Comparison of diagnostic and treatment guidelines for undescended testis

Abstract

Cryptorchidism or undescended testis is the single most com mon genitourinary disease in male neonates. In most cases, the testes will descend spontaneously by 3 months of age. If the testes do not descend by 6 months of age, the probability of spontaneous descent thereafter is low. About 1%-2% of boys older than 6 months have undescended testes after their early postnatal descent. In some cases, a testis vanishes in the abdomen or reascends after birth which was present in the scrotum at birth. An inguinal undescended testis is sometimes mistaken for an inguinal hernia. A surgical specialist referral is recommended if descent does not occur by 6 months, unde scended testis is newly diagnosed after 6 months of age, or testicular torsion is suspected. International guidelines do not recommend ultrasonography or other diagnostic imaging because they cannot add diagnostic accuracy or change treat ment. Routine hormonal therapy is not recommended for undescended testis due to a lack of evidence. Orchiopexy is recommended between 6 and 18 months at the latest to pro tect the fertility potential and decrease the risk of malignant changes. Patients with unilateral undescended testis have an infertility rate of up to 10%. This rate is even higher in patients with bilateral undescended testes, with intraabdominal un de scended testis, or who underwent delayed orchiopexy. Pa tients with undescended testis have a threefold increased risk of testicular cancer later in life compared to the general pop ulation. Selfexamination after puberty is recommended to facilitate early cancer detection. A timely referral to a surgical specialist and timely surgical correction are the most important factors for decreasing infertility and testicular cancer rates.

Fertility outcomes and predictors for successful sperm retrieval and pregnancy in 327 azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction

“…In the present study, we not only reported sperm retrieval rate and risk factors for unsuccessful sperm extraction, but also predictors for successful pregnancy in the female partners of males who had spermatozoa on mTESE. Our limitations include some points: Cryptorchidism is an important risk factors for GCNIS and has also threefold increased risk of testicular cancer later in life, compared to general population 20‐22 . A piece of testicular tissue was taken for only histopathologic examination to evaluate stages of spermatogenesis in the absence of mature spermatozoa on mTESE.…”

“…Our limitations include some points: Cryptorchidism is an important risk factors for GCNIS and has also threefold increased risk of testicular cancer later in life, compared to general population. [20][21][22] A piece of testicular tissue was taken for only histopathologic examination to evaluate stages of spermatogenesis in the absence of mature spermatozoa on mTESE.…”

Undescended testis: importance of a timely referral to a surgical specialist

“…Thus, orchiopexy is recommended between 6 and 18 months at the latest based on international guidelines. In conclusion, this review by Shin and Jeon 10) describes the importance of a timely referral and indications for referral to a surgical specialist for UDT. However, it would be better if Shin and Jeon 10) mentioned Korean data about UDT in this review.…”

“…This article describes the diagnosis, differential diagnosis, hormone therapy, fertility, risk of testicular cancer, and timing of surgical therapy of UDT based on international guidelines. Shin and Jeon 10) suggest timely referral to a surgical specialist and timely surgical correction of UDT to improve fertility and decrease the risk of malignancy. Primary caregivers including general pediatricians should consider the following indications for referral: (1) the testis has not descended into the scrotum by 6 months of age, (2) newly diagnosed UDT after 6 months of age, or (3) suspected testicular torsion.…”

“…In addition, the AUA guidelines recommend indications for referral to a surgical specialist or multidisciplinary team as follows: (1) bilaterally nonpalpable testes, (2) bilaterally or unilaterally nonpalpable testis with hypospadias or suspected disorder of sex development, (3) difficulty differentiating among undescended, retractile, and ectopic testes. 6) Shin and Jeon 10) insisted that the original location of the UDT and age at orchiopexy are impor-tant factors in the prediction of fertility potential and future malignancy risk. Thus, orchiopexy is recommended between 6 and 18 months at the latest based on international guidelines.…”