Guidelines Summary

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

Obtain gestational history at initial evaluation of boys with suspected cryptorchidism. (Standard; Evidence Strength: Grade B)
Palpate testes for quality and position at each recommended well-child visit. (Standard; Evidence Strength: Grade B)
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. (Standard; Evidence Strength: Grade B)
Refer boys with possible newly diagnosed (acquired) cryptorchidism after 6 months (corrected for gestational age) to an appropriate surgical specialist. (Standard; Evidence Strength: Grade B)
Immediately consult an appropriate specialist for all phenotypic male newborns with bilateral, nonpalpable testes for evaluation of a possible disorder of sex development (DSD). (Standard; Evidence Strength: Grade A)
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. (Standard; Evidence Strength: Grade B)
Assess the possibility of a disorder of sex development (DSD) in cases of increasing severity of hypospadias with cryptorchidism. (Recommendation; Evidence Strength: Grade C)
In boys with bilateral, nonpalpable testes who do not have congenital adrenal hyperplasia (CAH), measure Müllerian Inhibiting Substance (MIS or Anti-Müllerian Hormone [AMH]) level), and consider additional hormone testing, to evaluate for anorchia. (Option; Evidence Strength: Grade C)
In boys with retractile testes, assess the position of the testes at least annually to monitor for secondary ascent. (Standard; Evidence Strength: Grade B)

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. (Standard; Evidence Strength: Grade B). 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. (Standard; Evidence Strength: Grade B)
In prepubertal boys with palpable, cryptorchid testes, perform scrotal or inguinal orchidopexy. (Standard; Evidence Strength: Grade B)
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. (Standard; Evidence Strength: Grade B)
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. (Clinical Principle)
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. (Clinical Principle)

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. (Clinical Principle)

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 (Level of Evidence [LE] 2a, Grade A)
Offer surgical orchidolysis and orchidopexy before the age of 12 months, and by 18 months at the latest (LE 2b, Grade B)
Evaluate male neonates with bilateral non-palpable testes for possible DSDs (LE 1b, Grade A)
In boys with non-palpable testes and no evidence of DSDs, offer laparoscopic intervention because of its excellent sensitivity and specificity in identifying an intra-abdominal testis, as well as the possibility for subsequent treatment in the same session (LE 1a, Grade A)
Do not routinely offer hormonal therapy, either in an adjuvant or neo-adjuvant setting, for testicular descent; patients have to be evaluated on an individual basis (LE 2a, Grade C)
In cases of bilateral undescended testes, offer endocrine treatment to possibly improve further fertility potential (E 4, Grade C)
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 (LE 3, Grade B)

