Cryptorchidism is a common condition in male infants where one or both testicles do not descend into the scrotum. About 1% of full-term male newborns have this condition. In approximately 30% of cases, the testicle is not palpable and may be located within the abdomen. These guidelines focus only on management in adults.

Causes and Impacts

Cryptorchidism can be part of testicular dysgenesis syndrome (TDS), a condition that affects testicular development, often due to environmental or genetic factors during early pregnancy. TDS can also involve issues such as hypospadias, reduced fertility, an increased risk of tumors, and hormonal dysfunctions.

Effects on Undescended Testicles

Germ Cell Degeneration In undescended testicles, germ cell degeneration begins after the first year of life and may vary depending on the testicle’s position. During the second year, the number of these cells decreases. Early surgical intervention, ideally between six and eighteen months of age, is recommended to preserve spermatogenesis and reduce the risk of tumors. Surgery is generally the most effective treatment, while hormonal treatments such as GnRH and hCG may have variable and potentially negative effects on future fertility.

Impact on Fertility Men with cryptorchidism may have altered semen parameters. However, early surgery can improve fertility chances. For those with unilateral cryptorchidism, the paternity rate is nearly the same as that of men without cryptorchidism. In contrast, those with bilateral cryptorchidism may experience a significant reduction in fertility, with lower paternity rates and a higher likelihood of issues such as oligozoospermia and azoospermia.

Germ Cell TumorsCryptorchidism increases the risk of testicular cancer and may be associated with microcalcifications and other anomalies. About 5-10% of testicular tumors may have a history of cryptorchidism. The risk of developing a testicular tumor is significantly higher compared to the general population. However, orchidopexy performed before puberty can reduce this risk.

Disease Management

Hormonal Treatment Hormonal treatments such as human chorionic gonadotropin or GnRH are not recommended for cryptorchidism in adults.

Surgical Treatment In adolescence, removal of the intra-abdominal testicle may be advised to reduce the risk of malignancy. In adults, removing a non-palpable testicle is not always necessary as it may still produce testosterone. Correcting bilateral cryptorchidism, even in adulthood, can sometimes restore sperm production in men who were previously azoospermic. Serious complications of orchidopexy can include testicular atrophy, occurring in a percentage of cases. A testicular biopsy during orchidopexy in adulthood is recommended to detect any abnormalities. When performing an orchiectomy for germ cell tumors, a biopsy of the contralateral testicle should be considered for patients at high risk.

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