ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Undescended testes (cryptorchidism) in children: Management

Undescended testes (cryptorchidism) in children: Management
Literature review current through: Jan 2024.
This topic last updated: Aug 04, 2023.

INTRODUCTION — Cryptorchidism is the most common congenital abnormality of the genitourinary tract [1]. Most cryptorchid testes are undescended, but some are absent (due to agenesis or atrophy). True undescended testes have stopped short along their normal path of descent into the scrotum (figure 1). They may remain in the abdominal cavity (picture 1) or they may be palpable in the inguinal canal (intracanalicular) or just outside the external ring (suprascrotal (picture 2)) [2].

An overview of the management of undescended testes in children will be provided here. The clinical features and evaluation of undescended testes in children are discussed separately. (See "Undescended testes (cryptorchidism) in children: Clinical features and evaluation".)

TERMINOLOGY

Cryptorchidism – Cryptorchidism by definition suggests a hidden testis: a testis that is not within the scrotum and does not descend spontaneously into the scrotum by four months of age (or corrected age for premature infants) (picture 3). Cryptorchid testes may be absent or undescended.

Absent testis – An absent testis may be due to agenesis or atrophy secondary to intrauterine vascular compromise (eg, prenatal testicular torsion), also known as the "vanishing testis syndrome" or testicular regression syndrome [3]. Boys who have bilaterally absent testes have anorchia. (See "Neonatal testicular torsion", section on 'Prenatal'.)

Undescended testes – True undescended testes stop short along their normal path of descent into the scrotum (figure 1). They may remain in the abdominal cavity (picture 1) or they may be palpable in the inguinal canal (intracanalicular) or just outside the external ring (suprascrotal (picture 1)) [2].

Retractile testes – Retractile testes are normally descended testes that can be pulled into a suprascrotal position by the cremasteric reflex. These testes can be brought into a dependent scrotal position and will remain there if the cremasteric reflex is overcome (eg, by holding the testis in the scrotum for at least one minute to fatigue the cremaster muscle) [4]. (See "Undescended testes (cryptorchidism) in children: Clinical features and evaluation", section on 'Examination'.)

Ascending testes – Ascending testes are noted to be in a scrotal position in early childhood and then to "ascend" and become undescended (ie, acquired undescended testes) [5-8]. The ascent may occur at any age before puberty [9].

INDICATIONS FOR REFERRAL — Indications for referral in phenotypic males with cryptorchidism include:

Phenotypically male newborn infants with bilaterally nonpalpable testes, unilaterally nonpalpable testis with hypospadias, or suspected difference of sex development (including congenital adrenal hyperplasia) – Immediate consultation with or referral to a multidisciplinary team (see "Management of the infant with atypical genital appearance (difference of sex development)", section on 'Initial stabilization')

Bilateral nonpalpable testes in boys beyond infancy – Referral for exploratory surgery (as an initial step, some clinicians may perform a hormonal evaluation to exclude absent testes) (see "Undescended testes (cryptorchidism) in children: Clinical features and evaluation", section on 'Older child')

Congenital unilateral nonpalpable testis – Referral for examination under anesthesia and exploratory surgery, ideally between 4 and 12 months of age (see 'Nonpalpable testes' below)

Congenital palpable undescended testis (unilateral or bilateral) in infants – Referral for evaluation and possible orchiopexy, ideally between 4 and 12 months of age (see 'Palpable testes' below)

Ascending testis in boys beyond infancy – Referral for evaluation and possible orchiopexy whenever the physical examination change is noted (see 'Timing of surgery' below)

Palpable tissue in the scrotum that is thought to be an atrophic testis – Referral for exploratory surgery to exclude an intra-abdominal testis [10] (see 'Exploratory surgery' below)

Difficulty differentiating between undescended, retractile, or ectopic testis (at any age) – Refer for evaluation and possible orchiopexy if beyond four months of age

NATURAL HISTORY — Most testes that are undescended at birth complete their descent within the first three to four months of life [11]. Spontaneous descent in term infants is rare after four months of age [12,13].

The growth of a unilaterally undescended testicle may be impaired compared with the normally descended contralateral testicle, whether the undescended testicle descends spontaneously or is surgically corrected [14]. Treatment before one year of age may be associated with partial catch-up growth [15]. (See 'Timing of surgery' below.)

In testes that remain undescended, changes related to fertility may occur by one year of age, as illustrated by the following observations from testicular biopsies of undescended testes performed at the time of orchiopexy [16-24]:

The normal transformation of the fetal gonocyte into the adult dark-type spermatogonia (which usually occurs by four months of age) was impaired; fetal gonocytes persisted and then underwent degeneration.

Germ cell density decreased over time, evident as early as one year of age.

Spermatogonia were absent in 30 to 40 percent of undescended testes at two years of age.

In boys with unilateral cryptorchidism, primary spermatocytes failed to appear in the undescended testis and were present in only 19 percent of the contralateral testicles at four to five years of age.

Spermatogenesis was absent in most post-pubertal unilateral abdominal testes.

These observations suggest that, to the extent that orchiopexy alters these fertility-related changes, it may be best performed before they occur, ideally as soon as possible after four months of age [25,26]. (See 'Timing of surgery' below.)

