RISK FACTORS: Increased risk in - firstborn child, c-section delivery, toxemia of pregnancy, hypospadias, congenital subluxation of hip, low birth weight, pre-term birth, advanced maternal age, maternal obesity, F h/o cryptorchidism
GENERAL MEASURES :
β’ Rule out retractile testis
β’ Administration of chorionic gonadotropin - may cause testicular descent in some boys. Reports of efficacy are inconsistent.
SURGICAL MEASURES:
β’ Reasons to consider: Avoids torsion, averts trauma, decreases but does not eliminate risk of malignancy,
and prevents further alterations in spermatogenesis
β’ Orchiopexy should be performed by age 1. Alterations in germ cell count in the cryptorchid testis have been
identified by age 2.
DRUG(S) OF CHOICE :
. The International Health Foundation recommends biweekly HCG injections for 5 weeks: 250 IU for infants,
500 IU for children up to 6 years of age and 1000 IU . 6 years.
. Success rates for descent into scrotum are 25-55% in uncontrolled studies versus 6-21% in randomized
blinded studies; the more distal the testis the more likely the descent.
CONTRAINDICATIONS: HCG therapy contraindicated in patients with a clinically apparent inguinal hernia,
those with a history of previous ipsilateral groin surgery or in ectopic testicles
PATIENT MONITORING :
β’ Patients should be followed after surgery to evaluate testicular growth
β’ Testicular tumors occur mainly at puberty or after and thus these children should be taught self-examination
when older
.
PREVENTION/AVOIDANCE : No preventive measures known
POSSIBLE COMPLICATIONS :
β’ Progressive failure of spermatogenesis, if left untreated. Even with orchiopexy, the fertility rate is still reduced,
especially with bilateral undescended testicles. Spermatogenesis related to duration of cryptorchidism and the location of the testis. Formerly bilaterally cryptorchid men have a greater decrease in fertility compared to
unilateral cryptorchid male and to the general male population. Abnormalities have also been identified
in the contralateral descended testis, although less severe.
β’ Higher risk (20-46 times) of testicular cancer (risk may remain despite orchiopexy). Risk of cancer is 4 fold
higher in intra-abdominal testes compared to inguinal UDT.
β’ Hernia development (25%)
EXPECTED COURSE/PROGNOSIS :
β’ Disorder usually corrected with medical or surgical therapy, however; possible lifelong consequences
β’ If testicle is absent or orchiectomy required, may consider placement of testicular prosthesis