Materiały źródłowe

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

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

  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.

• #2 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. […] If the testis has not descended by 6 months, surgical correction through orchiopexy is recommended to minimize risks and potential complications. […] The primary hormone utilized for hormone therapy is hCG. A course of hCG injections is administered, and then the status of the undescended testicle is reassessed. The reported success rate for this treatment method ranges from 5% to 50%. […] According to the AUA guidelines, surgery is advised for congenital undescended testes between the ages of 6 and 18 months.

• #3

  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. […] 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. […] 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.

• #4 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. […] 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. […] 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.

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

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

  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.

• #6 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. […] The timing for initial referral and subsequent surgical correction has been debated. […] 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.

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

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

  Primary hormonal therapy with hCG (see choriogonadotropin alfa) or gonadotropin-releasing hormone (GnRH or luteinizing hormonereleasing hormone [LHRH]) has been used for many years, especially in Europe. In the United States, only hCG is currently available. […] A meta-analysis of hCG treatment of cryptorchidism concluded that hCG treatment is no more effective than placebo. 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. […] Success rates for descent into the scrotum are 25-55% in uncontrolled studies but only 6-21% in randomized blinded studies. Distally located testes in older boys are more likely to descend in response to hormonal treatment than are abdominal testes.

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

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

  Primary hormonal therapy with hCG (see choriogonadotropin alfa) or gonadotropin-releasing hormone (GnRH or luteinizing hormonereleasing hormone [LHRH]) has been used for many years, especially in Europe. In the United States, only hCG is currently available. […] A meta-analysis of hCG treatment of cryptorchidism concluded that hCG treatment is no more effective than placebo. 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. […] Success rates for descent into the scrotum are 25-55% in uncontrolled studies but only 6-21% in randomized blinded studies. Distally located testes in older boys are more likely to descend in response to hormonal treatment than are abdominal testes.

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

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

  Primary hormonal therapy with hCG (see choriogonadotropin alfa) or gonadotropin-releasing hormone (GnRH or luteinizing hormonereleasing hormone [LHRH]) has been used for many years, especially in Europe. In the United States, only hCG is currently available. […] A meta-analysis of hCG treatment of cryptorchidism concluded that hCG treatment is no more effective than placebo. 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. […] Success rates for descent into the scrotum are 25-55% in uncontrolled studies but only 6-21% in randomized blinded studies. Distally located testes in older boys are more likely to descend in response to hormonal treatment than are abdominal testes.

• #10 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. […] Successful surgical placement of the testis in the scrotum is based on the principles originally described by Bevan in 1899. These include adequate mobilization of the testis and spermatic vessels, ligation of the associated hernia sac, and adequate fixation of the testis in a dependent portion of the scrotum. […] 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).

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

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

  Primary hormonal therapy with hCG (see choriogonadotropin alfa) or gonadotropin-releasing hormone (GnRH or luteinizing hormonereleasing hormone [LHRH]) has been used for many years, especially in Europe. In the United States, only hCG is currently available. […] A meta-analysis of hCG treatment of cryptorchidism concluded that hCG treatment is no more effective than placebo. 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. […] Success rates for descent into the scrotum are 25-55% in uncontrolled studies but only 6-21% in randomized blinded studies. Distally located testes in older boys are more likely to descend in response to hormonal treatment than are abdominal testes.

• #12 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.

• #13 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. […] 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. […] 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.

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

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

  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.

• #15 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.

• #16 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. […] 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. […] If testicles dont drop into the scrotum, they may not function properly or produce healthy sperm. They can cause infertility later in life.

• #17

  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. […] 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. […] 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.

• #18 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.

• #19 Undescended Testicle Causes and Treatment | UPMC

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

  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. […] The operation to move high testicles into the scrotum is more difficult than for the testicles that are in the groin. […] UPMC pediatric urologists and others have been developing and refining the technique of laparoscopic orchidopexy, which has proven to be a safe and effective method for bringing these testicles down. […] 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. […] For this reason, and due to the increased risk of anesthesia in older patients, it has been recommended that nothing be done about these testicles after age 32.

