Management of Undescended Testis in Adults

Decision Algorithm Based on Hormonal and Fertility Status

• The European Association of Urology recommends orchidectomy for adult men with unilateral undescended testis who have normal hormonal function and spermatogenesis, with a strong recommendation 1, 2
• For adults with biochemical hypogonadism or spermatogenic failure, orchidopexy is offered if technically feasible, with a weak recommendation from the European Association of Urology guidelines 1, 2
• Testosterone levels and semen analysis are crucial for assessing hormonal function and spermatogenic status, respectively 1, 2

Critical Additional Procedures Required

• The European Association of Urology guidelines provide a strong recommendation for simultaneous testicular biopsy at the time of surgery to detect intratubular germ cell neoplasia in situ 1, 2
• Sperm cryopreservation is recommended before orchidectomy to preserve future fertility options, with a strong recommendation from the European Association of Urology 1, 2

Why Hormonal Treatment is NOT an Option

• The European Association of Urology guidelines strongly recommend against hormonal treatment for cryptorchidism in postpubertal men, due to its limited efficacy and potential risks 1, 2

Common Pitfalls to Avoid

• Attempting orchidopexy when orchidectomy is indicated provides no benefit and increases cancer surveillance burden, according to the European Association of Urology guidelines 1, 2
• Omitting testicular biopsy at the time of adult cryptorchidism surgery misses the opportunity to detect pre-malignant changes, with a strong recommendation from the European Association of Urology guidelines 1, 2