COMPLICATIONS AND SEQUELAE — Complications and sequelae of undescended testes and associated conditions include inguinal hernia, testicular torsion, testicular trauma, subfertility, and testicular cancer. The potential seriousness of these complications and sequelae supports early referral for definitive treatment. (See 'Indications for referral' above and 'Management of undescended testes' below.)

Inguinal hernia — As many as 90 percent of congenital true undescended testes have an associated patent processus vaginalis [27-29]. In boys with untreated undescended testis, inguinal hernia can present at any time with the typical symptoms or complications, including incarceration. (See "Inguinal hernia in children", section on 'Clinical features and diagnosis'.)

The management of inguinal hernia is discussed separately. (See "Inguinal hernia in children", section on 'Initial management'.)

Testicular torsion — Testicular torsion is estimated to be 10 times more common in undescended than in normal scrotal testes, but the true relative risk is not known [30-33]. Torsion of an undescended testis is a surgical emergency. The rate of salvage of torsion in cryptorchid testes is decreased compared to that in normally descended testes, perhaps related to delay in diagnosis [30,33,34]. Early diagnosis and surgical treatment of cryptorchidism with orchiopexy may prevent testicular torsion.

Testicular torsion can occur at any age. Torsion of an undescended testis may occur in the setting of testicular tumor, presumably caused by increased weight and distortion of the normal dimensions of the organ [35]. (See "Neonatal testicular torsion" and "Causes of scrotal pain in children and adolescents", section on 'Testicular torsion'.)

Clinical findings of torsion of a cryptorchid intracanalicular testis may include inguinal swelling with or without tenderness with an empty ipsilateral hemiscrotum [31,34]. In males with these findings, ultrasonography is of limited value and should not delay surgical consultation. Torsion of an intra-abdominal testis can present as an acute abdomen, with the diagnosis of torsion made only at the time of abdominal exploration [36-38].

Testicular trauma — Undescended testes that remain in the inguinal canal are at increased risk for blunt traumatic injury because of the potential for compression against the pubic bone.

Subfertility — Men with a history of undescended testes (including ascending or acquired undescended testes) have an increased incidence of lower sperm counts, sperm of poorer quality, and lower fertility rates than men with normally descended testes [39-42]. Impaired spermatogenesis in the undescended testis probably is related to underlying genetic, hormonal, and developmental abnormalities, some of which may be partially reversible through early surgical intervention. Sperm counts in adulthood are directly related to prepubertal germ cell counts and types of testicular cells (gonocyte versus adult dark spermatogonia) at the time of orchiopexy [43-45]. (See 'Natural history' above and 'Timing of surgery' below.)

The degree of germ-cell dysfunction increases with bilateral involvement and with increasing duration of suprascrotal location [22,26,46-51]. Intra-abdominal and intracanalicular undescended testicles are affected similarly [52], probably related to the damaging effect of higher temperatures outside the scrotum on spermatogenesis [53,54].

Elevated follicle stimulating hormone (FSH) concentration and decreased serum inhibin B concentration are endocrinologic markers of Sertoli cell/seminiferous tubule dysfunction. In most studies of men with a history of cryptorchidism, Sertoli cell/seminiferous tubule function (spermatogenesis) is impaired, but Leydig cell function (virilization) is not [49,55-58]. (See "Approach to the male with infertility".)

In a cohort study, men with unilateral cryptorchidism who underwent orchiopexy by age two years had higher inhibin B and lower FSH concentrations than those who underwent surgery later in life, suggesting that orchiopexy before age two years may have beneficial effects on fertility [59]. Other observational studies suggest that orchiopexy after age one to two years (and before age 12 years) has little effect on fertility potential [46,51,60,61]. Taken together, these observations suggest that early orchiopexy is advantageous to fertility preservation.

Testicular cancer — Men with a history of undescended testis have an increased risk of developing testicular cancer compared with men in the general population in whom the age adjusted incidence is approximately 5.4 per 100,000 [62]. However, the magnitude of increased risk is poorly quantified [1].

In a 2013 meta-analysis of nine case-control studies (including a total of 2281 cases) and three cohort studies (including more than 2 million boys), the pooled odds ratio (OR) of testicular cancer in men with a history of isolated cryptorchidism was 2.9 (95% CI 2.2-3.8) but limitations included significant heterogeneity among studies (with individual ORs ranging from 3 to 50), risk of publication bias, and overall lack of high-quality evidence [63]. In a 2023 meta-analysis of three case-control studies (including a total of 3404 cases) and three cohort studies (including 368,367 children), all of whom were treated surgically before adulthood, the pooled odds of developing testicular cancer was four times greater compared with those who did not have cryptorchidism (OR 4.0, 95% CI 2.8-5.7) [64].

The risk of developing testicular cancer is further increased in men with bilateral cryptorchidism (which may be associated with endocrinologic abnormalities or abnormal karyotype) and intra-abdominal undescended testes [1,65-67]. (See "Epidemiology and risk factors for testicular cancer", section on 'Cryptorchidism' and "Clinical manifestations, diagnosis, and staging of testicular germ cell tumors", section on 'Cryptorchidism'.)

