that influence testicular development and descent. […] The primary hormone utilized for hormone therapy is hCG. […] According to the AUA guidelines, surgery is advised for congenital undescended testes between the ages of 6 and 18 months. […] Many specialists endorse early surgical intervention, often around 6 months, to optimize testicular growth and preserve fertility. […] The longer the cryptorchid testis remains untreated, the more significant the loss of germ cell becomes as well as the subsequent decrease in fertility. […] Orchiopexy is associated with 2 major testicular complicationsatrophy and testicular ascent. […] These complications occur in approximately 1% of the time for palpable testes. […] The rate increases to around 5% for laparoscopic orchiopexies. […] In FS orchiopexies, whether performed in 1 or 2 stages, the rate of testicular atrophy is around 20% to 30%, with the 1-stage procedure resulting in worse outcomes.

• #1 Cryptorchidism – StatPearls – NCBI Bookshelf

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

  Cryptorchidism can disrupt communication between the testes and the endocrine system, potentially leading to transient hormone deficiencies. […] These hormonal imbalances may contribute to the failure of testicular descent and impede the development of the spermatogenic tissue, consequently compromising fertility. […] Cryptorchidism is associated with male infertility in adulthood, primarily due to poor semen quality, which can be linked to compromised Sertoli cell function and its impact on Leydig cell function. […] The absence of an appendix testis has been associated with abdominal and cryptorchid testes, mainly when located proximal to the external ring. However, the exact role of the appendix testis in testicular descent remains unclear. […] The cause of cryptorchidism is often indeterminate in full-term infants, rendering it a common yet sporadic, idiopathic congenital abnormality.

• #2 Cryptorchidism – Pathophysiology – Managment – TeachMePaediatrics

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

  Cryptorchidism is a congenital absence of one or both testes in the scrotum due to a failure of the testes to descend during development. […] Under normal embryological development the testis descends from the abdomen to the scrotum, pulled by the gubernaculum, within the processes vaginalis. This process is incomplete in the context of true undescended testis; or tracks to an abnormal position in an ectopic testis. However, particularly with bilateral cryptorchidism, hormonal causes such as androgen insensitivity syndrome or disorder of sex development must also be excluded.

• #3

  https://www.beaumont.org/conditions/undescended-testicle

  Undescended testicle (cryptorchidism) is a condition that affects about 3% of full-term baby boys and up to 30% of premature baby boys. […] There are several possible causes of cryptorchidism, including hormonal problems, genetic abnormalities, and intrauterine compression. […] The exact cause of undescended testicles is unknown, but it is thought to be due to a combination of genetic and environmental factors. […] If undescended testicles are not treated, it can lead to fertility problems later in life. […] Undescended testicles can lead to tumor growth, as the testicles cannot properly regulate their temperature. […] The surgery to correct an undescended testicle is called orchiopexy. […] Surgery may be recommended if the testicle has not descended by six months of age. […] The earlier the surgery is performed, the better. […] Any associated hernia between the abdomen and scrotum is closed at the same time.

• #4 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. […] The testes begin as an immigration of primordial germ cells into testicular cords along the gonadal ridge in the abdomen of the early embryo. […] The interaction of several male genes organizes this developing gonad into a testis rather than an ovary by the second month of gestation. […] During the third to fifth months, the cells in the testes differentiate into testosterone-producing Leydig cells, and anti-Mullerian hormone-producing Sertoli cells. […] The first phase, movement across the abdomen to the entrance of the inguinal canal, appears controlled (or at least greatly influenced) by anti-Mullerian hormone (AMH). […] The second phase, in which the testes move through the inguinal canal into the scrotum, is dependent on androgens (most importantly testosterone).

• #4 Cryptorchidism – Wikipedia

  https://en.wikipedia.org/wiki/Cryptorchidism

  Maldevelopment of the gubernaculum or deficiency or insensitivity to either AMH or androgen can, therefore, prevent the testes from descending into the scrotum. […] At least one contributing mechanism for reduced spermatogenesis in cryptorchid testes is temperature. […] Some circumstantial evidence suggests tight underwear and other practices that raise the testicular temperature for prolonged periods can be associated with lower sperm counts. […] Nevertheless, research in recent decades suggests that the issue of fertility is more complex than a simple matter of temperature. […] Subtle or transient hormone deficiencies or other factors that lead to a lack of descent also may impair the development of spermatogenic tissue. […] The inhibition of spermatogenesis by ordinary intra-abdominal temperature is so potent that continual suspension of normal testes tightly against the inguinal ring at the top of the scrotum by means of special „suspensory briefs” has been researched as a method of male contraception, and was referred to as „artificial cryptorchidism” by one report. […] An additional factor contributing to infertility is the high rate of anomalies of the epididymis in boys with cryptorchidism (over 90% in some studies).