Questions

[Guideline] Kolon TF, Herndon CD, Baker LA, Baskin LS, Baxter CG, Cheng EY, et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014 Aug. 192 (2):337-45. [Medline]. [Full Text].
Heyns CF, Hutson JM. Historical review of theories on testicular descent. J Urol. 1995 Mar. 153(3 Pt 1):754-67. [Medline].
Elert A, Jahn K, Heidenreich A, et al. [The familial undescended testis]. Klin Padiatr. 2003 Jan-Feb. 215(1):40-5. [Medline].
Cheng Z, Wang M, Xu C, Pei Y, Liu JC, Huang H, et al. Mutational analysis of HOXA10 gene in Chinese patients with cryptorchidism. Andrologia. 2017 Feb. 49 (1):[Medline].
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].
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].
Hutson JM, Donahoe PK. The hormonal control of testicular descent. Endocr Rev. 1986 Aug. 7(3):270-83. [Medline].
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].
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].
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].
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].
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.
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].
Wensing CJ. The embryology of testicular descent. Horm Res. 1988. 30(4-5):144-52. [Medline].
Backhouse KM. The natural history of testicular descent and maldescent. Proc R Soc Med. 1966 Apr. 59(4):357-60. [Medline].
Hutson JM, Beasley SW. The mechanisms of testicular descent. Aust Paediatr J. 1987 Aug. 23(4):215-6. [Medline].
Heyns CF. The gubernaculum during testicular descent in the human fetus. J Anat. 1987 Aug. 153:93-112. [Medline].
Levard G, Laberge JM. The fate of undescended testes in patients with gastroschisis. Eur J Pediatr Surg. 1997 Jun. 7(3):163-5. [Medline].
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].
Frey HL, Peng S, Rajfer J. Synergy of abdominal pressure and androgens in testicular descent. Biol Reprod. 1983 Dec. 29(5):1233-9. [Medline].
Hadziselimovic F, Duckett JW, Snyder HM 3rd, et al. Omphalocele, cryptorchidism, and brain malformations. J Pediatr Surg. 1987 Sep. 22(9):854-6. [Medline].
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].
Murase K, Murase J, Machidori K, Mizuno K, Hayashi Y, Kohri K. Nationwide Increase in Cryptorchidism After the Fukushima Nuclear Accident. Urology. 2018 May 8. [Medline].
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].
Rabinowitz R, Hulbert WC Jr. Late presentation of cryptorchidism: the etiology of testicular re-ascent. J Urol. 1997 May. 157(5):1892-4. [Medline].
Scorer CG, Farrington GH. Congenital Deformities of the Testis and Epididymis, New York, Appleton-Century-Crofts. 1971.
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].
McAleer IM, Packer MG, Kaplan GW, et al. Fertility index analysis in cryptorchidism. J Urol. 1995 Apr. 153(4):1255-8. [Medline].
Tzvetkova P, Tzvetkov D. Etiopathogenesis of cryptorchidism and male infertility. Arch Androl. 1996 Sep-Oct. 37(2):117-25. [Medline].
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].
Huff DS, Fenig DM, Canning DA, et al. Abnormal germ cell development in cryptorchidism. Horm Res. 2001. 55(1):11-7. [Medline].
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].
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].
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].
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].
Farrer JH, Walker AH, Rajfer J. Management of the postpubertal cryptorchid testis: a statistical review. J Urol. 1985 Dec. 134(6):1071-6. [Medline].
Whitaker RH. Management of the undescended testis. Br J Hosp Med. 1970. 4:25.
Abratt RP, Reddi VB, Sarembock LA. Testicular cancer and cryptorchidism. Br J Urol. 1992 Dec. 70(6):656-9. [Medline].
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].
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].
Campbell HE. Incidence of malignant growth of the undescended testicle: A critical and statistical study. Arch Surg. 1942. 44:353.
Martin DC, Menck HR. The undescended testis: management after puberty. J Urol. 1975 Jul. 114(1):77-9. [Medline].
Martin DC. Germinal cell tumors of the testis after orchiopexy. J Urol. 1979 Apr. 121(4):422-4. [Medline].
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].
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].
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].
Shoukry M, Pojak K, Choudhry MS. Cryptorchidism and the value of ultrasonography. Ann R Coll Surg Engl. 2015 Jan. 97 (1):56-8. [Medline].
Tasian GE, Copp HL, Baskin LS. Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness. J Pediatr Surg. 2011 Dec. 46(12):2406-13. [Medline].
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].
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].
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].
Wei Y, Wang Y, Tang X, Liu B, Shen L, Long C, et al. Efficacy and safety of human chorionic gonadotropin for treatment of cryptorchidism: A meta-analysis of randomised controlled trials. J Paediatr Child Health. 2018 Apr 14. [Medline].
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].
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].
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].
Hadziselimovic F, Girard J, Herzog B, et al. Hormonal treatment of cryptorchidism. Horm Res. 1982. 16(3):188-92. [Medline].
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].
[Guideline] Radmayr C, Dogan HS, Hoebeke P, Kocvara R, Nijman R, Silay S, et al. Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines. J Pediatr Urol. 2016 Dec. 12 (6):335-343. [Medline]. [Full Text].
Sfoungaris D, Mouravas V, Petropoulos A, Filippopoulos A. Prentiss orchiopexy applied in younger age group. J Pediatr Urol. 2011 Nov 1. [Medline].
Docimo SG. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol. 1995 Sep. 154(3):1148-52. [Medline].
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].
Allin BSR, Dumann E, Fawkner-Corbett D, Kwok C, Skerritt C, Paediatric Surgery Trainees Research Network. Systematic review and meta-analysis comparing outcomes following orchidopexy for cryptorchidism before or after 1 year of age. BJS Open. 2018 Feb. 2 (1):1-12. [Medline]. [Full Text].
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].
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].
Jarow JP. Clinical significance of intratesticular arterial anatomy. J Urol. 1991 Apr. 145(4):777-9. [Medline].
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].
Jordan GH, Robey EL, Winslow BH:. Laparoendoscopic surgical management of the abdominal/transinguinal undescended testicle. J Endourol. 1992. 6:159.
Shehata S, Shalaby R, Ismail M, Abouheba M, Elrouby A. Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique): Stretching the limits for preservation of testicular vasculature. J Pediatr Surg. 2016 Feb. 51 (2):211-5. [Medline].
Alzahem A. Laparoscopy-assisted orchiopexy versus laparoscopic two-stage fowler stephens orchiopexy for nonpalpable testes: Comparative study. Urol Ann. 2013 Apr. 5 (2):110-4. [Medline]. [Full Text].
Chung JM, Lee SD. Individualized Treatment Guidelines for Postpubertal Cryptorchidism. World J Mens Health. 2015 Dec. 33 (3):161-6. [Medline]. [Full Text].
Giwercman A, Dezuyei N, Lundwall A, et al. Testicular cancer and molecular genetics. Andrologia. 2005 Dec. 37(6):224-5. [Medline].
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].
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].
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].
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].

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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