Management of Undescended Testes

Introduction to Management

The American Urological Association recommends that the management of undescended testes is primarily surgical via orchidopexy, which should be performed by 18 months of age in children, while adult management depends on testicular function with orchidectomy recommended for unilateral cases with normal contralateral function, and hormonal therapy is not recommended at any age 1, 2

Infants with cryptorchidism at birth should be observed until 6 months of age, as spontaneous descent may occur during this period, according to the European Association of Urology 3
Immediate referral to a surgical specialist is required if no spontaneous descent occurs by 6 months, as testes that remain undescended beyond this point are unlikely to descend spontaneously, as stated by the American Academy of Pediatrics 3
Boys diagnosed with cryptorchidism after 6 months of age should be promptly referred without delay, as recommended by the European Society for Paediatric Urology 3
Imaging studies (ultrasound, CT, MRI) are not recommended prior to referral, as they rarely assist in decision-making and do not change management, according to the American College of Radiology 3

The management strategy depends on hormonal and spermatogenic evaluation of the contralateral testis, as recommended by the European Association of Urology 2, 4
Orchidectomy should be offered to adult men with unilateral undescended testis and normal hormonal function/spermatogenesis (strong recommendation), as stated by the European Urology Association 2, 5
Orchidopexy may be offered if the patient has biochemical hypogonadism and/or spermatogenic failure (infertility) to preserve androgen production and fertility, according to the American Urological Association 2, 4

Perform simultaneous testicular biopsy for detection of intratubular germ cell neoplasia in situ if undescended testes are corrected in adulthood (strong recommendation), as recommended by the European Urology Association 2, 4
All men with cryptorchidism should perform regular testicular self-examinations, as they have a 3.6-7.4 times higher risk of germ cell tumors compared to the general population, according to the American Cancer Society 4, 7

Men with unilateral cryptorchidism have paternity rates nearly equivalent to men without cryptorchidism, as reported by the European Urology Association 4, 7
Men with bilateral cryptorchidism have significantly reduced paternity rates of 35-53% and should be counseled accordingly, according to the American Society for Reproductive Medicine 4, 7
Men with cryptorchidism have a 2-6% lifetime risk of developing testicular tumors, as stated by the European Urology Association 4, 7
Orchidopexy performed before puberty reduces testicular cancer risk by 2-6 fold compared to postpubertal surgery, according to the American Academy of Pediatrics 1

Regular monitoring of testicular position and development is necessary throughout childhood and adolescence, as recommended by the American Academy of Pediatrics 1, 3
Patient education must include counseling on long-term risks of infertility and cancer, even after successful orchidopexy, according to the European Association of Urology 1, 3