• #20

  https://medschool.cuanschutz.edu/surgery/divisions-centers-affiliates/pediatric/patient-care/orchidopexy

  Orchidopexy is a surgical procedure that moves an undescended testicle into the scrotum. The operation is performed to reduce the risk of crush injury, correct the associated hernia, and/or alleviate the psychological concerns of having only one testicle visible in the scrotum. […] If, on the other hand, the child is six months old and one must repeatedly manipulate the testicle to bring it into the scrotum, and it does not remain there when released by the examiner, it is undescended and will require surgical correction. […] Orchidopexy does, however, offer a crucial benefit: by moving the testicle into the scrotum, it makes it much easier to monitor for signs of cancer in the future (i.e., doctors can feel for irregularities in the testicle by hand). […] If the testicle is healthy, it may be relocated via orchidopexy. […] If the testicle is found near the groin, a standard orchidopexy can be performed. […] If the testicle is high (near the kidney), then the testicular vessels should be clipped and divided in preparation for a second-stage orchidopexy in 3-4 months.

• #21

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

  A testicle found inside the abdomen can occasionally be brought down to the scrotum in a single operation, but sometimes this has to be done in 2 separate stages. […] 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. […] 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.

• #22 Undescended testicles | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/undescended-testicles

  Surgery is the best treatment for undescended testicles. Ideally, the child should be aged between six months and one year at the time of surgery. […] Research suggests that future sperm quality in the affected testicle is compromised if the condition is corrected after the child is two years old. However, the operation is still possible at a later age for example, if the child developed acquired undescended testicles. About 10 per cent of males who undergo surgical correction experience reduced fertility later in life. […] Surgery to relocate the testicles inside the scrotum is called orchidopexy. The operation procedure generally includes: […] A general anaesthetic is given. […] An incision is made in the groin to access the testicle inside the inguinal canal (lower abdomen). […] The testicle is taken out of the inguinal canal.

• #23 Undescended testicles | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/undescended-testicles

  The spermatic cord that links the testicle to the body is unkinked and gently stretched to its full length. Obstructive tissue may have to be cut away to achieve this. […] An incision is made in the scrotum. […] The testicle is placed inside the scrotum and stitched securely. […] All incisions are closed.

• #24 Undescended testicles | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/undescended-testicles

  Surgery is the best treatment for undescended testicles. Ideally, the child should be aged between six months and one year at the time of surgery. […] Research suggests that future sperm quality in the affected testicle is compromised if the condition is corrected after the child is two years old. However, the operation is still possible at a later age for example, if the child developed acquired undescended testicles. About 10 per cent of males who undergo surgical correction experience reduced fertility later in life. […] Surgery to relocate the testicles inside the scrotum is called orchidopexy. The operation procedure generally includes: […] A general anaesthetic is given. […] An incision is made in the groin to access the testicle inside the inguinal canal (lower abdomen). […] The testicle is taken out of the inguinal canal.

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

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

  Definitive surgical therapy should be performed between ages 6 and 12 months. […] The child is placed supine in the frog-leg position. Reexamination is performed under anesthesia. A previously nonpalpable testis may become palpable, circumventing abdominal exploration. […] The preferred method of testis fixation is controversial. Options are as follows: A subcutaneous pouch with suture fixation versus a sutureless subdartos pouch, Absorbable versus permanent suture, Tunica vaginalis fixation versus tunica albuginea fixation. […] Pain medication is used as needed. Keep the surgical area dry for 1-2 days. Absorbable sutures are used during closure; therefore, removal is not necessary. […] Treatment of cryptorchidism should not end with the first postoperative visit. The primary care provider or surgeon should evaluate the child at 2-3 weeks and 6-12 months following surgery to determine testis location, size, and viability.