A history of cryptorchidism is also a risk factor for developing germ cell neoplasia in situ (formerly called intratubular germ cell neoplasia of unclassified type [68]), a premalignant condition. (See "Testicular germ cell neoplasia in situ", section on 'Cryptorchidism'.)

Surgical repositioning of the testis (orchiopexy) before puberty appears to decrease the risk of testicular cancer but does not completely eliminate it [1,69-72]. In a cohort of 16,983 men who underwent orchiopexy between 1964 and 1999 and were followed for a total of 209,984 person-years, 56 cases of testicular cancer were identified [69]. Among those who were treated before 13 years of age, the RR of testicular cancer compared with the general population was 2.2 (95% CI 1.6-3.1). Among those who were treated at ≥13 years of age, the RR was 5.4 (95% CI 3.2-8.6). These findings support those of several smaller case-control and cohort studies [65,73-76]. (See 'Timing of surgery' below.)

Testicular malposition is not the only factor in the development of testicular cancer in men with a history of cryptorchidism because surgical repositioning does not completely eliminate the risk. In addition, in a meta-analysis of 12 observational studies of 199 testicular tumors in men with unilaterally undescended testis, 21 percent of the tumors occurred in the normally descended testis [77]. (See "Epidemiology and risk factors for testicular cancer", section on 'Risk factors'.)

MANAGEMENT OF UNDESCENDED TESTES

Overview — The goal of management is to place and fix viable undescended testes in a normal scrotal position or to remove nonviable testicular remnants. Scrotal positioning reduces the risk of torsion and blunt traumatic injury (for intracanalicular testes) and permits easier examination of the testis. If performed sufficiently early, surgical correction may also reduce the risk of infertility and testicular cancer. Finally, having the testis in a normal, dependent scrotal position may improve body satisfaction, although the psychological impact of abnormal testicular position has not been studied.

Treatment for undescended testes is almost always surgical. Historically, hormonal therapy has been tried before surgery but has not proven to be efficacious in inducing testicular descent. Some centers use hormonal therapy as an adjunct to surgical therapy to improve fertility. (See 'Hormonal treatment' below.)

Surgical treatment

Timing of surgery — Surgical treatment of undescended testes is recommended as soon as possible after four months of age for congenitally undescended testes and definitely should be completed before the child is two years old (ideally before one year) [25,78-82]. In children with testicular ascent later in childhood, surgery generally should be performed within six months of identification.

Spontaneous descent rarely, if ever, occurs after four months of age [12,83]. Treatment of congenital undescended testes before two years (ideally before one year) of age is associated with improved testicular growth and fertility potential [46,51,59-61]. (See 'Natural history' above and 'Subfertility' above.)

In a randomized trial, 149 boys with unilateral palpable undescended testis were assigned to orchiopexy at nine months or three years of age [14,15,18,84]. At 12, 24, 36, and 48 months of age, testes in the nine-month group were larger and had greater increase in size compared with baseline than testes in the three-year group [15,84]. No significant growth was noted in the three-year group [15]. Testicular biopsies demonstrated a decline in the number of germ and Sertoli cells between nine months and three years [18]. (See 'Subfertility' above.)

Treatment of undescended testes before puberty also may reduce the risk of testicular cancer, permit earlier detection of testicular masses, and prevent testicular torsion. (See 'Testicular cancer' above and 'Testicular torsion' above.)

Palpable testes

Orchiopexy — Orchiopexy is a well-established surgical procedure for repositioning undescended or ectopic testes that are palpable [85,86]. The testis and cord are freed from surrounding attachments, and the testis is manipulated into the scrotum and sutured in place. The procedure is performed through an inguinal and/or scrotal incision. Primary orchiopexy is possible if the testis is of normal size and appearance and the testicular vessels are of adequate length [86].

In a 2012 systematic review, the average success rate for primary orchiopexy was 96 percent, with success defined by scrotal position of the testis [86]. A detailed knowledge of the retroperitoneal anatomy is required to achieve safe and adequate mobilization of the high undescended testis [87]. Thus, orchiopexy is an operation that is best performed by a surgeon with a full-time interest in pediatric urology.

Orchiopexy is safe in infants younger than one year [78,88]. The most significant complication is testicular atrophy (related to ischemic injury secondary to the dissection of the testicular vessels and/or postoperative swelling and inflammation). In a 2012 systematic review, the pooled rate of testicular atrophy following primary orchiopexy was 1.8 percent [86]. Other potential complications include reascent of the testis (requiring repeat procedure), inguinal hernia, infection, and bleeding.

Postoperative management is fairly straightforward. To prevent dislodgement of the testis from the scrotum, straddle toys such as bicycles are avoided for several weeks. Sports activities also are limited in the older child.

Examination one to two weeks postoperatively allows assessment of wound healing and testicular location, although many consider this visit to be optional. The more important examination is performed at least three months postoperatively to assess testicular position and size.

Nonpalpable testes

Imaging — Imaging is not routinely warranted to locate nonpalpable testes. Imaging studies lack the sensitivity and the specificity to alter the need for exploratory surgery [86,89]. (See "Undescended testes (cryptorchidism) in children: Clinical features and evaluation", section on 'Imaging'.)