• #5 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. It isnt clear what causes undescended testicles. If the testicles dont descend after six months, your child may need surgery or hormone therapy. […] Healthcare providers and medical researchers arent sure why some babies have undescended testicles at birth. In some cases, they think a testosterone deficiency during fetal development may interfere with how the testicles develop. […] If testicles dont drop into the scrotum, they may not function properly or produce healthy sperm. They can cause infertility later in life. […] 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. […] 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.

• #6 Pediatric Cryptorchidism Surgery: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1017420-overview

  In cryptorchidism (from Greek kryptos [„hidden”] and orchis [„testis”]), the testis is not located in the scrotum; it can be ectopic, incompletely descended, retractile, and absent or atrophic. […] Since then, testicular maldescent has been the subject of many clinical studies, but its embryology, effects on fertility, and ultimate clinical impact remain topics of discussion and research. […] The embryology of testis development is critical to understanding the most common theories formulated to explain cryptorchidism. […] Several potential explanations for the pathophysiology of cryptorchidism have been proposed, including gubernacular abnormalities, reduced intra-abdominal pressures, intrinsic testicular or epididymal abnormalities, and endocrine abnormalities, as well as anatomic anomalies (eg, fibrous bands within the inguinal canal or abnormal arrangement of the cremasteric muscle fibers).

• #6 Pediatric Cryptorchidism Surgery: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1017420-overview

  The gubernaculum testis is a structure that attaches the lower portion of the tunica vaginalis to base of the scrotum. […] Cryptorchidism is common in patients with prune belly syndrome and those with gastroschisis; both are associated with decreased intra-abdominal pressures. […] Another theory of testicular maldescent has been based on intrinsic testicular or epididymal abnormalities. […] Abnormalities in the hypothalamic-pituitary-gonadal axis have been postulated as a possible explanation for anomalies of testicular descent and abnormal germ cell development. […] The molecular mechanisms by which the newly determined testicle descends from its position in the posterior abdomen into the scrotum is a complex process that likely involves multiple genetic, hormonal, environmental, and stochastic factors. […] Although a comprehensive explanation has not yet been elucidated, several observations have suggested that specific genetic loci play important roles in normal testicular descent and the occurrence of cryptorchidism.

• #7 Pathology Outlines – Cryptorchidism

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

  Absence of one or both testes in the scrotum most commonly due to failure of descent into the scrotum during fetal development […] Testicular descent from initial position on abdominal wall is divided into 2 stages with abnormalities of migration thought to be associated with undescended testicle […] Transabdominal descent: the gubernaculum, a caudal ligament connecting the testicle to the internal ring, holds testicle near internal ring as abdominal cavity develops; insulin-like factor 3 (INSL3) and anti-Müllerian hormone dependent […] Inguinoscrotal descent: the gubernaculum shortens, pulling testicle through inguinal canal to position within scrotum; androgen dependent […] May be a component of testicular dysgenesis syndrome, which includes increased levels of testicular malignancy, poor semen quality and hypospadias

• #7 Pathology Outlines – Cryptorchidism

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

  Numerous genes implicated; lack of a clear association in human studies suggests multifactorial causes […] Associated with and increased risk in certain chromosomal abnormalities and genetic syndromes, such as Klinefelter and Prader-Willi syndrome […] Environmental factors likely play a role: diethylstilbestrol and pesticide exposure have been associated with increased rates; maternal and paternal smoking may increase risk […] 80% of undescended testicles palpated within inguinal canal or high scrotal area […] Associated with increased risk of testicular germ cell tumor […] Increasing risk of malignancy with delayed treatment […] Relative risk of malignancy is 2 – 8x; higher risks associated with delayed repair, bilateral cryptorchidism, additional endocrinopathies, abnormal karyotype and intra-abdominal testes

• #7 Pathology Outlines – Cryptorchidism

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

  Laparoscopy is gold standard in diagnosing a nonpalpable testis […] In cases of bilateral undescended testicles, hormonal studies (LH, FSH, Müllerian inhibiting substance [MIS] and testosterone) may support diagnosis of gonadal dysgenesis with abnormal hCG stimulation test […] Delayed repair reduces fertility, which is worse with bilateral cryptorchidism […] Relative risk for testicular germ cell tumor is 2.2x with prepubertal repair versus 5.4x with postpubertal repair […] Orchiopexy may be performed at 6 – 18 months as it is unlikely that testicle will spontaneously descend after this time […] American Urological Association does not recommend hormonal therapy (hCG) to promote the descent of the undescended testicle due to low response rates.

• #8 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. […] The testicular descent is controlled by the antimllerian hormone, insulin-like hormone 3 (Insl3), and by androgens (DHT and testosterone). The gubernaculum testis, also called genitoinguinal ligament, connects the testis to the inguinal region and is the key structure for the abdominal part of the descent. The hormones mentioned above cause a swelling reaction of the gubernaculum and enlarge the inguinal canal. The testis migrates caudally due to the growth in length of the embryo. As the descent progresses, muscle cells migrate into the gubernaculum. Regression of the gubernaculum and muscle contraction (innervation by the genitofemoral nerve) trigger the inguinal part of the testicular descent.