• #26

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

  A testicle found inside the abdomen can occasionally be brought down to the scrotum in a single operation, but sometimes this has to be done in 2 separate stages. […] 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. […] 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.

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

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

  Many specialists endorse early surgical intervention, often around 6 months, to optimize testicular growth and preserve fertility. […] 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. […] For nonpalpable testes under anesthesia, exploratory laparoscopy is the recommended approach. […] 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. […] The selection of a surgical approach depends on the surgeon’s specific training, experience, skill level, and personal preference.

• #28 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.

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

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

  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.

• #30 Cryptorchidism – StatPearls – NCBI Bookshelf

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

  Many specialists endorse early surgical intervention, often around 6 months, to optimize testicular growth and preserve fertility. […] 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. […] Treatment options include surgical intervention (orchiopexy) between 6 and 18 months of age to reposition the undescended testicle(s) into the scrotum.

• #31 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.

• #32 How Undescended Testicles Can Cause Fertility Problems

  https://www.webmd.com/infertility-and-reproduction/undescended-testicle-and-fertility-problems

  Normalnie, jądra przemieszczają się z dolnej części brzucha do moszny – worek skóry poniżej penisa – w ostatnich miesiącach przed narodzinami. Ale czasami jedno lub oba nie opadają na miejsce. To nazywa się niezstąpionym jądrem, i może to wpłynąć na płodność później w życiu. […] W większości przypadków jądro opada samo w ciągu około 6 miesięcy po urodzeniu. Jeśli tak się nie stanie, twój lekarz prawdopodobnie zasugeruje operację. Kiedy chodzi o płodność, wczesne leczenie może mieć duże znaczenie. […] Lekarze teraz wiedzą, że ważne zmiany w jądrach zachodzą bardzo wcześnie w życiu. Do czasu, gdy chłopiec ma zaledwie 1 rok, niezstąpione jądro może zacząć tracić komórki, które produkują plemniki. A im dłużej jądro pozostaje zablokowane, tym większe ryzyko, że problem może się pogorszyć. […] Mężczyźni z jednym niezstąpionym jądrem mogą mieć dzieci, ale ich płodność jest niższa niż normalnie o około połowę. Jeśli przejdą operację w celu jej skorygowania, zwłaszcza w młodszym wieku, ich płodność jest zbliżona do tej, jakby nigdy nie mieli problemu.

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

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

  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.

• #34

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

  A testicle found inside the abdomen can occasionally be brought down to the scrotum in a single operation, but sometimes this has to be done in 2 separate stages. […] 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. […] 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.

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

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

  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. […] Undescended testicles are relatively common. They dont cause your baby pain, and treatment is available and highly successful.

• #36 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. […] 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. […] The overall success rate of this operation is 70-85%. […] Hormonal treatment with gonadotrophin-releasing hormone or human chorionic gonadotropin has been investigated but has not proven efficacious in promoting testicular descent.

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

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

  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. […] 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.

• #38 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). […] Patient selection is paramount to achieve satisfactory results. Higher success rates are reported in older children and in patients with testes in a lower pretreatment position. 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%.

• #39 How Undescended Testicles Can Cause Fertility Problems

  https://www.webmd.com/infertility-and-reproduction/undescended-testicle-and-fertility-problems

  Normalnie, jądra przemieszczają się z dolnej części brzucha do moszny – worek skóry poniżej penisa – w ostatnich miesiącach przed narodzinami. Ale czasami jedno lub oba nie opadają na miejsce. To nazywa się niezstąpionym jądrem, i może to wpłynąć na płodność później w życiu. […] W większości przypadków jądro opada samo w ciągu około 6 miesięcy po urodzeniu. Jeśli tak się nie stanie, twój lekarz prawdopodobnie zasugeruje operację. Kiedy chodzi o płodność, wczesne leczenie może mieć duże znaczenie. […] Lekarze teraz wiedzą, że ważne zmiany w jądrach zachodzą bardzo wcześnie w życiu. Do czasu, gdy chłopiec ma zaledwie 1 rok, niezstąpione jądro może zacząć tracić komórki, które produkują plemniki. A im dłużej jądro pozostaje zablokowane, tym większe ryzyko, że problem może się pogorszyć. […] Mężczyźni z jednym niezstąpionym jądrem mogą mieć dzieci, ale ich płodność jest niższa niż normalnie o około połowę. Jeśli przejdą operację w celu jej skorygowania, zwłaszcza w młodszym wieku, ich płodność jest zbliżona do tej, jakby nigdy nie mieli problemu.

