eMedicine Specialties > Urology > Common Problems of the Testicle

Cryptorchidism: Follow-up

Author: Joel M Sumfest, MD, Director of Pediatric Urology, Janet Weis Children's Hospital, Geisinger Medical Center; Vice Chairman, Department of Urology, Geisinger Medical Center
Coauthor(s): Thomas F Kolon, MD, Department of Urology, Division of Pediatric Urology, Assistant Professor of Urology, The Children's Hospital of Philadelphia; Daniel B Rukstalis, MD, Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group
Contributor Information and Disclosures

Updated: Jan 2, 2009

Outcome and Prognosis

Success rates of medical or surgical orchiopexy are addressed in Treatment.

Future and Controversies

Testis cancer

Giwercman et al recommend biopsy of all cryptorchid testes in adults. If carcinoma in situ (CIS) is present, they recommend contralateral biopsy and unilateral orchiectomy. If the remaining contralateral testis also harbors CIS, they recommend radiation therapy.55

Lenz et al demonstrated an abnormal echo pattern in 3% of postpubertal testes that had undergone orchiopexy. This abnormal ultrasonographic finding may be associated with CIS, and they suggest offering scrotal ultrasonography to postpubertal patients.56

Infertility

Based on retrospective human data and orchiopexy studies in rats, Bellinger et al believe that the practice of transparenchymal sutures to fixate the testis or the use of scrotal wall bolsters put the testis at significant risk for direct trauma. Suture violation of the blood-testis barrier may also play a role in future antisperm antibody development. Further investigation is necessary to fully define this concept of testicular injury.50

Studies have shown that patients with a fertility index of less than 0.2 based on testis biopsy at orchiopexy are at a severe risk for later infertility, and these counts correlate with sperm density in adulthood. Hadziselimovic et al (1997) suggested that such patients may benefit from adjuvant hormonal therapy with resultant increased numbers of germ cells later in life.57 LHRH agonists may improve testicular germ cell and postpubertal sperm counts. Huff et al (2001) showed that 75% of boys with significantly reduced germ cell counts who were treated with nafarelin after orchiopexy and bilateral testicular biopsy showed a significant improvement in total germ cell counts on rebiopsy after 5 months.26 Neoadjuvant GnRH in prepubescent boys may also positively affect future fertility, with the highest fertility indices reported with therapy before age 2 years.58

Future

Schneck et al reported a trend of significantly lower inhibin B levels in boys with cryptorchidism compared with age-matched controls. Inhibin B is produced by the Sertoli cells and is an important regulator of FSH secretion. Kawada et al demonstrated that adult patients who previously had cryptorchidism and markedly low inhibin levels and elevated FSH levels had severely compromised sperm production.59

Kolon et al demonstrated mutations in the developmental homeobox gene, HOXA10, in boys with cryptorchidism and polymorphisms in patients with cryptorchidism and in the general population.60 Analysis of paralogous and orthologous genes of HOXA10 will help elucidate the role of regulatory genes in normal and abnormal testicular descent. Several authors have examined the role of various gene alterations in humans; however, despite findings in animal models, no human isolated cryptorchidism gene has yet been identified. This further supports the notion that the etiology of cryptorchidism is multifactorial.

Further evaluation is needed to identify the role, if any, of isolated cryptorchidism in the spectrum of intersexuality. Histologic, molecular, radiologic, and hormonal studies may reveal similar or dissimilar etiologies for the common isolated undescended testis compared with the relatively uncommon ambiguous genitalia of intersexuality.

 


More on Cryptorchidism

Overview: Cryptorchidism
Workup: Cryptorchidism
Treatment: Cryptorchidism
Follow-up: Cryptorchidism
Multimedia: Cryptorchidism
References
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References

  1. Elert A, Jahn K, Heidenreich A, et al. [The familial undescended testis]. Klin Padiatr. Jan-Feb 2003;215(1):40-5. [Medline].

  2. Heyns CF, Hutson JM. Historical review of theories on testicular descent. J Urol. Mar 1995;153(3 Pt 1):754-67. [Medline].

  3. Toppari J, Kaleva M. Maldescendus testis. Horm Res. Dec 1999;51(6):261-9. [Medline].

  4. Hutson JM, Donahoe PK. The hormonal control of testicular descent. Endocr Rev. Aug 1986;7(3):270-83. [Medline].

  5. Shono T, Ramm-Anderson S, Goh DW, et al. The effect of flutamide on testicular descent in rats examined by scanning electron microscopy. J Pediatr Surg. Jun 1994;29(6):839-44. [Medline].