• #8 Cryptorchidism – Undescended Testicle

  https://www.urology-textbook.com/cryptorchidism.html

  An absolute (low concentration) or relative (reduced sensitivity of the target tissue) androgen deficiency leads to cryptorchidism, although the abdominal part of the testicular descent is not impaired. Many reasons for androgen deficiency are known, e.g., 5-reductase deficiency or mutations of the androgen receptor. Hormone treatment with HCG or GnRH leads to higher testosterone concentrations and has been a treatment option in cryptorchidism (see below). […] 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). Early orchidopexy can prevent histopathological changes. […] 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. Germ cell tumors usually develop after puberty. A testicular biopsy at the time of orchidopexy cannot judge the risk of tumors. The contralateral orthotopic testis is also at risk, but to a lesser extent.

• #8 Cryptorchidism – Undescended Testicle

  https://www.urology-textbook.com/cryptorchidism.html

  Typical histopathological signs of testicular damage in untreated cryptorchidism: Decreased number of Leydig cells (early signs), Degeneration of Sertoli cells, Persistence of fetal gonocytes and missing development of the adult dark spermatogonia, Missing development of primary spermatocytes, Peritubular fibrosis, Within two years after birth, the complete histopathological picture can be expected.

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

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

  A normal hypothalamic-pituitary-gonadal axis is a prerequisite for testicular descent. […] Furthermore, testosterone and its conversion to dihydrotestosterone (DHT) are also necessary for continued migration, especially during the inguinoscrotal phase. […] Although its exact mechanism of action is unclear, the gubernaculum has significant importance in undescended testes. In patients with cryptorchidism, the gubernaculum is not firmly attached to the scrotum, and the testis is not pulled into the scrotum. […] Both hormonal and mechanical factors appear to mediate the aid of the gubernaculum and descent of the testis. […] Intra-abdominal pressure also appears to play a role in testicular descent. […] The effect of decreased intra-abdominal pressure is most significant during transinguinal migration to the scrotum, probably in conjunction with androgens and a patent processus vaginalis.

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

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

  Cryptorchidism is the most common genital problem encountered in pediatrics. Cryptorchidism literally means hidden or obscure testis and generally refers to an undescended or maldescended testis. […] Understanding the abnormalities of morphogenesis and the molecular and hormonal milieu associated with cryptorchidism is critical to contemporary diagnosis and treatment of this extremely common entity. […] The etiology of cryptorchidism is multifactorial. Extensive research and clinical observations have elucidated some of the factors involved, but the exact mechanism of cryptorchidism has proved elusive. […] Birth weight is the principal determining factor for undescended testes at birth to age 1 year, independent of the length of gestation. […] Mutations in the homeobox gene HOXA10, which plays a pivotal role in regulation of testicular descent, may be involved in select cases.

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

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

  Cryptorchidism refers to an absence of a testis (or testes) in the scrotal sac. It may refer to an undescended testis, ectopic testis, or an atrophic or absent testis. Correct localization of the testes is essential because surgical management varies on location. […] The testes develop in the abdomen and at ~21 weeks of gestation migrate toward the inguinal canal through the deep inguinal ring. The migration is complete at ~30 weeks. The gubernaculum is the ligament which connects the testes to the scrotum. Under hormonal influence (probably testosterone), the gubernaculum contracts, and the testes descend into the scrotum. […] Causes/associations of undescended testes are: premature birth (birth occurs before full descent of testes), intrauterine growth restriction (IUGR), associations with smoking, alcohol intake during pregnancy, androgen insensitivity syndrome, congenital syndromes, gestational diabetes.

• #11 Cryptorchidism | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20158

  A normal hypothalamic-pituitary-gonadal axis is a prerequisite for normal testicular descent, as it coordinates hormonal signals necessary for the developmental process. […] The cause of cryptorchidism is often indeterminate in full-term infants, rendering it a common yet sporadic, idiopathic congenital abnormality. Experts believe that a combination of genetics, maternal factors, and environmental influences may disrupt the hormonal and physical processes that influence testicular development and descent. […] Cryptorchidism can disrupt communication between the testes and the endocrine system, potentially leading to transient hormone deficiencies. These hormonal imbalances may contribute to the failure of testicular descent and impede the development of the spermatogenic tissue, consequently compromising fertility.