• #40 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. […] Successful surgical placement of the testis in the scrotum is based on the principles originally described by Bevan in 1899. These include adequate mobilization of the testis and spermatic vessels, ligation of the associated hernia sac, and adequate fixation of the testis in a dependent portion of the scrotum. […] 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).

• #41 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. […] Successful surgical placement of the testis in the scrotum is based on the principles originally described by Bevan in 1899. These include adequate mobilization of the testis and spermatic vessels, ligation of the associated hernia sac, and adequate fixation of the testis in a dependent portion of the scrotum. […] 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).

• #42 How Undescended Testicles Can Cause Fertility Problems

  https://www.webmd.com/infertility-and-reproduction/undescended-testicle-and-fertility-problems

  Bez leczenia mężczyźni z 2 niezstąpionymi jądrami prawdopodobnie nie będą w stanie mieć dzieci. Ale operacja, aby przenieść oba jądra w dół, może znacznie poprawić ich płodność. […] Wczesna operacja może mieć duży wpływ. Na przykład chłopcy, którzy przechodzą operację przed ukończeniem 2 lat, będą około 5 razy bardziej płodni niż ci, którzy mają ją w wieku 13 lat. […] Jeśli jesteś dorosłym mężczyzną z niezstąpionym jądrem, operacja w celu jego skorygowania prawdopodobnie nie zmieni twojego poziomu płodności.

• #43 How Undescended Testicles Can Cause Fertility Problems

  https://www.webmd.com/infertility-and-reproduction/undescended-testicle-and-fertility-problems

  Bez leczenia mężczyźni z 2 niezstąpionymi jądrami prawdopodobnie nie będą w stanie mieć dzieci. Ale operacja, aby przenieść oba jądra w dół, może znacznie poprawić ich płodność. […] Wczesna operacja może mieć duży wpływ. Na przykład chłopcy, którzy przechodzą operację przed ukończeniem 2 lat, będą około 5 razy bardziej płodni niż ci, którzy mają ją w wieku 13 lat. […] Jeśli jesteś dorosłym mężczyzną z niezstąpionym jądrem, operacja w celu jego skorygowania prawdopodobnie nie zmieni twojego poziomu płodności.

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

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

  Orchiopexy is the most successful therapy to relocate the testis into the scrotum. […] Hormonal therapy is not recommended. […] Successful scrotal repositioning of the testis may reduce but does not prevent the potential long-term issues of infertility and testicular cancer. […] Early reposition of the testis into the scrotum has been a mainstay of treatment to reduce the risk of infertility; however, even with successful orchiopexy at age 6-12 months, 20-25% of boys with nonsyndromic cryptorchidism have compromised fertility potential. […] Males with undescended testis are 40 times as likely to develop testicular cancer as males without undescended testis. […] Prepubertal orchiopexy reduces this risk. […] The ability for patients to perform testicular self-examination with the testes in the scrotum is a clear benefit of surgery.

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

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

  Orchiopexy is the most successful therapy to relocate the testis into the scrotum. […] Hormonal therapy is not recommended. […] Successful scrotal repositioning of the testis may reduce but does not prevent the potential long-term issues of infertility and testicular cancer. […] Early reposition of the testis into the scrotum has been a mainstay of treatment to reduce the risk of infertility; however, even with successful orchiopexy at age 6-12 months, 20-25% of boys with nonsyndromic cryptorchidism have compromised fertility potential. […] Males with undescended testis are 40 times as likely to develop testicular cancer as males without undescended testis. […] Prepubertal orchiopexy reduces this risk. […] The ability for patients to perform testicular self-examination with the testes in the scrotum is a clear benefit of surgery.

