A practical guide to cryptorchidism for the primary care physician

• Authors: Lovin Jennifer Margaret , Khater Nazih , Mata John A.
• Languages of publication: EN

Abstracts

Cryptorchidism, also known as undescended testis, affects 3–5% of full term male infants at birth and 23% of preterm or low birth weight infants. Current guidelines recommend that all boys with cryptorchidism without testicular descent by 6 months of age be referred to an appropriate specialist for evaluation, with surgery preferably performed by 18 months. We aim to examine areas of controversy still being debated by reviewing published articles, in order to provide primary providers with a practical guide to diagnosis and management of the undescended testis. Our review examined published articles from 2000 to 2018, related to undescended testes, and their management. 32 articles were reviewed from 2000 to 2018 and showed with a high level of evidence that failure of testicular descent by 6 months of age (gestational) should prompt referral to an appropriate specialist. Physical exam is crucial. The main concerns for patients with cryptorchidism are the increased risk of testicular cancer and sub fertility. Routine use of scrotal ultrasound is not recommended in the evaluation of cryptorchidism. Diagnostic laparoscopy serves to confirm the presence of an intra-abdominal testicle. Surgical intervention within 18 months of age is imperative. Cryptorchidism should be corrected surgically between 6 months and 18 months of age. Early detection with diagnostic laparoscopy is the standard of care for treatment of palpable, undescended testis.

Keywords

EN

cryptorchidism; physicians; primary care; orchiopexy.

• Publisher: Stowarzyszenie Przyjaciół Medycyny Rodzinnej i Lekarzy Rodzinnych
• Journal: Family Medicine & Primary Care Review
• Year: 2019
• Issue: 1
• Pages: 78-82

Contributors

author

Lovin Jennifer Margaret

author

Khater Nazih

author

Mata John A.