• #12 Molecular Mechanisms of Syndromic Cryptorchidism: Data Synthesis of 50 Studies and Visualization of Gene-Disease Network

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6070605/

  Cryptorchidism or undescended testes is characterized as the failure of one (unilateral) or both (bilateral) testes and associated structures to descend from retroperitoneal abdomen to their normal position in scrotal sac during fetal development. It is one of the most frequent congenital birth defects in male children and is present in 24% of full-term male births. Men with a history of cryptorchidism have an increased risk of infertility. Hormone treatment with androgens, human chorionic gonadotropin (hCG) and luteinizing hormone-releasing hormone (LHRH), intended to sufficiently bring testes to a scrotal position, has so far proved to have limited success. The second common effect of cryptorchidism is increased risk for testicular neoplasia, specifically seminoma and testicular torsion. Testes descent is a complex, multistage series of events requiring the interaction of several anatomical factors, including normal gubernaculum development, nervous system, and hormonal factors. Among the factors critically responsible for testicular descent are insulin-like factor 3 (INSL3) and hormones, in particular androgens such as testosterone. Mutations in genes encoding for these hormones or their receptors often lead to the occurrence of cryptorchidism. Various genetic loci have been associated with cryptorchidism development, including protein-coding genes, chromosomal mutations, copy number variations and microRNAs. Testicular maldescent can occur as an isolated event, or as part of a variety of syndromes (syndromic cryptorchidism) and other non-syndromic diseases (non-syndromic cryptorchidism). Molecular mechanisms for co-presence of symptoms in a syndrome could be explained using systems biology approach. The aim of the present study was therefore to catalog the genetic loci associated with syndromic cryptorchidism. The visualization of network consisting of syndromes connected to microdeletions or genes which caused them was also interpreted in systems biology manner as a contribution to growing diseasome map. The study is ongoing and further studies will be needed to develop a complete catalog with the data from upcoming publications. Additional studies will also be needed for revealing of molecular mechanisms associated with syndromic cryptorchidism and revealing complete diseasome network.

• #13 Cryptorchidism – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/congenital-renal-and-genitourinary-anomalies/cryptorchidism

  Cryptorchidism is failure of one or both testes to descend into the scrotum; in younger children, it is typically accompanied by inguinal hernia. […] Pathophysiology of Cryptorchidism: Normally, the testes develop at 7 to 8 weeks of gestation and remain cephalad to the internal inguinal ring until about 28 weeks, when they begin their descent into the scrotum guided by condensed mesenchyme (the gubernaculum). Onset of descent is mediated by hormonal (eg, androgens, mullerian-inhibiting factor), physical (eg, gubernacular regression, intra-abdominal pressure), and environmental (eg, maternal exposure to estrogenic or antiandrogenic substances) factors. […] Undescended testes may cause subfertility and are associated with testicular carcinoma, mainly in the undescended testis and particularly with intra-abdominal malposition. However, in patients with one undescended testis, 10% of cancers develop on the normal side. […] Surgery should be done at about 6 months of age in term infants and at 1 year of age in preterm infants because early intervention improves fertility potential and may reduce cancer risk.

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

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

  A testicle that doesn’t move down into its proper place in the scrotum before birth is called an undescended testicle. It’s also known as cryptorchidism (krip-TOR-kih-diz-um). […] The exact cause of an undescended testicle isn’t known. Genes, the health of the baby’s mother and other factors might have a combined effect. Together they may disrupt the hormones, physical changes and nerve activity that play roles in how the testicles develop. […] The testicles need to be slightly cooler than regular body temperature to develop and work well. The scrotum provides this cooler place. Complications of a testicle not being located where it’s supposed to be include: […] Men who’ve had an undescended testicle have a higher risk of testicular cancer. This disease often begins in testicle cells that make immature sperm. It’s not clear why these cells turn into cancer. […] Fertility problems make it harder to get a partner pregnant. They’re more likely to happen in men who’ve had an undescended testicle. Fertility problems might be worse if an undescended testicle goes without treatment for a long time.

• #15

  https://link.springer.com/article/10.1007/BF00442176

  Impaired intrauterine gonadotropin secretion was the cause of cryptorchidism in 78% of cryptorchid boys studied. On the one hand, this impairement implied the underdevelopment of the epididymis and thus the cryptorchid state of the gonad. On the other hand, the histological alterations of the testis, due to impaired gonadotropin secretion were Leydig cell atrophy and an impairment in the number of the germ cells. […] The secondary damage, due to the unfavorable position, started during the second year of life. To avoid this damage, early treatment is highly recommended. Hormonal treatment with GnRH is the treatment of first choice. This treatment was successful in 60% of cryptorchid boys. An additional treatment of nonresponders with low doses of hCG increased the overall success rate to 80%. Six months after treatment, 14.5% of those successfully treated suffered a relapse.

• #16

  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. […] The etiology of acquired undescended testes remains inconclusive, clinical diagnostic standards are unclear, and treatment approaches are still controversial. […] The prevailing view is that acquired undescended testes occur due to the partial absorption of the gubernaculum, which forms part of the parietal peritoneum. […] The etiology of acquired undescended testes is closely related to the continuous pull of the residual gubernacular fibers on the spermatic cord, which prevents the cord from extending proportionately to body growth. […] The mechanism of ascending testes remains a controversial issue. […] The mainstream belief is that some of the processus vaginalis were absorbed into part of the parietal peritoneum, and the remaining processus vaginalis fibers continue to pull the spermatic cord.

