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Pediatric Cryptorchidism Surgery Workup

  • Author: Marcos Perez-Brayfield, MD; Chief Editor: Marc Cendron, MD  more...
 
Updated: Jul 27, 2015
 

Laboratory Studies

Routine laboratory workup is not indicated with unilateral cryptorchidism.

Patients with bilateral nonpalpable testis and those with unilateral or bilateral undescended testis associated with hypospadias should undergo evaluation to rule out a disorder of sexual development (DSD). The evaluation should include chromosomal analysis and measurement of 17-hydroxylase progesterone, testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). For bilateral nonpalpable testis, abdominal-pelvic ultrasonography is advisable, mainly to determine if any müllerian structures, such as a uterus, are present.

Anorchia can be confirmed by means of hormonal stimulation with human chorionic gonadotropin (hCG), with baseline and poststimulation measurement of LH, FSH, and testosterone hormone levels. Many hCG stimulation protocols are described. The authors favor a single injection of hCG 2940 IU/m2 body surface area, with hormonal levels assessed at 72 hours. Anorchia is found in patients with elevated baseline LH and FSH levels and low testosterone levels without an increase in testosterone after stimulation.

Another marker of testicular function is müllerian-inhibiting substance (MIS; also known as antimüllerian hormone [AMH]). MIS levels that exceed 5 ng/mL suggest the presence of testicular tissue and are an indication for exploration. However, this study is rarely used and may not have any application in older children.

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Imaging Studies

Imaging studies have little or no role in the diagnosis of cryptorchidism.

Ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and angiography have been used to detect undescended testes. However, these studies have unacceptable false-positive and false-negative rates. CT exposes the patient to high levels of radiation, and MRI requires sedation or anesthesia; both are costly.[3]

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Diagnostic Laparoscopy

Diagnostic laparoscopy (see the image below) is the most reliable technique for localizing the nonpalpable testis. It is performed in conjunction with definitive therapy (laparoscopic orchiopexy or open orchiopexy). Laparoscopic findings can be helpful in determining the need for inguinal exploration, for deciding between one-stage and two-stage repair, and for assessing gonadal viability. They can also help clarify the anatomy in complex DSD cases.

Diagnostic laparoscopy of a crossed ectopic testis Diagnostic laparoscopy of a crossed ectopic testis.
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Histologic Findings

The histologic findings of an undescended testis range from normal histology to acquired germ-cell hypoplasia with Leydig cell hyperplasia. The severity of the histologic findings is correlated with an intra-abdominal testis, delayed orchiopexy, or both.

Carcinoma in situ is present in as many as 8% of infertile patients undergoing testicular biopsy with a history of orchiopexy. In children with undescended testis, the overall incidence of carcinoma in situ is approximately 0.4%. The clinical significance of these two findings is unclear.

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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, American Urological Association

Disclosure: Nothing to disclose.

Coauthor(s)

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

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

Disclosure: Received consulting fee from Salix for speaking and teaching; Received royalty from Cook for device.

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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, 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, American Urological 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, New Hampshire Medical Society, Society for Pediatric Urology, Society for Fetal Urology, Johns Hopkins Medical and Surgical Association, European Society for Paediatric Urology

Disclosure: Nothing to disclose.

Additional Contributors

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, Massachusetts Medical Society

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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