  6. Ahmed SF, Cheng A, Dovey L, et al. Phenotypic features, androgen receptor binding, and mutational analysis in 278 clinical cases reported as androgen insensitivity syndrome. J Clin Endocrinol Metab. Feb 2000;85(2):658-65. [Medline].

  7. Yamanaka J, Baker M, Metcalfe S, et al. Serum levels of Mullerian inhibiting substance in boys with cryptorchidism. J Pediatr Surg. May 1991;26(5):621-3. [Medline].

  8. Hutson JM, Watts LM. Both gonadotropin and testosterone fail to reverse estrogen-induced cryptorchidism in fetal mice: Further evidence for nonandrogenic control of testicular descent in the fetus. Pediatr Surg Int. 1990;5:13-18.

  9. Fentener van Vlissingen JM, Koch CA, Delpech B, et al. Growth and differentiation of the gubernaculum testis during testicular descent in the pig: changes in the extracellular matrix, DNA content, and hyaluronidase, beta-glucuronidase, and beta-N-acetylglucosaminidase activities. J Urol. Sep 1989;142(3):837-45. [Medline].

  10. Wensing CJ. The embryology of testicular descent. Horm Res. 1988;30(4-5):144-52. [Medline].

  11. Backhouse KM. The natural history of testicular descent and maldescent. Proc R Soc Med. Apr 1966;59(4):357-60. [Medline].

  12. Hutson JM, Beasley SW. The mechanisms of testicular descent. Aust Paediatr J. Aug 1987;23(4):215-6. [Medline].

  13. Heyns CF. The gubernaculum during testicular descent in the human fetus. J Anat. Aug 1987;153:93-112. [Medline].

  14. Levard G, Laberge JM. The fate of undescended testes in patients with gastroschisis. Eur J Pediatr Surg. Jun 1997;7(3):163-5. [Medline].

  15. Koivusalo A, Taskinen S, Rintala RJ. Cryptorchidism in boys with congenital abdominal wall defects. Pediatr Surg Int. Mar 1998;13(2-3):143-5. [Medline].

  16. Frey HL, Peng S, Rajfer J. Synergy of abdominal pressure and androgens in testicular descent. Biol Reprod. Dec 1983;29(5):1233-9. [Medline].

  17. Hadziselimovic F, Duckett JW, Snyder HM 3rd, et al. Omphalocele, cryptorchidism, and brain malformations. J Pediatr Surg. Sep 1987;22(9):854-6. [Medline].

  18. Elder JS. Epididymal anomalies associated with hydrocele/hernia and cryptorchidism: implications regarding testicular descent. J Urol. Aug 1992;148(2 Pt 2):624-6. [Medline].

  19. Cisek LJ, Peters CA, Atala A, et al. Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. J Urol. Sep 1998;160(3 Pt 2):1145-9; discussion 1150. [Medline].

  20. Rabinowitz R, Hulbert WC Jr. Late presentation of cryptorchidism: the etiology of testicular re-ascent. J Urol. May 1997;157(5):1892-4. [Medline].

  21. Scorer CG, Farrington GH. Congenital Deformities of the Testis and Epididymis, New York, Appleton-Century-Crofts. 1971.

  22. Cendron M, Huff DS, Keating MA, et al. Anatomical, morphological and volumetric analysis: a review of 759 cases of testicular maldescent. J Urol. Mar 1993;149(3):570-3. [Medline].

  23. McAleer IM, Packer MG, Kaplan GW, et al. Fertility index analysis in cryptorchidism. J Urol. Apr 1995;153(4):1255-8. [Medline].

  24. Tzvetkova P, Tzvetkov D. Etiopathogenesis of cryptorchidism and male infertility. Arch Androl. Sep-Oct 1996;37(2):117-25. [Medline].

  25. Cortes D, Thorup JM, Visfeldt J. Cryptorchidism: aspects of fertility and neoplasms. A study including data of 1,335 consecutive boys who underwent testicular biopsy simultaneously with surgery for cryptorchidism. Horm Res. 2001;55(1):21-7. [Medline].

  26. Huff DS, Fenig DM, Canning DA, et al. Abnormal germ cell development in cryptorchidism. Horm Res. 2001;55(1):11-7. [Medline].

  27. Hadziselimovic F, Herzog B. The importance of both an early orchidopexy and germ cell maturation for fertility. Lancet. Oct 6 2001;358(9288):1156-7. [Medline].