• #16

  https://journals.lww.com/md-journal/fulltext/2024/07050/diagnoses_and_treatment_of_acquired_undescended.20.aspx

  An increasing number of studies suggest that a critical factor in the pathogenesis of aUDT is the relative insufficiency of spermatic cord length. […] The testis may remain stationary, unable to maintain a stable position in the scrotum, moving from a high scrotal position to the inguinal region. […] The decreased activity of the Cremaster muscle resulting from its sensitivity to androgens during periods of high androgen production, especially in infancy and adolescence, contributes to the decrease of testicular contractility, leading to testicular ascent. […] 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. […] The efficacy of hormonal therapy for aUDT is unclear. […] Surgical treatment remains the mainstay of therapy for aUDT. […] The use of HCG in the treatment of aUDT is still highly controversial, and longitudinal studies with larger sample sizes are needed to clarify its therapeutic effects.

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

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

  The likelihood of subfertility increases with bilateral involvement and increasing age at the time of orchiopexy. […] Impaired spermatogenesis may be partially caused by underlying genetic abnormalities that can increase the risk of germ cell neoplasia. […] Although there is little solid evidence, the incidence of testicular torsion is thought to be higher in undescended testes than in normal scrotal testes. […] Most true cases of undescended testicles are associated with a patent processus vaginalis. […] Treatment for cryptorchidism can be hormonal, surgical or a combination of the two. […] Because the process of testicular descent is hormonally mediated, it can sometimes be induced with hormone administration. […] The inguinal orchiopexy is a well-established operation for the palpable undescended testicle. […] The most significant complication of orchiopexy is testicular atrophy. […] Surgery for the nonpalpable testicle is diagnostic and potentially therapeutic.

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

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

  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. […] The rationale for treatment of the undescended testicle is the prevention of potential sequelae. The most common problems associated with undescended testicles are testicular neoplasm, subfertility, testicular torsion and inguinal hernia. […] It has been well documented that men with a history of undescended testicle have a higher-than-expected incidence of testicular germ cell cancers. […] As a group, men who have had an undescended testicle have lower sperm counts, poorer quality sperm and lower fertility rates than men whose testicles descended normally.

• #18 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). […] Cryptorchidism, or undescended testis (UDT), is defined as failure of a testis to descend into a scrotal position. This situation most commonly refers to a testis that is present but in an extrascrotal position, but may also lead to identification of an absent testis. […] In a large population-based twin study, Jensen et al. observed increasing concordance rates of treated cryptorchidism based on family relationships: 1.8% in unrelated males, 2.4-4.3% in half-brothers, 7.5% in full brothers, and 16.7% in dizygotic and 26.7% in monozygotic twins.

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

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

  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’). […] In summary, although there is some suggestion that the examined genomic loci may contribute to cryptorchidism susceptibility, the evidence is weak at this point and likely due to the multifactorial nature of the trait, the heterogeneous phenotypic manifestation of cryptorchidism as well as the lack of simultaneous assessment of potential gene-environment interactions. […] 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.

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

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

  The increased incidence of malignancy in cryptorchid testes varies from 49/100,000 (0.05%) to 12/1,075 (1%). […] Formerly bilateral cryptorchid men have greatly reduced fertility compared with men with a history of unilateral cryptorchidism and the general male population. […] In summary, although there is some suggestion that the examined genomic loci may contribute to cryptorchidism susceptibility, the evidence is weak at this point and likely due to the multifactorial nature of the trait, the heterogeneous phenotypic manifestation of cryptorchidism as well as the lack of simultaneous assessment of potential gene-environment interactions.

• #19 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Symptoms-and-Causes-of-Undescended-Testicles.aspx

  Undescended testicles, otherwise known as cryptorchidism, is the most common congenital malformation and endocrine disease to occur in male infants. If left untreated, cryptorchidism can increase the likelihood that the patient experiences infertility and/or testicular cancer later in life. […] While complex in its etiology, UT is believed to be the result of a combination of factors including environmental factors, such as maternal health and exposure to endocrine-disrupting chemicals (EDCs), premature birth, or genetic predispositions, such as polymorphisms in different genes or chromosomal aberrations. […] The two pathogenic mechanisms that could be responsible for absent testes include testicular agenesis and atrophy following an intrauterine torsion. […] Therefore, the combination of hormone treatment with orchidopexy, which is the surgical procedure that moves the undescended testes to its appropriate location within the scrotum, has been found to increase testosterone levels and the number of adult spermatogonia. […] In addition to these long-term benefits, early treatment of UT with orchidopexy has been found to reduce the degradation of spermatogenic tissue, and the reduction in spermatogonia as compared to when UT is left untreated.