Exploratory surgery — Exploratory surgery for the nonpalpable testis is diagnostic and potentially therapeutic. The first surgical objective is to determine whether or not the testis is present; viable testes are positioned and fixed within the scrotum; nonviable testicular remnants are removed. At the time of surgery, approximately 10 percent of boys with nonpalpable testes are found to have blind-ending testicular vessels, indicating an absent testicle (picture 4) [90].

Two surgical approaches are used in the management of boys with nonpalpable testes: the open inguinal approach and the laparoscopic approach. The laparoscopic approach usually is undertaken if the surgeon has laparoscopic expertise.

Examination under anesthesia is the first step in the surgical management of the clinically nonpalpable testis [83]. In a series of 263 nonpalpable testes, 18 percent were palpable in the groin during examination under anesthesia, obviating the need for laparoscopy [90]. In addition, if a "nubbin" is palpated in the scrotum, scrotal exploration can confirm the diagnosis of an atrophied testis [91]. Criteria for making a diagnosis of an atrophied testis include identification of a hemosiderin deposit and/or the clear identification of atretic vas deferens and vessels.

Exploration of the groin is the first step in the open inguinal approach [92]. If cord structures or testicular remnants are found, they are removed and the procedure is terminated. Exploration proceeds to the peritoneum if the groin exploration is negative [93].

The diagnostic laparoscopy is a safe procedure in experienced hands [94-96]. The laparoscope, placed via the umbilicus, is used to examine the inguinal rings, determine the patency of the processus vaginalis, and examine the Wolffian structures and testicular vessels. The finding of blind-ending spermatic vessels (picture 4), confirming the absent testis, permits termination of the procedure without a groin incision. Groin exploration is carried out if testicular vessels and vas deferens are visualized exiting the internal ring. The laparoscopic identification of an intra-abdominal testis (picture 1) permits planning for the definitive procedure (eg, open versus laparoscopic).

Associated inguinal hernia — If a patient with undescended testes presents with an incarcerated or strangulated inguinal hernia, expeditious repair at the time of presentation along with orchiopexy should be undertaken. Otherwise, the hernia should be repaired at the time of orchiopexy. (See "Inguinal hernia in children", section on 'Initial management' and 'Orchiopexy' above.)

Hormonal treatment — We do not suggest hormonal treatment for undescended testes. However, historically, some centers have used hormonal treatment in an attempt to induce testicular descent and may continue to use it as an adjunct to surgical treatment to improve fertility [80,97,98]. (See "Undescended testes (cryptorchidism) in children: Clinical features and evaluation", section on 'Pathogenesis'.)

Testicular descent depends upon local concentrations of testosterone considerably greater than can be achieved through systemic administration [99]. However, administration of gonadotropins (either urine-derived human chorionic gonadotropin [hCG] or gonadotropin-releasing hormone [GnRH] analogs) can stimulate the testes to increase production of testosterone sufficiently to achieve the necessary local concentration.

A 2012 systematic review of seven heterogeneous studies (including 995 boys, 1215 testes) of hormonal treatment of cryptorchidism found that [86]:

Hormonal treatment was associated with modestly higher rates (approximately 10 percent) of testicular descent than placebo. The reported rates of testicular descent in individual studies varied widely (range 9 to 62 percent).

The initial location of the testis may influence the likelihood of success. Greater rates of descent usually are achieved with more distally located testes [100,101]. However, it is possible that some of the distally located testes may have been retractile rather than truly undescended [102-104]. One study suggests that hormonal therapy is effective for retractile testes but not for truly undescended testes [105].

Information about long-term effects (eg, testicular cancer, fertility) was lacking.

There was insufficient evidence to suggest the superiority of any particular agent or dosing regimen. GnRH analogs and urine-derived hCG appeared to be similarly effective in achieving testicular descent (range 6 to 35 percent). Only urine-derived hCG is available in the United States.

Adverse effects are mild and transient, typically resolving within six months of treatment. The most common adverse effects were virilization (eg, hair growth, increase in penis size, erections) and aggressive behavior.

Hormonal treatment is controversial [106,107]. The Nordic consensus on treatment of undescended testes and the 2014 American Urological Association guideline on the evaluation and treatment of cryptorchidism recommend against hormonal treatment [25,83], whereas 2016 European guidelines suggest that hormonal treatment before or after surgical treatment may have a beneficial effect on fertility [80,97].

Long-term follow-up — Boys who have undergone treatment for undescended testes have an increased risk of testicular cancer. We suggest that boys who have undergone treatment for undescended testes be taught how to perform testicular self-examination during adolescence and instructed to perform the examination monthly, in agreement with the recommendations of the American Urologic Association [83]. However, there is a lack of consensus regarding this suggestion. (See "Clinical manifestations, diagnosis, and staging of testicular germ cell tumors", section on 'Testicular examination' and "Screening for testicular cancer".)

MANAGEMENT OF RETRACTILE TESTES — Retractile testes should be examined annually and referred to the urologist for any concerns of ascent to a true undescended position [83,108-110]. Retractile testes are not associated with the same complications as true undescended testes such as increased risk of malignant transformation or subfertility.

In a retrospective review of 204 retractile testes in 122 boys (mean age 5.4 years) who were followed annually for a mean of 2.8 years, approximately one-third became undescended (ascending or acquired undescended), one-third were descended on examination, and one-third remained retractile at the most recent follow-up [111]. Another study suggested that if examination of the contralateral testicle under anesthesia remained abnormal/retractile at the time of a planned unilateral orchidopexy, a bilateral orchiopexy may be warranted because of the risk of developing a metachronous undescended testis [112].