• #46 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.

• #47 Undescended testes: What general practitioners need to know

  https://www1.racgp.org.au/ajgp/2019/january%E2%80%93february/undescended-testes

  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. […] The literature has shown there may be an association between UDT and infertility, but it does not appear to be as great as once feared or as parents are often told, particularly for unilateral UDT.

• #48 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. […] 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. […] 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.

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

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

  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.

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

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

  Complications of orchiopexy are as follows: Inadequate testis position occurs in up to 10% of patients and is due to incomplete retroperitoneal dissection. It is usually corrected with a second procedure. Testicular atrophy due to devascularization during dissection of the cord occurs in approximately 5% of patients. […] In children or young adults who present late with cryptorchidism, some authors recommend initial management with orchiopexy while others advise proceeding directly to orchiectomy. […] Studies have shown that patients with a fertility index of less than 0.2 based on testis biopsy at orchiopexy are at a severe risk for later infertility, and these counts correlate with sperm density in adulthood.

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

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

  Complications of orchiopexy are as follows: Inadequate testis position occurs in up to 10% of patients and is due to incomplete retroperitoneal dissection. It is usually corrected with a second procedure. Testicular atrophy due to devascularization during dissection of the cord occurs in approximately 5% of patients. […] In children or young adults who present late with cryptorchidism, some authors recommend initial management with orchiopexy while others advise proceeding directly to orchiectomy. […] Studies have shown that patients with a fertility index of less than 0.2 based on testis biopsy at orchiopexy are at a severe risk for later infertility, and these counts correlate with sperm density in adulthood.

• #52

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

  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.

• #53

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

  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.

• #54

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

  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.

• #55

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

  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.

• #56

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

  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.

• #57

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

  A testicle found inside the abdomen can occasionally be brought down to the scrotum in a single operation, but sometimes this has to be done in 2 separate stages. […] 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. […] 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.

• #58 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. […] 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. […] 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.

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

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

  Definitive surgical therapy should be performed between ages 6 and 12 months. […] The child is placed supine in the frog-leg position. Reexamination is performed under anesthesia. A previously nonpalpable testis may become palpable, circumventing abdominal exploration. […] The preferred method of testis fixation is controversial. Options are as follows: A subcutaneous pouch with suture fixation versus a sutureless subdartos pouch, Absorbable versus permanent suture, Tunica vaginalis fixation versus tunica albuginea fixation. […] Pain medication is used as needed. Keep the surgical area dry for 1-2 days. Absorbable sutures are used during closure; therefore, removal is not necessary. […] Treatment of cryptorchidism should not end with the first postoperative visit. The primary care provider or surgeon should evaluate the child at 2-3 weeks and 6-12 months following surgery to determine testis location, size, and viability.

• #60 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. […] 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. […] 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.

• #61 Undescended and Retractile Testicles – UChicago Medicine

  https://www.uchicagomedicine.org/comer/conditions-services/urology/undescended-retractile-testicles

  At the University of Chicago Medicine Comer Children’s Hospital, our experienced team provides expert care and treatment for children with undescended or retractile testicles. […] If the testicles do not move down on their own, your child will need surgery. […] When surgery is needed, our renowned pediatric urologist performs a procedure called an orchiopexy (or orchidopexy) to bring one or both of the testicles down into the scrotum. […] Orchiopexy can be done in one or two stages using open or laparoscopic (minimally invasive) surgical techniques, depending on the location of the testicles. […] Surgery is done under general anesthesia. This will make your childs whole body go to sleep, and he will not feel any pain or have any memory of it. […] Your child will have his first appointment one month after surgery and additional follow-up as needed. […] Your child cannot swim or take a tub bath for one week after surgery. Your child also cannot take part in contact sports, biking, straddling toys, or gym class until after the follow-up appointment.

