Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Cryptorchidism

  • Author: Joel M Sumfest, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Jan 05, 2016
 

Background

Cryptorchidism is the most common genital problem encountered in pediatrics. Cryptorchidism literally means hidden or obscure testis and generally refers to an undescended or maldescended testis. Despite more than 100 years of research, many aspects of cryptorchidism are not well defined and remain controversial. Untreated cryptorchidism clearly has deleterious effects on the testis over time. Understanding the abnormalities of morphogenesis and the molecular and hormonal milieu associated with cryptorchidism is critical to contemporary diagnosis and treatment of this extremely common entity.

According to the guidelines published by the American Urological Association in May 2014, imaging for cryptorchidism is not recommended prior to referral, which should occur by 6 months of age. In addition, orchiopexy is the most successful therapy to relocate the testis into the scrotum, and hormonal therapy is not recommended. Successful scrotal repositioning of the testis may reduce but does not prevent the potential long-term issues of infertility and testis cancer, and appropriate counseling and follow-up of the patient are essential.[1]

Next

History of the Procedure

This condition was first described in 1786 by Hunter and has been recognized for centuries. The first surgical orchiopexy was attempted in 1820 by Rosenmerkal. However, it was not until 1877 that Annandale performed the first successful orchiopexy.

Previous
Next

Problem

Normal testicular development begins at conception. The testis-determining factor is now identified as the SRY gene (sex-determining region on Y chromosome). The presence of this gene and an intact downstream pathway generally result in testicular formation.

At 3-5 weeks' gestation, the gonadal ridge or indifferent gonad develops, and, at 6 weeks' gestation, primordial germ cell migration occurs. Soon after, Sertoli cells develop and secrete müllerian-inhibiting substance (MIS), the level of which remains high throughout gestation and causes regression of müllerian ducts. At 9 weeks' gestation, Leydig cells develop and secrete testosterone.

Prenatal ultrasonography shows no testicular descent before 28 weeks' gestation, other than transabdominal movement to the internal inguinal ring. Transinguinal migration, thought to be under hormonal control, occurs at 28-40 weeks' gestation, usually resulting in a scrotal testis by the end of a full term of gestation.

Previous
Next

Epidemiology

Frequency

Overall, 3% of full-term male newborns have cryptorchidism, decreasing to 1% in male infants aged 6 months to 1 year. The prevalence of cryptorchidism is 30% in premature male neonates. Factors that Predispose to cryptorchidism include prematurity, low birth weight, small size for gestational age, twinning, and maternal exposure to estrogen during the first trimester. Seven percent of siblings of boys with undescended testes have cryptorchidism. Spontaneous descent after the first year of life is uncommon.

In the United States, the prevalence of cryptorchidism ranges from 3.7% at birth to 1.1% from age 1 year to adulthood. Internationally, prevalence ranges from 4.3-4.9% at birth to 1-1.5% at age 3 months to 0.8-2.5% at age 9 months. Cryptorchidism is identified in 1.5-4% of fathers and 6.2% of brothers of patients with cryptorchidism. Heritability in first-degree male relatives is estimated to be 0.67.

Previous
Next

Etiology

The etiology of cryptorchidism is multifactorial. Extensive research and clinical observations have elucidated some of the factors involved, but the exact mechanism of cryptorchidism has proven to be elusive.

Birth weight is the principal determining factor for undescended testes at birth to age one year, independent of the length of gestation.

One study found that almost 23% of index patients with undescended testes had a positive family history of cryptorchidism, as opposed to 7.5% in control families.[2] The familial cluster is 3.6 fold overall, 6.9 if sibling is affected and 4.6 if father.

Transabdominal descent of the testis involves differential growth of vertebrae and pelvis until 23 weeks’ gestation. Afterward, further descent is facilitated by the development of the gubernaculum, processus vaginalis, spermatic vessels, and scrotum.[3] A normal hypothalamic-pituitary-gonadal axis is a prerequisite for testicular descent.[4] Furthermore, testosterone and its conversion to dihydrotestosterone (DHT) are also necessary for continued migration, especially during the inguinoscrotal phase.[5, 6, 7]