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

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

  Undescended testicles, also known as cryptorchidism, is a fairly common and normally painless congenital condition in which one or both of a baby’s testicles (testes) have not moved into the proper position. […] Experts have yet to identify any single cause of undescended testicles. The following factors may interfere with the normal descent and development of the testicles: Abnormal anatomy, Hormonal problems, Environmental influences. […] Undescended testicles can increase the risk of infertility. Normally, when the testicles are in the scrotum, they’re about three to five degrees cooler than they would be if they remained inside the body’s abdominal cavity. The warmer temperatures inside the body may impair the development of the testicles and may affect the production of healthy sperm when the boy is older.

• #20 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. The advantage of surgery, however, is that it moves the testes into a place that allows for routine self-examination, which could lead to early detection of any abnormalities later in life. […] 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. […] 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.

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

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

  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. […] Warmer temperatures inside the body can impair the development of the testes and may affect the production of healthy sperm. Orchiopexy moves the testicles into the scrotum, where they’re about three to five degrees cooler than they would be if they remained inside the abdominal cavity. This improves the chances of fertility later in life.

• #21 Plasma concentration of MMP-17 is elevated in boys with cryptorchidism and correlates with HSP-70 | Scientific Reports

  https://www.nature.com/articles/s41598-024-84214-5

  Cryptorchidism, the absence of one or both testicles in the scrotum, is the most common anomaly of genitourinary tract in males. The pathogenesis of undescended testes is unknown however the role of inflammation, tissue remodeling and oxidative stress is postulated. […] Our results demonstrate that MMP-17 and HSP-70 might be involved in pathogenesis of cryptorchidism and are in line with current knowledge that high temperature has a negative influence on male gonads. […] Cryptorchidism is a pathologic condition with multifactorial pathogenesis. The process of descending of the testes to the scrotum seems to be abrupted during embryogenesis leading to irreversible changes in cell functions. Higher temperature impairs spermatogenesis and steroidogenesis via oxidative stress which eventually may lead to male infertility.

• #22 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P03081

  Undescended testes means that 1 or both of the male testes have not passed down (descended) into the scrotal sac. This is a condition seen in some newborn baby boys. […] Undescended testes are more often seen in babies who are born early (preterm or premature babies). This is because the testes dont pass down from the belly into the scrotal sac until month 7 of a babys growth in the uterus. Other causes may include hormone problems or spina bifida. […] In other cases, treatment may be needed. This may include: Surgery. The undescended testicle may be moved into the scrotal sac with surgery. This surgery is called orchiopexy. Its often done between ages 6 and 18 months. It works for most children. […] If testes dont descend, this can cause problems, such as: Infertility. This is most common when both testes dont descend. […] Risk for testicular cancer. This risk increases greatly by age 30 or 40. Men with undescended tests will need to do monthly testicular self-exams.

• #23 Undescended Testes in Children – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=undescended-testes-in-children-90-P03081

  Undescended testes are more often seen in babies who are born early (preterm or premature babies). This is because the testes don’t pass down from the belly into the scrotal sac until month 7 of a baby’s growth in the uterus. […] It may be caused by a reflex that causes a testicle to move up and down from the scrotum back into the groin (retractile testes). In some cases, the testes are missing. In rare cases, a boy who has inguinal hernia repair may develop undescended testes. […] In many cases, the testes descend on their own into the scrotum by age 3 months. In most cases, the testes pass down by age 6 months without any treatment. […] In other cases, treatment may be needed. This may include surgery. The undescended testicle may be moved into the scrotal sac with surgery. This surgery is called orchiopexy. It’s often done between ages 6 and 18 months. It works for most children. […] Certain hormones may trigger the body to make testosterone. This helps the testes descend into the scrotal sac. This treatment is only used in some cases. […] If testes don’t descend, this can cause problems such as infertility, higher risk of testicular cancer, and other problems.

• #24 Undescended Testicle | Texas Children’s

  https://www.texaschildrens.org/content/conditions/undescended-testicle

  Cyptrorchidism (also known as undescended testicle) occurs when 1 or both testicles fail to move into the scrotum before birth. […] This condition occurs when testicles develop inside a fetus’ abdomen but do not descend to the scrotum during his mother’s pregnancy. […] The cause remains unknown and is believed to include both genetic and environmental risk factors. Perinatal risk factors include prematurity, low birth weight, breech presentation and maternal diabetes. […] Problems associated with undescended testicles include: inguinal hernia, risk of infertility, tumor and testicular torsion. […] Hormonal treatment of undescended testes has limited success and is not generally suggested in the US. […] Patients with undescended testicles have a higher but undefined risk of testis tumor.