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Undescended testes".)

INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or email these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient education" and the keyword[s] of interest.)

Basics topic (see "Patient education: Undescended testes (The Basics)")

SUMMARY AND RECOMMENDATIONS

Phenotypically male newborn infants with bilaterally nonpalpable testes, unilaterally nonpalpable testis with hypospadias, or suspected difference of sex development (including congenital adrenal hyperplasia) should be immediately referred to a multidisciplinary team for evaluation and initial management of possible difference of sex development. (See "Evaluation of the infant with atypical genital appearance (difference of sex development)" and "Management of the infant with atypical genital appearance (difference of sex development)".)

Indications for referral to pediatric urologist or pediatric surgeon may include (see 'Indications for referral' above):

Congenital palpable or nonpalpable undescended testes (unilateral or bilateral); referral between 4 and 12 months of age is recommended

Ascending testis in boys beyond infancy (whenever the examination change is noted)

Palpable tissue in the scrotum that is thought to be an atrophic testis

Difficulty differentiating between undescended, retractile, or ectopic testis (at any age)

Most testes that are undescended at birth complete their descent within the first three to four months of life. Spontaneous descent is rare after four months of age. In testes that remain undescended, changes related to fertility may begin to occur before one year of age. (See 'Natural history' above.)

Complications and sequelae of undescended testes include inguinal hernia, testicular torsion, testicular trauma, subfertility, and testicular cancer. The potential seriousness of these complications and sequelae demands early referral for definitive treatment. (See 'Complications and sequelae' above.)

The goal of management is to place and fix viable undescended testes in a normal scrotal position or to remove nonviable testicular remnants. Scrotal positioning reduces the risk of torsion and blunt traumatic injury (for intracanalicular testes) and permits easier examination of the testis. If performed sufficiently early, surgical correction also may reduce the risk of infertility and testicular cancer. (See 'Overview' above.)

Surgical treatment of congenitally undescended testes is recommended as soon as possible after four months of age and definitely should be completed before the child is two years old. In children with testicular ascent later in childhood, surgery generally should be performed within six months of identification. (See 'Timing of surgery' above.)

Retractile testes should be examined annually and referred for further evaluation if there is concern for ascent. In many cases this will require follow-up until puberty. (See 'Management of retractile testes' above.)