References

• Kolon TF, Herndon CD, Baker LA, et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol 2014; 192(2): 337–345.
• Barthold J, Hagerty J. Etiology, diagnosis, and management of the undescended testis. In: Wein A, Kavoussi L, Partin A, Peters C, eds.Campbell-Walsh urology. 11th ed. Philadelphia: Elsevier; 2016: 3430–3452.
• Hutson JM, Vikraman J, Li R, et al. Undescended testis: what paediatricians need to know. J Paediatr Child Health 2017; 53(11): 1101––1104.
• Ghirri P, Ciulli C, Vuerich M, et al. Incidence at birth and natural history of cryptorchidism: a study of 10,730 consecutive male infants.J Endocrinol Invest 2002; 25(8): 709–715.
• Acerini CL, Miles HL, Dunger DB, et al. The descriptive epidemiology of congenital and acquired cryptorchidism in a UK infant cohort.Arch Dis Child 2009; 94(11): 868–872
• Gurney JK, McGlynn KA, Stanley J, et al. Risk factors for cryptorchidism. Nat Rev Urol 2017; 14(9): 534–548.
• Favorito LA, Costa SF, Julio-Junior HR, et al. The importance of the gubernaculum in testicular migration during the human fetal period.Int Braz J Urol 2014; 40(6): 722–729.
• Barteczko KJ, Jacob MI. The testicular descent in human. Origin, development and fate of the gubernaculum Hunteri, processus vaginalis peritonei, and gonadal ligaments. Adv Anat Embryol Cell Biol 2000; 156: 1–98.
• Lim LY, Nah SA, Lakshmi NK, et al. Undescended testis: level of knowledge among potential referring health-care providers. J Paediatr Child Health 2015; 51(11): 1109–1114.
• Cho A, Ball M, Read K, et al. Educational survey of regional general practitioner’s management of paediatric patients with undescended testis. J Pediatr Urol 2016; 12(3): 151.e1–7, doi: 10.1016/j.jpurol.2015.11.010.
• Zundel S, Blumenstock G, Herrmann-Werner A, et al. Undescended testis? How best to teach the physical examination. J Pediatr Urol 2016; 12(6): 406e1–406e6.
• Bruijnen CJ, Vogels HD, Beasley SW. Age at orchidopexy as an indicator of the quality of regional child health services. J Paediatr Child Health 2012; 48(7): 556–559.
• Williams K, Baumann L, Shah A, et al. Age at orchiopexy for undescended testis in the United States. J Pediatr Surg 2017, doi: 10.1016/j.jpedsurg.2017.10.020.
• Savoie KB, Bachier-Rodriguez M, Schurtz E, et al. Health disparities in the appropriate management of cryptorchidism. J Pediatr 2017;185: 187–192.e1, doi: 10.1016/j.jpeds.2017.03.003.
• Boehme P, Geis B, Doerner J, et al. Shortcomings in the management of undescended testis: guideline intention vs. reality and the underlying causes – insights from the biggest German cohort. BJU Int 2018; 122(4): 644–653, doi: 10.1111/bju.14171
• Kim JK, Chua ME, Ming JM, et al. A critical review of recent clinical practice guidelines on management of cryptorchidism. J Pediatr Surg 2017; 53(10): 2041–2047, doi: 10.1016/j.jpedsurg.2017.11.050.
• Shoukry M, Pojak K, Choudhry MS. Cryptorchidism and the value of ultrasound. Ann R Coll Surg Engl 2015; 97(1): 56–58.
• Berger C, Haid B, Becker T, et al. Nonpalpable testes: ultrasound and contralateral testicular hypertrophy predict the surgical access,avoiding unnecessary laparoscopy. J Pediatr Urol 2018; 14(2): 163.e1–163e7, doi: 10.1016/j.jpurol.2017.10.010.
• Braga LH, Lorenzo AJ. Cryptorchidism: a practical review for all community healthcare providers. Can Urol Assoc 2017; 11(1–2 Suppl.1): S26–S32, doi: 10.5489/cuaj.4343.
• Shepard CL, Kraft KH. The nonpalpable testis: a narrative review. J Urol 2017; 198(6): 1410–1417.
• Tasian GE, Yiee JH, Copp HL. Imaging use and cryptorchidism: determinants of practice patterns. J Urol 2011; 185(5): 1882–1887.
• Hartigan S, Tasian GE. Unnecessary diagnostic imaging: review of the literature on preoperative imaging for boys with undescended testes. Transl Androl Urol 2014; 3(4): 359–364.
• Tasian GE, Copp HL, Baskin LS. Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness. J Pediatr Surg 2011; 46(12):2406–2413.
• Chan KW, Lee KH, Wong HY, et al. Use of laparoscopy as the initial surgical approach of impalpable testes: 10-year experience. World J Clin Pediatr 2015; 4(4): 155–159.
• Rohayem J, Luberto A, Nieschlag E, et al. Delayed treatment of undescended testes may promote hypogonadism and infertility. Endocrine 2017; 55(3): 914–924.
• Tseng CS, Chiang IN, Hong CH, et al. Advantage of early orchiopexy for undescended testis: analysis of testicular growth percentage ratio in patients with unilateral undescended testicle. Sci Rep 2017; 7(1): 17476, doi: 10.1038/s41598-017-17825-w.
• Lee PA, Coughlin MT. The single testis: paternity assessment after presentation as unilateral cryptorchidism. J Urol 2002; 168(4 Pt 2):1680–1682.
• Lip SZ, Murchison LE, Cullis PS, et al. A meta-analysis of the risk of boys with isolated cryptorchidism developing testicular cancer later in life. Arch Dis Child 2013; 98(1): 20–26.
• 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(3): 687–689.
• 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(4 Pt 1): 1440–1446.
• 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(18): 1835–1841.
• Braga LH, Lorenzo AJ, Romao RLP. Canadian Urological Association-Pediatric Urologists of Canada (CUA-PUC) guideline for the diagnosis,management, and follow up of cryptorchidism. Can Urol Assoc J 2017; 11(7): E251–60..