• #25 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 higher prevalence of undescended testes in cases with Prader-Willi syndrome, Kallman syndrome, pituitary hypoplasia and anencephaly indicates the critical role of the hypothalamic-pituitary axis and it is suggested that the major cause of undescended testes is hypothalamic-pituitary axis dysfunction. […] Several hormonal factors play important roles in testicular descent to the scrotum following the transinguinal phase. Gonadotropins, hCG, AMH, androgens, and defensins have a critical effect in testicular descent. […] 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 success rate of these therapies depends on the position of the testes, inclusion criteria, and type and dosage of these drugs.

• #25 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. […] Hormonal therapy may lead to penile growth, painful erection, and behavioral changes while on treatment. In recent years, it has been reported that human chorionic gonadotropin (hCG) treatment was associated with interstitial edema due to increased vascular permeability, inflammation-like changes, and several adverse effects on germ cells by increasing pressure and apoptotic process. […] Several factors including humoral and genetic components are involved in testicular descent. […] Although the exact etiology is still unknown, it is postulated that genetic, hormonal (hypothalamic-pituitary-gonadal axis dysfunction, congenital hypogonadotropic hypogonadism, testicular dysgenesis), and anatomical (short vas deferens and spermatic vessels) factors are involved.

• #26 Rapid evolution and molecular convergence in cryptorchidism-related genes associated with inherently undescended testes in mammals | BMC Ecology and Evolution | Full Text

  https://bmcecolevol.biomedcentral.com/articles/10.1186/s12862-021-01753-5

  The mammalian testis is an important male exocrine gland and spermatozoa-producing organ that usually lies in extra-abdominal scrotums to provide a cooler environment for spermatogenesis and sperm storage. Testicles sometimes fail to descend, leading to cryptorchidism. […] Although several anatomical and hormonal factors involved in testicular descent have been studied, there is still a paucity of comprehensive research on the genetic mechanisms underlying the evolution of testicular descent in mammals and how mammals with ascrotal testes maintain their reproductive health. […] Our results suggest that the scrotal testis is an ancestral state in mammals, and the ascrotal phenotype was derived multiple times in independent lineages. […] In addition, the adaptive evolution of genes involved in testicular descent and the development of the gubernaculum contributed to the evolution of ascrotal testes. Accurate DNA replication, the proper segregation of genetic material, and appropriate autophagy are the potential mechanisms for maintaining physiological normality during spermatogenesis in ascrotal mammals. Furthermore, the molecular convergence of GTPases is probably a mechanism in the ascrotal testes of different mammals.

• #26 Rapid evolution and molecular convergence in cryptorchidism-related genes associated with inherently undescended testes in mammals | BMC Ecology and Evolution | Full Text

  https://bmcecolevol.biomedcentral.com/articles/10.1186/s12862-021-01753-5

  Overall, both the etiology of cryptorchidism and the genetic mechanisms related to the evolution of testicular descent remain largely unknown. […] Our study provides some novel insights into the evolution of testicular descent in mammals, contributes to a better understanding of the pathogenesis of cryptorchidism in humans, and offers further experimental validation for these candidate genes and residues.

• #27

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=rt1112

  Doctors don’t really know what causes an undescended testicle. This common condition runs in some families (can be inherited). […] Treatment is important because having an undescended testicle increases the risk of: […] Infertility. Damage to a testicle’s sperm-making ability can begin as early as 12 months of age. That’s why many doctors advise treating an undescended testicle by the time a baby is 1 year old and no later than age 2. Treatment helps lower the chance of infertility. […] Cancer of the testicles. Men who were born with undescended testicles have a higher rate of testicular cancer than other men. But this cancer is rare. It can be cured if found early. If you are a young man who was born with an undescended testicle, talk with your doctor about what you should do.

• #28 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. The mechanisms of normal testicular descent, testicular reascent, and testicular regression have not been fully established yet. Undescended testis is known to be associated with decreased fertility and increased malignancy rates. Timely referral to a surgical specialist and timely surgical correction may improve fertility rates and decrease malignancy rates related to undescended testis. Undescended testis interferes with the differentiation of primitive germ cells that produce germ cells and finally spermatogenesis. Thus, delayed orchiopexy decreases germ cell production, testicular volume, and fertility. The original location of the undescended testis is important in the risk of testicular cancer and fertility. Age at orchiopexy is also an important factor for predicting fertility. Patients with undescended testis have a threefold increased risk of testicular cancer later in life compared to the general population. Timely referral to a surgical specialist and timely surgical correction may improve fertility and decrease malignancy rates related to undescended testis.

• #29 The Undescended Testis (14.08.2009)

  https://di.aerzteblatt.de/int/archive/article/65693

  The undescended testicle is the most common genital malformation in boys. Although the mechanism that regulates prenatal testicular descent is still partly obscure, there is persuasive evidence that endocrine, genetic, and environmental factors are involved. The treatment of undescended testis should begin after six months and ideally be completed by the child’s first birthday. Treatment comprises hormonal and/or surgical approaches. Early treatment can potentially minimize the risk of infertility, although treatment before the age of 13 doesn’t appear to lessen the risk of malignancy. The consensus view is that the mechanism that leads to cryptorchidism is already set in motion before birth or in infancy. Testicular malignancies develop from pre-invasive lesions, carcinoma in situ (CIS) or TIN (testicular intraepithelial neoplasia). The risk of developing testicular malignancy is higher with bilateral than with unilateral undescended testis. The results, obtained in a cohort of 16,983 patients, show that the risk of malignancy is almost twice as high in boys not operated until after age 13 years.