  1. Wood HM, Elder JS. Cryptorchidism and testicular cancer: separating fact from fiction. J Urol 2009; 181:452.
  2. Pillai SB, Besner GE. Pediatric testicular problems. Pediatr Clin North Am 1998; 45:813.
  3. Pirgon Ö, Dündar BN. Vanishing testes: a literature review. J Clin Res Pediatr Endocrinol 2012; 4:116.
  4. Keys C, Heloury Y. Retractile testes: a review of the current literature. J Pediatr Urol 2012; 8:2.
  5. Docimo SG. Testicular descent and ascent in the first year of life. Urology 1996; 48:458.
  6. Schiffer KA, Kogan SJ, Reda EF, Levitt SB. Acquired undescended testes. Am J Dis Child 1987; 141:106.
  7. Gracia J, Navarro E, Guirado F, et al. Spontaneous ascent of the testis. Br J Urol 1997; 79:113.
  8. Hack WW, Meijer RW, Van Der Voort-Doedens LM, et al. Previous testicular position in boys referred for an undescended testis: further explanation of the late orchidopexy enigma? BJU Int 2003; 92:293.
  9. Dinkelbach L, Lehnick D, Shavit S, et al. Acquired undescended testis: When does the ascent occur? J Pediatr Surg 2021; 56:2027.
  10. Marshall FF, Weissman RM, Jeffs RD. Cryptorchidism: the surgical implications of non-union of the epididymis and testis. J Urol 1980; 124:560.
  11. Berkowitz GS, Lapinski RH, Dolgin SE, et al. Prevalence and natural history of cryptorchidism. Pediatrics 1993; 92:44.
  12. Wenzler DL, Bloom DA, Park JM. What is the rate of spontaneous testicular descent in infants with cryptorchidism? J Urol 2004; 171:849.
  13. Hamza AF, Elrahim M, Elnagar, et al. Testicular descent: when to interfere? Eur J Pediatr Surg 2001; 11:173.
  14. Kollin C, Granholm T, Nordenskjöld A, Ritzén EM. Growth of spontaneously descended and surgically treated testes during early childhood. Pediatrics 2013; 131:e1174.
  15. Kollin C, Karpe B, Hesser U, et al. Surgical treatment of unilaterally undescended testes: testicular growth after randomization to orchiopexy at age 9 months or 3 years. J Urol 2007; 178:1589.
  16. Huff DS, Hadziselimovic F, Snyder HM 3rd, et al. Histologic maldevelopment of unilaterally cryptorchid testes and their descended partners. Eur J Pediatr 1993; 152 Suppl 2:S11.
  17. Huff DS, Fenig DM, Canning DA, et al. Abnormal germ cell development in cryptorchidism. Horm Res 2001; 55:11.
  18. Kollin C, Stukenborg JB, Nurmio M, et al. Boys with undescended testes: endocrine, volumetric and morphometric studies on testicular function before and after orchidopexy at nine months or three years of age. J Clin Endocrinol Metab 2012; 97:4588.
  19. AbouZeid AA, Mousa MH, Soliman HA, et al. Intra-abdominal testis: histological alterations and significance of biopsy. J Urol 2011; 185:269.
  20. Huff DS, Hadziselimović F, Snyder HM 3rd, et al. Early postnatal testicular maldevelopment in cryptorchidism. J Urol 1991; 146:624.
  21. Hadziselimović F, Thommen L, Girard J, Herzog B. The significance of postnatal gonadotropin surge for testicular development in normal and cryptorchid testes. J Urol 1986; 136:274.
  22. Hadziselimovic F, Herzog B, Buser M. Development of cryptorchid testes. Eur J Pediatr 1987; 146 Suppl 2:S8.
  23. Rogers E, Teahan S, Gallagher H, et al. The role of orchiectomy in the management of postpubertal cryptorchidism. J Urol 1998; 159:851.
  24. Hildorf S, Clasen-Linde E, Cortes D, et al. Fertility Potential is Compromised in 20% to 25% of Boys with Nonsyndromic Cryptorchidism despite Orchiopexy within the First Year of Life. J Urol 2020; 203:832.
  25. Ritzén EM, Bergh A, Bjerknes R, et al. Nordic consensus on treatment of undescended testes. Acta Paediatr 2007; 96:638.
  26. Tasian GE, Hittelman AB, Kim GE, et al. Age at orchiopexy and testis palpability predict germ and Leydig cell loss: clinical predictors of adverse histological features of cryptorchidism. J Urol 2009; 182:704.
  27. Elder JS. Cryptorchidism: isolated and associated with other genitourinary defects. Pediatr Clin North Am 1987; 34:1033.
  28. Aggarwal H, Kogan BA, Feustel PJ. One third of patients with a unilateral palpable undescended testis have a contralateral patent processus. J Pediatr Surg 2012; 47:1711.
  29. Bassel YS, Scherz HC, Kirsch AJ. Scrotal incision orchiopexy for undescended testes with or without a patent processus vaginalis. J Urol 2007; 177:1516.
  30. Williamson RC. Torsion of the testis and allied conditions. Br J Surg 1976; 63:465.
  31. Moore CP, Marr JK, Huang CJ. Cryptorchid testicular torsion. Pediatr Emerg Care 2011; 27:121.
  32. Singal AK, Jain V, Dubey M, Deshpande P. Undescended testis and torsion: is the risk understated? Arch Dis Child 2013; 98:77.
  33. Zilberman D, Inbar Y, Heyman Z, et al. Torsion of the cryptorchid testis--can it be salvaged? J Urol 2006; 175:2287.
  34. Kargl S, Haid B. Torsion of an undescended testis - A surgical pediatric emergency. J Pediatr Surg 2020; 55:660.
  35. Ein SH. Torsion of an undescended intraabdominal benign testicular teratoma. J Pediatr Surg 1987; 22:799.
  36. Riegler HC. Torsion of intra-abdominal testis: an unusual problem in diagnosis of the acute surgical abdomen. Surg Clin North Am 1972; 52:371.
  37. Frank RG, Gerard PS, Barbera JT, et al. Torsion of an intraabdominal testis tumor presenting as an acute abdomen. Urol Radiol 1990; 12:50.
  38. Lee KF, Tang YC, Leong HT. Emergency laparoscopic orchidectomy for torsion of intra-abdominal testis: a case report. J R Coll Surg Edinb 2001; 46:110.