Exposure to endocrine-disrupting chemicals may contribute to cryptorchidism, and may account for the increasing incidence rate of cryptorchidism seen in some regions. Synthetic chemicals identified as endocrine disruptors include phthalates, pesticides, brominated flame retardants, diethylstilbestrol, and dioxins.[8] Different studies have found conflicting data regarding the involvement of müllerian-inhibiting substance, prenatal estrogen exposure, and descendin (a specific gubernacular growth factor) in the pathophysiology of cryptorchidism.[9, 10, 11]

Although its exact mechanism of action is unclear, the gubernaculum has significant importance in undescended testes. In patients with cryptorchidism, the gubernaculum is not firmly attached to the scrotum, and the testis is not pulled into the scrotum.[12] Both hormonal and mechanical factors appear to mediate the aid of the gubernaculum and descent of the testis.[13] The genitofemoral nerve may also aid in descent and gubernacular differentiation, which may be mediated by calcitonin gene-related peptide.[14, 15]

Intra-abdominal pressure also appears to play a role in testicular descent. Conditions associated with decreased pressure include prune belly syndrome, cloacal exstrophy, omphalocele, and gastroschisis, among other various syndromes. Each is associated with an increased risk of undescended testes.[16, 17] The effect of decreased intra-abdominal pressure is most significant during transinguinal migration to the scrotum, probably in conjunction with androgens and a patent processus vaginalis.[18, 19]

Epididymal abnormalities often accompany undescended testes, but the causal relationship has not been established. In 1992, Elder concluded that most epididymal abnormalities probably do not contribute to maldescent.[20]

Previous
Next

Presentation

In cryptorchidism, the most useful determination is whether the testes are palpable upon physical examination. Although this is seemingly self-explanatory, it is occasionally difficult to accurately determine the exact location of the testis. Body habitus, testicular position, and compliance of the child all are factors during the physical examination. Approximately 80% of undescended testes are palpable and 20% are nonpalpable.[21] Nonpalpable testes may be intra-abdominal or absent. Palpable testes may be undescended, ectopic, or retractile.

Approximately 20-30% of patients with cryptorchidism have nonpalpable testes. Most intra-abdominal testes are found within a few centimeters of the internal ring. Absent or vanishing testes are thought to be due to an intrauterine or perinatal vascular event, most likely during late gestation since most of these testicular nubbins are found below the internal inguinal ring. Only 20-40% of nonpalpable testes are absent upon surgical exploration.

Ectopic testes exit the external inguinal ring and are then misdirected along the normal course of the testis. Retractile testes may be palpated anywhere along the natural course of the testis, although most are inguinal. Although not truly undescended, these testes may be suprascrotal secondary to an active cremasteric reflex. This reflex is usually weak in infants and most active in boys aged 5 years. These testes can be manipulated into the scrotum, where they remain without tension. This condition is considered a variant of normal; however, the risk of ascent may approach 50%.[22, 23] Ascent probably represents an undescended testis that was almost in normal position. The distinction can be difficult, even to an experienced pediatric urologist. Therefore, children with retractile testes should be monitored regularly, at least until puberty.

Several authors have examined the anatomic position of cryptorchid testes. Cendron and Duckett documented the position upon physical examination and compared this with position at the time of surgery.[24] On physical examination, testicular positions were as follows:

  • Nonpalpable - 32.8%
  • Above the tubercle - 11.8%
  • At the tubercle - 34.7%
  • Upper scrotum - 15.3%
  • Suspected ectopia - 5.4%

At surgery, testicular findings were as follows:

  • Intra-abdominal - 9%
  • Peeping testis - 20%
  • Tubercle - 42%
  • Upper scrotum - 8%
  • Superficial inguinal pouch (SIP)/ectopic - 12%
  • Absent or atrophic - 9%

Associated anomalies and conditions may include the following:

  • Patent processus vaginalis
  • Abnormal epididymis
  • Mental retardation
  • Abdominal wall defects (eg, gastroschisis, omphalocele, prune belly syndrome)

In general, ductal abnormalities, hernias (patent processus vaginalis), and testicular maldevelopment are more common in patients with abdominal testes. Overall, 32-79% of undescended testes are associated with some type of epididymal abnormality. However, abnormalities that inhibit sperm transport (eg, complete caput separation, atresia, agenesis) have been reported in only 8% of patients with cryptorchidism. In addition, when the processus vaginalis is patent, the epididymis is more likely to be abnormal.

History

The medical history should cover the following questions:

  • Has the testis ever been palpable in the scrotum?
  • Was the patient born prematurely?
  • Has the patient undergone prior inguinal surgery?
  • Is or was the patient's mother on a vegetarian diet? Was the patient fed soy formula during infancy?
  • What was the patient's birth weight?