• #30

  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. […] In some cases, the undescended testicle may be twisted, in a condition called testicular torsion. As a result, its blood supply may be stopped, causing pain in the inguinal (groin) or scrotal area.

• #30

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

  Before birth, a baby boy’s testes (testicles) develop inside the abdomen. Closer to delivery, these organs travel through a canal in the groin. When all goes as it should, the testicles then fall into place in the scrotum, the bag of skin beneath the penis. […] In some boys, especially those who are born premature, one or both testicles do not make it down to the scrotum before birth. This is known as cryptorchidism, more commonly called undescended testicles. […] Nobody is certain what causes undescended testicles. Premature birth plays a role, but the condition may also be genetic. […] The goals of this surgery include: […] Reduce the risk of potential hormone and fertility problems. […] Reduce the risk of testicular cancer, which is slightly raised if testicles are undescended.

• #31 Cryptorchidsm / Undescended Testes | ColumbiaDoctors

  https://www.columbiadoctors.org/treatments-conditions/cryptorchidsm-undescended-testes

  Surgical repair is an operation to locate the undescended testicle and advance it to the scrotal sac. Called orchiopexy, the surgery is usually performed in children between 6 and 18 months old and is successful in 98 percent of our patients. […] If cryptorchidism is not repaired, these complications may occur as your child grows and matures: increased risk of testicular cancer, infertility (most common in bilateral cases, where both testes are affected), inguinal hernia (a weakened area in the lower abdominal wall or inguinal canal where intestines protrude), psychological consequences associated with an empty scrotum, testicular torsion (painful twisting of the testes that decreases blood supply to the testes), Risk of inguinal hernia.

• #32 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: Laparoscopy. A small tube with a camera on it is placed through a small cut in the belly. Laparoscopy is done to locate a testicle in the stomach area. […] The surgeon might be able to fix the undescended testicle during the same procedure. But another surgery might be needed. Sometimes, laparoscopy might not find an undescended testicle. Or it might find damaged or dead testicle tissue that doesn’t work, and the surgeon removes it. […] Open surgery. This uses a larger cut to look inside the stomach area or groin to find the undescended testicle. […] The goal of treatment is to move the undescended testicle to its proper place in the scrotum. Treatment before age 1 might lower the risk of health problems linked with an undescended testicle, such as infertility and testicular cancer. Earlier treatment is better. Experts often recommend that surgery take place before the child is 18 months old.

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

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

  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 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. […] In some cases, the testicle might be damaged or made of dead tissue. The surgeon should remove this tissue. […] 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.

• #33 Undescended Testis | Pediatric Urology Book

  https://pediatricurologybook.com/book/chapters/05-28_undescended-testis/

  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 rationale for hormonal therapy is based on the experimental results that undescended testicles result from an abnormality in the hypothalamus-pituitary-gonadal axis, testicular descent is regulated by male androgens, and high concentrations of active metabolites synthesized in the testes are involved in the pathogenesis of cryptorchidism. […] It is presumed that the hormone affects the spermatic cord and the cremasteric muscle to induce the natural descent of the testicles and enhance fertility. However, the success rate of hormonal therapy using hCG or GnRH is only 20% and almost 20% of these descended testes may re-ascend later.

• #34 Undescended Testicles – Treatment | familydoctor.org

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

  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. […] Hormone therapy is one type of treatment. It involves injections (shots) of a hormone called hCG. This helps the testicles make male hormones (testosterone). A higher level of male hormones may move the testicle down into the scrotum. […] If the testicle hasn’t come down by the time your baby is 9 months old, the doctor may suggest surgery. The operation is called orchiopexy. The surgeon makes a small cut in the groin to bring down the testicle. The surgery and healing time are short.

• #35 Undescended Testes | UCSF Department of Urology

  https://urology.ucsf.edu/patient-care/children/genital-anomalies/undescended-testes

  The testes develop within the fetuss abdomen during gestation and migrate down to the scrotum before birth. In undescended testicles, the normal migration stops in the abdomen or groin area. Genetic factors and maternal hormones may play a role in this process. […] If uncorrected, an undescended testicle can be associated with infertility, inguinal hernia, an increased risk for testicular tumor, psychological difficulties surrounding the appearance of the genitals, or injury due to twisting (torsion) of the testicle. […] The most effective treatment is surgical correction (orchiopexy). The ideal timing for surgery is around 1 year of age. If the testicle has not descended by one year of age, it is unlikely to descend as the child gets older.

Zobacz więcej