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

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

  Definitive surgical therapy should be performed between ages 6 and 12 months. […] The child is placed supine in the frog-leg position. Reexamination is performed under anesthesia. A previously nonpalpable testis may become palpable, circumventing abdominal exploration. […] The preferred method of testis fixation is controversial. Options are as follows: A subcutaneous pouch with suture fixation versus a sutureless subdartos pouch, Absorbable versus permanent suture, Tunica vaginalis fixation versus tunica albuginea fixation. […] Pain medication is used as needed. Keep the surgical area dry for 1-2 days. Absorbable sutures are used during closure; therefore, removal is not necessary. […] Treatment of cryptorchidism should not end with the first postoperative visit. The primary care provider or surgeon should evaluate the child at 2-3 weeks and 6-12 months following surgery to determine testis location, size, and viability.

• #63 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. […] Most children can return home the day of surgery. […] 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. […] Another follow-up visit is usually scheduled for about four months after surgery.

• #64 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. […] Most children can return home the day of surgery. […] 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. […] Another follow-up visit is usually scheduled for about four months after surgery.

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

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

  Definitive surgical therapy should be performed between ages 6 and 12 months. […] The child is placed supine in the frog-leg position. Reexamination is performed under anesthesia. A previously nonpalpable testis may become palpable, circumventing abdominal exploration. […] The preferred method of testis fixation is controversial. Options are as follows: A subcutaneous pouch with suture fixation versus a sutureless subdartos pouch, Absorbable versus permanent suture, Tunica vaginalis fixation versus tunica albuginea fixation. […] Pain medication is used as needed. Keep the surgical area dry for 1-2 days. Absorbable sutures are used during closure; therefore, removal is not necessary. […] Treatment of cryptorchidism should not end with the first postoperative visit. The primary care provider or surgeon should evaluate the child at 2-3 weeks and 6-12 months following surgery to determine testis location, size, and viability.

• #66 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.

• #67 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.

• #68 Undescended Testicle | Children’s Hospital Pittsburgh

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

  Laparoscopic orchidopexy is an operation that has recently gained popularity for these difficult intra-abdominal testicles. […] Laparoscopic orchidopexy can follow diagnostic laparoscopy at the same sitting. […] If you are an adult with an undescended testicle, the options are a bit different. […] For this reason, and the increased risk of anesthesia with increasing age, it has been recommended that after age 32 or so, nothing needs to be done about these testicles.

• #69 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.

• #70 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.

• #71 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.

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

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

  Complications of orchiopexy are as follows: Inadequate testis position occurs in up to 10% of patients and is due to incomplete retroperitoneal dissection. It is usually corrected with a second procedure. Testicular atrophy due to devascularization during dissection of the cord occurs in approximately 5% of patients. […] In children or young adults who present late with cryptorchidism, some authors recommend initial management with orchiopexy while others advise proceeding directly to orchiectomy. […] Studies have shown that patients with a fertility index of less than 0.2 based on testis biopsy at orchiopexy are at a severe risk for later infertility, and these counts correlate with sperm density in adulthood.

• #73 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. […] The timing for initial referral and subsequent surgical correction has been debated. […] 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.

• #74 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.

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

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

  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.

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

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

  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. […] Undescended testicles are relatively common. They dont cause your baby pain, and treatment is available and highly successful.

• #77 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.

• #78

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

  If the testicles haven’t descended by 6 months, they’re very unlikely to do so and treatment will usually be recommended. […] Treatment will usually involve an operation called an orchidopexy to move the testicles into the correct position inside the scrotum. This is a relatively straightforward operation with a good success rate. […] Surgery is ideally carried out before 12 months of age. If undescended testicles are treated at an early age, the risk of fertility problems and testicular cancer can be reduced.

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