The prenatal history should cover the following questions:

  • Did the patient's parents used an assisted reproductive technique?
  • Did his mother receive hormonal treatment?
  • Were there multiple gestations?

The family history should cover the following topics:

Physical examination

Considerations and questions in the physical examination include the following:

  • The patient should be warm and relaxed for the examination.
  • Observation should precede the examination.
  • The patient should be placed in the frog-leg position for examination;  this is especially useful in obese children with fatty infiltration of the scrotum and when retractility is a concern.
  • Milk down, palpating from iliac crest to scrotum (soap or lubrication on fingertips may help).

See the list below:

  • What are the features of the scrotum and its contents (eg, hypoplasticity, bifidity, rugae, transposition, pigmentation)?
  • Is the contralateral testicle hypertrophic?
  • Is the undescended testis located in an unusual position, such as in an ectopic site (ie, superficial inguinal pouch or transverse scrotal, femoral, prepenile, perineal, or contralateral hemiscrotum)?
  • Note the presence of any hypospadias or chordee. Does the patient have a normal stretched penile length?
  • If the findings are equivocal, perform serial examinations.
Previous
Next

Indications

Indications for hormonal or surgical correction of cryptorchidism include the following:

To increase the likelihood of fertility

  • Impairment of germ cell maturation is a well-recognized consequence of cryptorchidism.
  • Early reposition of the testis into the scrotum has been a mainstay of treatment to reduce the risk of infertility; however, recent studies have cast some doubt on this. [25, 26, 27]
  • Abnormal germ cell maturation correlates with abnormal spermiogram findings in adulthood.
  • Biopsy findings in children with unilateral undescended testis demonstrated reduced total germ cell counts due to failure of the two critical prepubertal steps involved in maturation and proliferation of germ cells: (1) transformation of the fetal stem cell pool (gonocytes) into adult stem cell pool (type Ad spermatogonia) at age 2-3 months and (2) transformation of type Ad spermatogonia into primary spermatocytes at age 4-5 years. [28]
  • Hadziselimovic and Herzog (2001) found a negative association between age and germ cell count by age 6 months in children undergoing orchiopexy. [29]
  • Lee (1995) postulated that paternity itself is a better index than sperm count. Compared with controls, paternity was significantly compromised in men with bilateral, but not unilateral, undescended testes. [30] This finding was supported by two subsequent studies in which up to 90% men with unilateral undescended testis had fathered children, as opposed to only 33-65% with bilateral undescended testes. [31, 32]

Facilitation of testicular self-examination for testicular cancer

  • Males with undescended testis are 40 times as likely to develop testicular cancer as males without undescended testis. [33] Ten percent of testicular cancer cases involve patients with undescended testis. [34, 35]
  • Prepubertal orchiopexy reduces this risk. [36, 37]
  • The ability for patients to perform testicular self-examination with the testes in the scrotum is a clear benefit of surgery.
  • The location of the undescended testis affects the relative risk of testicular cancer. Up to 50% of malignant testicular tumors associated with cryptorchidism involve intra-abdominal testes. [38, 39]
  • Seminoma is the most common malignant tumor type associated with cryptorchidism. [40]
  • Correction of associated hernia: A patent processus vaginalis is found in more than 90% of patients with undescended testis. [23, 20]

Additional indications

  • Prevention of testicular torsion
  • Prevention of injury against pubic bone
  • Psychological effects of an empty scrotum

Treatment recommendations for postpubertal men

Men younger than 32 years with a unilateral undescended testis and normal contralateral testis should undergo orchiectomy. Men older than 32 years with a unilateral undescended testis should receive close observation and physical examination. If examination is difficult, orchiopexy or orchiectomy should be considered; this recommendation is based on the relative risk of testicular cancer along with the risks associated with anesthesia.[41, 42]

Previous
Next

Relevant Anatomy

The undescended testis, when palpable, is usually found in the superficial inguinal pouch or in the inguinal canal under the external oblique aponeurosis. Care must be taken during dissection to avoid the ilioinguinal nerve near the spermatic cord. After dissection of the cremasteric fibers off the cord, the patent processus vaginalis, or hernia sac, may be located on the anteromedial surface of the cord. The intra-abdominal view of the anatomy is best seen inthe image below. The vas deferens can be seen exiting the internal inguinal ring and crossing the median umbilical ligament (see image below). The testicular vessels (ie, spermatic artery) can be seen entering the internal ring from its origin off the aorta near the renal hilum.

