Pediatric Cryptorchidism Surgery Follow-up

  • Author: Marcos Perez-Brayfield, MD; Chief Editor: Marc Cendron, MD   more...
 
Updated: Nov 10, 2011
 

Further Inpatient Care

Most surgeries used to treat cryptorchidism are performed on an ambulatory basis.

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Further Outpatient Care

  • The surgical procedure is done on an outpatient basis.
    • Minimal pain medication is needed in the first 24-48 hours.
    • The surgical incision site should be kept dry for 48 hours.
    • If surgical buttons were used, consider removing them 7-10 days after the operation.
    • Children should avoid playing on straddle toys and participating in physical education for 1-2 weeks after surgery.
  • Office visits should be scheduled postoperatively and at 1 year to evaluate the location, size, and viability of the testis. Consideration should be given to seeing the patient back at the time of puberty.
  • Discussions of fertility issues and the need for self-examination to detect cancer should be revisited.
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Inpatient & Outpatient Medications

Pain control medications should be prescribed as needed.

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Deterrence/Prevention

Early orchiopexy performed before age 2 years may prevent possible damage to the testis and may improve spermatogenetic viability. The data from one study noted that orchiopexy, when performed on patients younger than 2 years, resulted in significant recovery of testicular volume at follow-up. These results suggest that time of surgery is a significant factory for recovery of delayed cryptorchid testicular growth.[6]

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Complications

  • Complications related to the surgical correction of the maldescended testis include the following:
    • Testicular atrophy (5%)
    • Injury to vas deferens (1%-2%)
    • Reascent of the testicle or abnormal anatomic position (< 10%)
    • Epididymoorchitis
    • Hydrocele
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Prognosis

  • Testicular cancer
    • In patients with cryptorchidism, the risk of testicular cancer is 3%-5%, a 4-7–fold increased risk compared with the 0.3%-0.7% risk in the healthy population.
    • The most common tumor in an undescended testis is a seminoma, whereas the most common tumor after successful orchiopexy is nonseminomatous germ-cell tumor. Approximately 20% of these tumors occur in a contralateral descended testis.
    • Carcinoma in situ occurs in approximately 0.4% of patients undergoing orchiopexy.
    • Orchiopexy is not protective against subsequent testis cancer but does place the testis in a favorable position for routine self-examination.
    • The patient and family must be educated about the risk of future testicular cancer.
    • Self-examination is important in the early recognition of testicular cancer.
  • Infertility
    • Approximately 6% of infertile men have a history of orchiopexy or untreated cryptorchidism.
    • The rate of infertility is greater in patients with bilateral cryptorchidism than in those with unilateral cryptorchidism or in the general male population.
    • The paternity rate for patients with bilateral cryptorchidism is around 60% versus 90% in patients with unilateral cryptorchidism. The rate in those with unilateral cryptorchidism is slightly less that the 94% in the general population.
    • The location of the undescended testis may play a role in fertility potential. Worsening testicular biopsy findings are correlated with high locations (eg, intra-abdominal testis).
    • Normal spermatogram findings are found in 20% of patients with bilateral undescended testis compared with 75% of patients with unilateral cryptorchidism.
    • The decision to perform orchiopexy in patients younger than 24 months might be made because testicular biopsy shows that the rate of germ-cell aplasia substantially increases after age 2 years. Long-term studies are needed to determine the true effect of early orchiopexy on fertility.
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Patient Education

  • One evaluation of the referral practices of local pediatricians showed that physicians tended to refer patients for treatment at a mean age of around 4 years. This finding shows the importance of educating primary physicians about the timing of surgery (before age 1 y) and the benefits of early surgical intervention.
  • The patient and his family should be informed about the risks of infertility and malignancy. Self-examination should be discussed as very important for the early diagnosis and successful treatment of testicular cancer.
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Contributor Information and Disclosures
Author

Marcos Perez-Brayfield, MD  Consulting Staff, HIMA-San Pablo; Assistant Professor, University of Puerto Rico School of Medicine

Marcos Perez-Brayfield, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, and American Urological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew J Kirsch, MD, FAAP, FACS  Clinical Professor of Urology, Emory University School of Medicine, Children's Healthcare of Atlanta; President, Georgia Urology, PA

Andrew J Kirsch, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, and Society for Fetal Urology

Disclosure: QMED Grant/research funds Investigation, Consulting; COOK Urological Royalty Consulting

Adam G Baseman, MD  Pediatric Urologist, North Texas Pediatric Urology Associates, Urology Clinics of North Texas

Disclosure: Nothing to disclose.

Specialty Editor Board

Bartley G Cilento, Jr, MD  Instructor, Department of Surgery, Division of Urology, Children's Hospital of Boston and Harvard Medical School

Bartley G Cilento, Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Harry P Koo, MD  Chairman of Urology Division and Director of Pediatric Urology, Professor of Surgery, Virginia Commonwealth University School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond

Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association

Disclosure: Nothing to disclose.

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Marc Cendron, MD  Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology

Disclosure: Nothing to disclose.

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Hypoplastic right hemiscrotum in a patient with an undescended right testis.
Ectopic testis.
Diagnostic laparoscopy of a crossed ectopic testis.
 
 
 
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