  28. Lee PA, O'Leary LA, Songer NJ, et al. Paternity after cryptorchidism: lack of correlation with age at orchidopexy. Br J Urol. Jun 1995;75(6):704-7. [Medline].

  29. Cendron M, Keating MA, Huff DS, et al. Cryptorchidism, orchiopexy and infertility: a critical long-term retrospective analysis. J Urol. Aug 1989;142(2 Pt 2):559-62; discussion 572. [Medline].

  30. Coughlin MT, Bellinger MF, LaPorte RE, et al. Testicular suture: a significant risk factor for infertility among formerly cryptorchid men. J Pediatr Surg. Dec 1998;33(12):1790-3. [Medline].

  31. Farrer JH, Walker AH, Rajfer J. Management of the postpubertal cryptorchid testis: a statistical review. J Urol. Dec 1985;134(6):1071-6. [Medline].

  32. Whitaker RH. Management of the undescended testis. Br J Hosp Med. 1970;4:25.

  33. Abratt RP, Reddi VB, Sarembock LA. Testicular cancer and cryptorchidism. Br J Urol. Dec 1992;70(6):656-9. [Medline].

  34. Tuazon E, Banks K, Koh CJ, et al. Re: Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular cancer. J Urol. Aug 2008;180(2):783-4; author reply 784-5. [Medline].

  35. Walsh TJ, Dall'Era MA, Croughan MS, et al. Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular cancer. J Urol. Oct 2007;178(4 Pt 1):1440-6; discussion 1446. [Medline].

  36. Campbell HE. Incidence of malignant growth of the undescended testicle: A critical and statistical study. Arch Surg. 1942;44:353.

  37. Martin DC, Menck HR. The undescended testis: management after puberty. J Urol. Jul 1975;114(1):77-9. [Medline].

  38. Martin DC. Germinal cell tumors of the testis after orchiopexy. J Urol. Apr 1979;121(4):422-4. [Medline].

  39. Pettersson A, Richiardi L, Nordenskjold A, et al. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med. May 3 2007;356(18):1835-41. [Medline].

  40. Rogers E, Teahan S, Gallagher H, et al. The role of orchiectomy in the management of postpubertal cryptorchidism. J Urol. Mar 1998;159(3):851-4. [Medline].

  41. Hrebinko RL, Bellinger MF. The limited role of imaging techniques in managing children with undescended testes. J Urol. Aug 1993;150(2 Pt 1):458-60. [Medline].

  42. Rajfer J, Handelsman DJ, Swerdloff RS, et al. Hormonal therapy of cryptorchidism. A randomized, double-blind study comparing human chorionic gonadotropin and gonadotropin-releasing hormone. N Engl J Med. Feb 20 1986;314(8):466-70. [Medline].

  43. De Muinck Keizer-Schrama SM, Hazebroek FW, Drop SL, et al. LH-RH nasal spray treatment for cryptorchidism. A double-blind, placebo-controlled study. Eur J Pediatr. 1987;146 Suppl 2:S35-7. [Medline].

  44. Fedder J, Boesen M. Effect of a combined GnRH/hCG therapy in boys with undescended testicles: evaluated in relation to testicular localization within the first week after birth. Arch Androl. May-Jun 1998;40(3):181-6. [Medline].

  45. Hesse V, Fischer G. Three injections of human chorionic gonadotropin are as effective as ten injections in the treatment of cryptorchidism. Horm Res. 1988;30(4-5):193-7. [Medline].

  46. Lala R, Matarazzo P, Chiabotto P, et al. Combined therapy with LHRH and HCG in cryptorchid infants. Eur J Pediatr. 1993;152 Suppl 2:S31-3. [Medline].

  47. Bica DT, Hadziselimovic F. The behavior of epididymis, processus vaginalis and testicular descent in cryptorchid boys treated with buserelin. Eur J Pediatr. 1993;152 Suppl 2:S38-42. [Medline].

  48. Hadziselimovic F, Girard J, Herzog B, et al. Hormonal treatment of cryptorchidism. Horm Res. 1982;16(3):188-92. [Medline].

  49. Docimo SG. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol. Sep 1995;154(3):1148-52. [Medline].

  50. Bellinger MF, Abromowitz H, Brantley S, et al. Orchiopexy: an experimental study of the effect of surgical technique on testicular histology. J Urol. Aug 1989;142(2 Pt 2):553-5; discussion 572. [Medline].