Laparoscopic view of normal vas deferens and testi Laparoscopic view of normal vas deferens and testicular vessels entering a closed internal inguinal ring.
Previous
 
 
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 Pediatric Urology, Society for Fetal Urology

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas F Kolon, MD, MS Associate Professor of Urology, Division of Pediatric Urology, The Children's Hospital of Philadelphia

Thomas F Kolon, MD, MS is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Urological Association, Society for Pediatric Urology, Society of University Urologists, Society for Fetal Urology, Society of Urology Chairpersons and Program Directors, Society for the Study of Male Reproduction

Disclosure: Nothing to disclose.

Daniel B Rukstalis, MD Professor of Urology, Wake Forest Baptist Health System, Wake Forest University School of Medicine

Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science, American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

References
  1. [Guideline] Kolon TF, Herndon A, Baker LA, et al. Evaluation and Treatment of Cryptorchidism: AUA Guideline. Journal of Urology. American Urological Association. Published online May 20, 2014. Available at http://www.jurology.com/article/S0022-5347(14)03531-9/fulltext. Accessed: November 12, 2014.

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

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

  4. Fantasia J, Aidlen J, Lathrop W, Ellsworth P. Undescended Testes: A Clinical and Surgical Review. Urol Nurs. 2015 May-Jun. 35 (3):117-26. [Medline].

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

  6. 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. 1994 Jun. 29(6):839-44. [Medline].

  7. 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. 2000 Feb. 85(2):658-65. [Medline].

  8. Hauser R, Skakkebaek NE, Hass U, Toppari J, Juul A, Andersson AM, et al. Male reproductive disorders, diseases, and costs of exposure to endocrine-disrupting chemicals in the European Union. J Clin Endocrinol Metab. 2015 Apr. 100 (4):1267-77. [Medline]. [Full Text].

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

  10. 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.

  11. 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. 1989 Sep. 142(3):837-45. [Medline].

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  27. 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].

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  44. Shoukry M, Pojak K, Choudhry MS. Cryptorchidism and the value of ultrasonography. Ann R Coll Surg Engl. 2015 Jan. 97 (1):56-8. [Medline].

  45. Tasian GE, Copp HL, Baskin LS. Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness. J Pediatr Surg. 2011 Dec. 46(12):2406-13. [Medline].

  46. 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. 1986 Feb 20. 314(8):466-70. [Medline].

  47. 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].

  48. 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. 1998 May-Jun. 40(3):181-6. [Medline].

  49. 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].

  50. 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].

  51. 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].

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

  53. Chua ME, Mendoza JS, Gaston MJ, Luna SL Jr, Morales ML Jr. Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review. J Pediatr Surg. 2014 Nov. 49 (11):1659-67. [Medline].

  54. Sfoungaris D, Mouravas V, Petropoulos A, Filippopoulos A. Prentiss orchiopexy applied in younger age group. J Pediatr Urol. 2011 Nov 1. [Medline].

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

  56. Feyles F, Peiretti V, Mussa A, Manenti M, Canavese F, Cortese MG, et al. Improved sperm count and motility in young men surgically treated for cryptorchidism in the first year of life. Eur J Pediatr Surg. 2014 Oct. 24(5):376-80. [Medline].

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

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

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

  60. 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. 2007 Dec. 70(6):1204-6. [Medline].

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

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

  63. 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].

  64. 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. 1997 Sep. 158(3 Pt 2):1193-5. [Medline].

  65. 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. 2005 Mar. 173(3):974-7. [Medline].

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

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

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

  69. 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].

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

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

 
Previous
Next
 
Laparoscopic view of normal vas deferens and testicular vessels entering a closed internal inguinal ring.
Laparoscopic view of atretic testicular vessels approaching the internal inguinal ring, leading to a diagnosis of vanishing testis syndrome (ie, testicular agenesis).
Laparoscopic first-stage endoligation of the testicular artery as part of a planned 2-stage Fowler-Stephens orchiopexy for an abdominal testis.
Laparoscopic view of testicular vessels entering an open inguinal hernia sac.
Blind-ending vas deferens.
Laparoscopic management of the vanishing testis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.