  39. Kogan SJ. Fertility in cryptorchidism. An overview in 1987. Eur J Pediatr 1987; 146 Suppl 2:S21.
  40. van Brakel J, Kranse R, de Muinck Keizer-Schrama SM, et al. Fertility potential in a cohort of 65 men with previously acquired undescended testes. J Pediatr Surg 2014; 49:599.
  41. Schneuer FJ, Milne E, Jamieson SE, et al. Association between male genital anomalies and adult male reproductive disorders: a population-based data linkage study spanning more than 40 years. Lancet Child Adolesc Health 2018; 2:736.
  42. Hildorf S, Clasen-Linde E, Fossum M, et al. Fertility Potential is Impaired in Boys with Bilateral Ascending Testes. J Urol 2021; 205:586.
  43. Hadziselimović F, Hecker E, Herzog B. The value of testicular biopsy in cryptorchidism. Urol Res 1984; 12:171.
  44. Hadziselimovic F, Herzog B. Importance of early postnatal germ cell maturation for fertility of cryptorchid males. Horm Res 2001; 55:6.
  45. Hadziselimovic F, Herzog B. The importance of both an early orchidopexy and germ cell maturation for fertility. Lancet 2001; 358:1156.
  46. Cortes D, Thorup JM, Lindenberg S. Fertility potential after unilateral orchiopexy: an age independent risk of subsequent infertility when biopsies at surgery lack germ cells. J Urol 1996; 156:217.
  47. Lipshultz LI, Caminos-Torres R, Greenspan CS, Snyder PJ. Testicular function after orchiopexy for unilaterally undescended testis. N Engl J Med 1976; 295:15.
  48. Werder EA, Illig R, Torresani T, et al. Gonadal function in young adults after surgical treatment of cryptorchidism. Br Med J 1976; 2:1357.
  49. Lee PA, Coughlin MT. Fertility after bilateral cryptorchidism. Evaluation by paternity, hormone, and semen data. Horm Res 2001; 55:28.
  50. Lee PA, Coughlin MT, Bellinger MF. Inhibin B: comparison with indexes of fertility among formerly cryptorchid and control men. J Clin Endocrinol Metab 2001; 86:2576.
  51. Okuyama A, Nonomura N, Nakamura M, et al. Surgical management of undescended testis: retrospective study of potential fertility in 274 cases. J Urol 1989; 142:749.
  52. Wilkerson ML, Bartone FF, Fox L, Hadziselimovic F. Fertility potential: a comparison of intra-abdominal and intracanalicular testes by age groups in children. Horm Res 2001; 55:18.
  53. Mieusset R, Grandjean H, Mansat A, Pontonnier F. Inhibiting effect of artificial cryptorchidism on spermatogenesis. Fertil Steril 1985; 43:589.
  54. Mieusset R, Fouda PJ, Vaysse P, et al. Increase in testicular temperature in case of cryptorchidism in boys. Fertil Steril 1993; 59:1319.
  55. Cortes D, Thorup J, Hogdall E, et al. The relation of germ cells per tubule in testes, serum inhibin B and FSH in cryptorchid boys. Pediatr Surg Int 2007; 23:163.
  56. de Gouveia Brazao CA, Pierik FH, Erenpreiss Y, et al. The effect of cryptorchidism on inhibin B in a subfertile population. Clin Endocrinol (Oxf) 2003; 59:136.
  57. Vinardi S, Magro P, Manenti M, et al. Testicular function in men treated in childhood for undescended testes. J Pediatr Surg 2001; 36:385.
  58. Cortes D, Thorup J, Lindenberg S, Visfeldt J. Infertility despite surgery for cryptorchidism in childhood can be classified by patients with normal or elevated follicle-stimulating hormone and identified at orchidopexy. BJU Int 2003; 91:670.
  59. Coughlin MT, Bellinger MF, Lee PA. Age at unilateral orchiopexy: effect on hormone levels and sperm count in adulthood. J Urol 1999; 162:986.
  60. Engeler DS, Hösli PO, John H, et al. Early orchiopexy: prepubertal intratubular germ cell neoplasia and fertility outcome. Urology 2000; 56:144.
  61. McAleer IM, Packer MG, Kaplan GW, et al. Fertility index analysis in cryptorchidism. J Urol 1995; 153:1255.
  62. SEER Stat Fact Sheets: Testis. http://seer.cancer.gov/statfacts/html/testis.html (Accessed on April 16, 2013).
  63. Lip SZ, Murchison LE, Cullis PS, et al. A meta-analysis of the risk of boys with isolated cryptorchidism developing testicular cancer in later life. Arch Dis Child 2013; 98:20.
  64. Florou M, Tsilidis KK, Siomou E, et al. Orchidopexy for congenital cryptorchidism in childhood and adolescence and testicular cancer in adults: an updated systematic review and meta-analysis of observational studies. Eur J Pediatr 2023; 182:2499.
  65. Aetiology of testicular cancer: association with congenital abnormalities, age at puberty, infertility, and exercise. United Kingdom Testicular Cancer Study Group. BMJ 1994; 308:1393.
  66. Batata MA, Chu FC, Hilaris BS, et al. Testicular cancer in cryptorchids. Cancer 1982; 49:1023.
  67. Cortes D, Thorup J, Petersen BL. Testicular neoplasia in undescended testes of cryptorchid boys-does surgical strategy have an impact on the risk of invasive testicular neoplasia? Turk J Pediatr 2004; 46 Suppl:35.
  68. Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO Classification of Tumours of the Urinary System and Male Genital Organs, 4th ed, IARC Press, 2016.
  69. Pettersson A, Richiardi L, Nordenskjold A, et al. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 2007; 356:1835.
  70. 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; 178:1440.
  71. Martin DC. Malignancy in the cryptorchid testis. Urol Clin North Am 1982; 9:371.
  72. Batata MA, Whitmore WF Jr, Chu FC, et al. Cryptorchidism and testicular cancer. J Urol 1980; 124:382.
  73. Herrinton LJ, Zhao W, Husson G. Management of cryptorchism and risk of testicular cancer. Am J Epidemiol 2003; 157:602.
