Kryptorchismus

Kryptorchismus, or cryptorchidism, is a condition in which one or both testes fail to descend into the scrotum. In most term-born infants, testes descend before or shortly after birth; many descend spontaneously within the first six months. If descent has not occurred by about six months of age, referral to a pediatric urologist is advised.

Cryptorchidism affects about 1% of term male infants and is more common in premature infants. The condition is usually unilateral, but bilateral cases occur. The etiology is multifactorial, involving hormonal influences, mechanical factors, and genetic or developmental conditions. The undescended testis may be palpable in the groin or nonpalpable (intra-abdominal or intra-inguinal). Imaging studies are not routinely needed and have limited accuracy; diagnostic laparoscopy may be used when the testis is nonpalpable to determine location and plan treatment.

Orchiopexy, the surgical bringing of the testis into the scrotum, is recommended to preserve fertility and reduce cancer risk. The typical target age for repair is around 6 to 12 months, depending on guidelines. Nonpalpable testes often require laparoscopy to locate; if the testis is absent or nonviable, removal is considered due to cancer risk. Hormonal therapies (e.g., human chorionic gonadotropin or GnRH) have limited effectiveness and are not standard of care.

Untreated kryptorchismus is associated with reduced fertility in adulthood and an increased risk of testicular cancer, especially for intra-abdominal testes. The risk persists after orchiopexy but is lower than in unrepaired cases. Other risks include inguinal hernia and, rarely, torsion.