Guidelines Summary

American Urological Association (AUA) guidelines on cryptorchidism contain the following recommendations on diagnosis by primary care providers^[1]:

Obtain gestational history at initial evaluation of boys with suspected cryptorchidism.
Palpate testes for quality and position at each recommended well-child visit.
Refer infants with a history of cryptorchidism (detected at birth) who do not have spontaneous testicular descent by 6 months (corrected for gestational age) to an appropriate surgical specialist for timely evaluation.
Refer boys with possible newly diagnosed (acquired) cryptorchidism after 6 months (corrected for gestational age) to an appropriate surgical specialist.
Immediately consult an appropriate specialist for all phenotypic male newborns with bilateral, nonpalpable testes for evaluation of a possible disorder of sex development (DSD).
Do not perform ultrasound (US) or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral, as these studies rarely assist in decision making.
Assess the possibility of a DSD in cases of increasing severity of hypospadias with cryptorchidism.
In boys with bilateral, nonpalpable testes who do not have congenital adrenal hyperplasia (CAH), consider measuring Müllerian inhibiting substance (MIS or anti-Müllerian hormone [AMH]) level), and consider additional hormone testing, to evaluate for anorchia.
In boys with retractile testes, assess the position of the testes at least annually to monitor for secondary ascent.

The AUA guidelines recommend against the use of hormonal therapy to induce testicular descent, due to low response rates and lack of evidence for long-term efficacy. AUA recommendations for treatment by surgical specialists are as follows:

If spontaneous testicular descent has not occurred by 6 months (corrected for gestational age), perform surgery within the next year. \
In prepubertal boys with palpable, cryptorchid testes, perform scrotal or inguinal orchidopexy.
In prepubertal boys with nonpalpable testes, perform examination under anesthesia to reassess for palpability of testes. If nonpalpable, surgical exploration—and, if indicated, abdominal orchidopexy—should be performed.
At the time of exploration for a nonpalpable testis in boys, identify the status of the testicular vessels to help determine the next course of action.
In boys with a normal contralateral testis, consider performing orchiectomy (removal of the undescended testis) if a boy has a normal contralateral testis and either very short testicular vessels and vas deferens, dysmorphic or very hypoplastic testis, or postpubertal age.

The AUA advises that providers should counsel boys with a history of cryptorchidism and/or monorchidism, and their parents, regarding potential long-term risks and provide education on infertility and cancer risk.

European guidelines

Guidelines on cryptorchidism from the European Association of Urology and the European Society for Paediatric Urology include the following recommendations^[58]:

Do not offer medical or surgical treatment to boys with retractile testes, but follow up closely until puberty.
Offer surgical orchidolysis and orchidopexy before the age of 12 months, and by 18 months at the latest.
Evaluate male neonates with bilateral non-palpable testes for possible DSDs.
Perform a diagnostic laparoscopy to locate an intra-abdominal testicle.
Hormonal therapy in unilateral undescended testes is of no benefit for future paternity.
In cases of bilateral undescended testes, consider offering endocrine treatment to possibly improve further fertility potential.
For an undescended testis in a post-pubertal boy or older who has a normal contralateral testis, discuss removal with the patient/parents because of the theoretical risk of a later malignancy.

Questions

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Media Gallery

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.

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