Pediatric Cryptorchidism Surgery Workup

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

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 an intersex condition.
    • The evaluation should include chromosomal analysis and measurement of 17-hydroxylase progesterone, testosterone, LH, and follicular-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 with hormonal stimulation (with 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 per 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 MIS. 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, CT scanning, MRI, and angiography have been used to detect undescended testes. However, these studies have unacceptable false-positive and false-negative rates. CT scanning exposes to high levels of radiation, and MRI requires sedation or anesthesia; both are costly.[3]
  • Diagnostic laparoscopy is the most effective and efficient modality to identify an intra-abdominal testis.
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Procedures

  • Laparoscopy
    • Diagnostic laparoscopy is the most reliable technique for localizing the nonpalpable testis.
    • Laparoscopy is performed in conjunction with definite therapy (laparoscopic orchiopexy or open orchiopexy).
    • Laparoscopic findings can be helpful in determining the need for inguinal exploration, for deciding between 1-stage and 2-stage repair, and for assessing viability of the gonad.
    • Findings from laparoscopy can also help clarify the anatomy in complex DSD (intersex) cases.Diagnostic laparoscopy of a crossed ectopic testisDiagnostic 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 and/or delayed orchiopexy.

Carcinoma in situ is present in up to 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 2 findings is unclear.

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Staging

No staging system is reported. The physical finding of a palpable testis versus a nonpalpable testis is the most reliable and easy way to group cryptorchidism cases.

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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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