Cryptorchidism

Background

• Testicles develop normally in the abdomen then descend into scrotal sac before birth
• Undescended testis is a common congenital abnormality
• Undescended testis (one or both); incomplete/partial descent of testis into scrotal sac (it can be located anywhere between the abdominal position and the scrotal sac)
• Patients with cryptoorchidism have impaired spermatogenesis but can have normal testosterone levels (Leydig cells are mostly unaffected by temperature)
• This condition is associated with prematurity and increased risk of germ cell tumors

Clinical features

• Patients usually present in infancy and school age (few present after puberty)
• Absence of one or both testes
• Swelling in the inguinal region (may be in the testis or a hernia)
• May present with pain (due to recurrent torsion of the testis or strangulation of an associated hernia)

Diagnosis

• Physical examination is the first stage in diagnosing undescended testicles (are the testicles palpable in the scrotum or unpalpable)
• Ultrasoundography
• CT scan
• Exploratory Laparoscopy

Treatment

• Orchipexy should be performed 6 months to 1 year of age (repositioning the testicles in the scrotum)

Complications

• Testicular atrophy or dysfunction (infertility)
• Undescended testis are more prone to trauma and testicular torsion
• Left untreated/treatment delayed (germ cell tumors)
• Inguinal hernias

Supplementary tables

Table 1: Cryptoorchidism risk factors, clinical features, treatment and complications