Cryptorchidism

Cryptorchidism is the failure of one or both testes to descend into the scrotum. Most testes descend spontaneously during infancy; if descent has not occurred by about 6 to 12 months, evaluation and treatment are recommended. The condition is more common in preterm infants and may reflect hormonal, developmental, or mechanical factors. It is associated with inguinal hernia, hypospadias, and other congenital anomalies.

There are several forms. Retractile testes can be moved into the scrotum but revert upward. Palpable undescended testes cannot be felt in the scrotum but are located in the groin. Nonpalpable testes lie in the abdomen or pelvis. Diagnosis is clinical. Imaging such as ultrasound is not routinely helpful. Laparoscopy is used when a testis cannot be palpated to locate it and guide treatment.

Management aims to place the testis in the scrotum to preserve fertility potential and allow cancer surveillance. Retractile testes may be observed. Most undescended testes require orchidopexy, ideally by about 12 months of age. Nonpalpable testes may require laparoscopic exploration with staged or single-stage repair, depending on location and vascular supply.

Hormonal therapies, such as human chorionic gonadotropin or GnRH, have limited efficacy and are not routinely recommended. Complications include reduced fertility, especially with bilateral disease, and an increased lifetime risk of testicular cancer. Orchidopexy does not eliminate cancer risk but facilitates examination and monitoring. Regular follow-up is advised to assess growth and detect hernias.