  74. Pottern LM, Brown LM, Hoover RN, et al. Testicular cancer risk among young men: role of cryptorchidism and inguinal hernia. J Natl Cancer Inst 1985; 74:377.
  75. Pike MC, Chilvers C, Peckham MJ. Effect of age at orchidopexy on risk of testicular cancer. Lancet 1986; 1:1246.
  76. Martin DC. Germinal cell tumors of the testis after orchiopexy. J Urol 1979; 121:422.
  77. Akre O, Pettersson A, Richiardi L. Risk of contralateral testicular cancer among men with unilaterally undescended testis: a meta analysis. Int J Cancer 2009; 124:687.
  78. Docimo SG. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol 1995; 154:1148.
  79. Kim SO, Hwang EC, Hwang IS, et al. Testicular catch up growth: the impact of orchiopexy age. Urology 2011; 78:886.
  80. Radmayr C, Dogan HS, Hoebeke P, et al. Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines. J Pediatr Urol 2016; 12:335.
  81. Chan E, Wayne C, Nasr A, FRCSC for Canadian Association of Pediatric Surgeon Evidence-Based Resource. Ideal timing of orchiopexy: a systematic review. Pediatr Surg Int 2014; 30:87.
  82. Diamond DA, Chan IHY, Holland AJA, et al. Advances in paediatric urology. Lancet 2017; 390:1061.
  83. Kolon TF, Herndon CD, Baker LA, et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol 2014; 192:337.
  84. Kollin C, Hesser U, Ritzén EM, Karpe B. Testicular growth from birth to two years of age, and the effect of orchidopexy at age nine months: a randomized, controlled study. Acta Paediatr 2006; 95:318.
  85. Koop CE. Technique of herniorraphy and orchidopexy. Birth Defects Orig Artic Ser 1977; 13:293.
  86. Penson DF, Krishnaswami S, Jules A, et al. Evaluation and treatment of cryptorchidism. Comparative Effectiveness Review No. 88. AHRQ December 2012. http://www.effectivehealthcare.ahrq.gov/ehc/products/300/1353/CER88_Cryptorchidism_FinalReport_20121207.pdf (Accessed on January 11, 2013).
  87. Hutcheson JC, Cooper CS, Snyder HM 3rd. The anatomical approach to inguinal orchiopexy. J Urol 2000; 164:1702.
  88. Kogan SJ, Tennenbaum S, Gill B, et al. Efficacy of orchiopexy by patient age 1 year for cryptorchidism. J Urol 1990; 144:508.
  89. Tasian GE, Copp HL. Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis. Pediatrics 2011; 127:119.
  90. Cisek LJ, Peters CA, Atala A, et al. Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. J Urol 1998; 160:1145.
  91. Belman AB, Rushton HG. Is the vanished testis always a scrotal event? BJU Int 2001; 87:480.
  92. Kirsch AJ, Escala J, Duckett JW, et al. Surgical management of the nonpalpable testis: the Children's Hospital of Philadelphia experience. J Urol 1998; 159:1340.
  93. Barqawi AZ, Blyth B, Jordan GH, et al. Role of laparoscopy in patients with previous negative exploration for impalpable testis. Urology 2003; 61:1234.
  94. Cortesi N, Ferrari P, Zambarda E, et al. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy 1976; 8:33.
  95. Docimo S. Improved technique for open laparoscopic access. J Endourol 1998; 12:S185.
  96. Lotan G, Klin B, Efrati Y, Bistritzer T. Laparoscopic evaluation and management of nonpalpable testis in children. World J Surg 2001; 25:1542.
  97. 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; 173:974.
  98. Chua ME, Mendoza JS, Gaston MJ, et al. 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; 49:1659.
  99. Rajfer J, Walsh PC. Hormonal regulation of testicular descent: experimental and clinical observations. J Urol 1977; 118:985.
  100. 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.
  101. Forest MG, David M, David L, et al. Undescended testis: comparison of two protocols of treatment with human chorionic gonadotropin. Effect on testicular descent and hormonal response. Horm Res 1988; 30:198.
  102. Osuna JA, Arata de Bellabarba G, Temponi AF, et al. Cryptorchidism: treatment with human chorionic gonadotropin--a Venezuelan experience. Arch Androl 1997; 39:229.
  103. Kaleva M, Arsalo A, Louhimo I, et al. Treatment with human chorionic gonadotrophin for cryptorchidism: clinical and histological effects. Int J Androl 1996; 19:293.
  104. Colodny AH. Undescended testes--is surgery necessary? N Engl J Med 1986; 314:510.
  105. 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; 314:466.
  106. Ludwikowski B, González R. The controversy regarding the need for hormonal treatment in boys with unilateral cryptorchidism goes on: a review of the literature. Eur J Pediatr 2013; 172:5.
  107. Hadziselimovic F. The controversy regarding the need for hormonal treatment in boys with unilateral cryptorchidism goes on: a review of the literature by B. Ludwikowski and R. González. Eur J Pediatr 2012; 171:1281; author reply 1283.
  108. Stec AA, Thomas JC, DeMarco RT, et al. Incidence of testicular ascent in boys with retractile testes. J Urol 2007; 178:1722.
  109. Hack WW, van der Voort-Doedens LM, Goede J, et al. Natural history and long-term testicular growth of acquired undescended testis after spontaneous descent or pubertal orchidopexy. BJU Int 2010; 106:1052.
  110. La Scala GC, Ein SH. Retractile testes: an outcome analysis on 150 patients. J Pediatr Surg 2004; 39:1014.
  111. Agarwal PK, Diaz M, Elder JS. Retractile testis--is it really a normal variant? J Urol 2006; 175:1496.
  112. Cancian M, Ellsworth P, Caldamone A. Contralateral metachronous undescended testis: Is it predictable? J Pediatr Urol 2017; 13:504.e1.
Topic 87856 Version 28.0

References

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