  51. Dixon TK, Ritchey ML, Boykin W, et al. Transparenchymal suture fixation and testicular histology in a prepubertal rat model. J Urol. May 1993;149(5):1116-8. [Medline].

  52. Jarow JP. Clinical significance of intratesticular arterial anatomy. J Urol. Apr 1991;145(4):777-9. [Medline].

  53. Storm D, Redden T, Aguiar M, et al. Histologic evaluation of the testicular remnant associated with the vanishing testes syndrome: is surgical management necessary?. Urology. Dec 2007;70(6):1204-6. [Medline].

  54. Jordan GH, Robey EL, Winslow BH:. Laparoendoscopic surgical management of the abdominal/transinguinal undescended testicle. J Endourol. 1992;6:159.

  55. Giwercman A, Dezuyei N, Lundwall A, et al. Testicular cancer and molecular genetics. Andrologia. Dec 2005;37(6):224-5. [Medline].

  56. Lenz S, Skakkebaek NE, Hertel NT. Abnormal ultrasonic pattern in contralateral testes in patients with unilateral testicular cancer. World J Urol. 1996;14 Suppl 1:S55-8. [Medline].

  57. Hadziselimovic F, Herzog B. Treatment with a luteinizing hormone-releasing hormone analogue after successful orchiopexy markedly improves the chance of fertility later in life. J Urol. Sep 1997;158(3 Pt 2):1193-5. [Medline].

  58. Schwentner C, Oswald J, Kreczy A, et al. Neoadjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol. Mar 2005;173(3):974-7. [Medline].

  59. Kawada T, Yamanaka H, Hasegawa Y. Decreased immunoreactive inhibin and increased FSH levels in cryptorchidism after orchidopexy. Endocr J. Aug 1995;42(4):577-80. [Medline].

  60. Kolon TF, Wiener JS, Lewitton M, et al. Analysis of homeobox gene HOXA10 mutations in cryptorchidism. J Urol. Jan 1999;161(1):275-80. [Medline].

  61. Huff DS, Hadziselimovic F, Snyder HM 3d, et al. Postnatal testicular maldevelopment in unilateral cryptorchidism. J Urol. Aug 1989;142(2 Pt 2):546-8; discussion 572. [Medline].

  62. Hutson JM, Baker M, Terada M, et al. Hormonal control of testicular descent and the cause of cryptorchidism. Reprod Fertil Dev. 1994;6(2):151-6. [Medline].

  63. Lee PA. Fertility in cryptorchidism. Does treatment make a difference?. Endocrinol Metab Clin North Am. Sep 1993;22(3):479-90. [Medline].

  64. Spencer JR. The endocrinology of testicular descent. AUA Update Series. 1994;XIII, Lesson 12:94-9.

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Further Reading

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Keywords

cryptorchidism, undescended testis, undescended testes, maldescended testis, maldescended testes, orchiopexy, orchidopexy, orchiectomy, hidden testis, obscure testis, cryptorchid testis, abdominal testes, maldescended testis, retractile testis, vanishing testis, vanishing testis syndrome, hypogonadotropic hypogonadism, epididymal abnormality, abnormal epididymis, intersex, intersexuality, pseudohermaphroditism, hypospadias

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Contributor Information and Disclosures

Author

Joel M Sumfest, MD, Director of Pediatric Urology, Janet Weis Children's Hospital, Geisinger Medical Center; Vice Chairman, Department of Urology, Geisinger Medical Center
Joel M Sumfest, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas F Kolon, MD, Department of Urology, Division of Pediatric Urology, Assistant Professor of Urology, The Children's Hospital of Philadelphia
Thomas F Kolon, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Urological Association, Society for Fetal Urology, Society for Pediatric Urology, Society for the Study of Male Reproduction, Society of University Urologists, and Society of Urology Chairpersons and Program Directors
Disclosure: Nothing to disclose.

Daniel B Rukstalis, MD, Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group
Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science and American Urological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Martin I Resnick, MD †, Former Lester Persky Professor and Chair, Department of Urology, Former Professor, Department of Oncology, Case Western Reserve University School of Medicine
Martin I Resnick, MD † is a member of the following medical societies: American College of Surgeons, American Federation for Medical Research, American Institute of Ultrasound in Medicine, American Medical Association, American Society for Bone and Mineral Research, American Society for Reproductive Medicine, American Society of Andrology, American Surgical Association, American Urological Association, Association for Academic Surgery, Endocrine Society, National Kidney Foundation, Ohio Urological Society, and Pan American Medical Association
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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