Materiały źródłowe

• #1 Cryptorchidism – StatPearls – NCBI Bookshelf

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

  With proper diagnosis and treatment, the prognosis for cryptorchidism is excellent. However, there is a slight increase in the risks of testicular cancer and infertility compared to the general population. A Danish study involving over 6000 men indicated that individuals with a history of cryptorchidism exhibited testicular hypofunction, with a 3.5 mL reduction in testis volume, a 28% reduction in sperm concentration, and diminished Leydig cell function compared to men without cryptorchidism. […] Orchiopexy is associated with 2 major testicular complications: atrophy 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. Over-skeletonization of the spermatic cord leading to the loss of the testis represents a severe complication of orchiopexy.

• #2 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. […] Successful scrotal relocation of the testis, however, may reduce but does not prevent these potential long-term sequelae in susceptible individuals. […] The purpose of this guideline is to provide physicians and non-physician providers (primary care and specialists) with a consensus of principles and treatment plans for the management of cryptorchidism. […] In the absence of spontaneous testicular descent by six months (corrected for gestational age), specialists should perform surgery within the next year.

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

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

  Cryptorchidism or undescended testis is the single most common genitourinary disease in male neonates. In most cases, the testes will descend spontaneously by 3 months of age. If the testes do not descend by 6 months of age, the probability of spontaneous descent thereafter is low. About 1%2% of boys older than 6 months have undescended testes after their early postnatal descent. […] A timely referral to a surgical specialist and timely surgical correction are the most important factors for decreasing infertility and testicular cancer rates. […] The original location of the testes and the age at orchiopexy are predictive factors for infertility and malignancy later in life. […] The fertility rate is low in patients with bilateral undescended testes, although orchiopexy is successful. The risk of testicular cancer in patients with undescended testis is increased compared to that in the general population. […] Timely referral to a surgical specialist and timely surgical correction may improve fertility and decrease malignancy rates related to undescended testis.

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

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

  Orchidopexy in the first 18 months of life is recommended to preserve available fertility potential. […] The overall rate of spontaneous descent in this latter study may be low because the referral population likely excluded cases of early postnatal spontaneous descent. […] The specific etiology for this compromised fertility remains unclear, but is likely related to germ cell depletion and/or defective germ cell maturation, loss of Leydig cells, and/or an increase in testicular fibrosis. […] 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. […] 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.

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

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

  In unilateral UDT, sperm density and sperm count in the abnormal adult dark (Ad) spermatogonia per tubule group remained within normal range but were significantly decreased. […] 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.

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

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

  If the testicles dont descend after six months, your child may need surgery or hormone therapy. […] Without treatment, undescended testicles can be serious. They can lower your childs testosterone levels and affect their sperm health. With or without treatment, your child may also have a slightly increased risk of developing testicular cancer. But earlier treatment decreases this increased risk. […] 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. […] If testicles dont drop into the scrotum, they may not function properly or produce healthy sperm. They can cause infertility later in life.

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

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

  We assessed the effectiveness of imaging for identifying and correctly locating testicles, the use of hormonal stimulation for treatment planning and hormones for achieving testicular descent, and choices among surgical treatments, including surgical approach (open vs. laparoscopic). […] Hormonal treatment is associated with testicular descent in some children, but rates generally do not exceed those seen with placebo by more than 10 percent. […] Surgical treatment for cryptorchidism is associated with success rates of testicular descent that range from 33 percent to 100 percent, depending on type of surgery. […] No specific imaging technique is able to completely identify anorchia or position of the undescended testicles and thus eliminate the need for further surgical evaluation. […] Hormonal stimulation testing may predict anorchia, but evidence is insufficient, with only two studies of fewer than 50 participants. […] Surgical options are effective, with high rates of testicular descent (moderate strength of evidence for Fowler-Stephens procedures, high for primary orchiopexy).

• #8

  https://link.springer.com/article/10.1007/s00383-024-05729-6

  This study aimed to investigate the rate of re-ascent requiring re-operation after primary orchidopexy and to investigate eventual differences between the inguinal and scrotal approach as well as other potential predictors for re-ascent. […] The rate of re-ascent was 6% and the atrophy rate was 0.15%. A larger study may find predictors for re-ascent but with very low absolute risk. The lower rate of re-ascent with the scrotal approach is probably due to selection bias. […] This retrospective cohort study of nearly 700 testes which underwent orchidopexy found a total rate of re-ascent of 6%. Patients who were re-operated were significantly younger, more often had congenital UDT, and were more often operated on with an inguinal approach. However, neither of these variables remained significant in adjusted analyses. Atrophy occurred only in one testis.

• #9

  https://link.springer.com/article/10.1007/s00383-024-05729-6

  The rate of atrophy was much lower in this study (only one of 662 testes; 0.15%) than previously reported rates of approximately 2%. […] Six percent of all orchidopexied testes needed a re-operation due to re-ascent after primary orchidopexy. The inguinal approach had double the rate of re-ascent compared to the scrotal approach but neither this nor other predictors of re-ascent remained significant in multivariate analyses. Atrophy was very rare. The scrotal approach had as expected significantly shorter operation times.

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