AUA: Cryptorchidism (2018)

See Original Guidelines

• Literature search up to October 2018

Definitions

• Cryptorchidism, or undescended testis (UDT): failure of a testis to descend into a scrotal position
  • Classified as congenital vs. acquired
    • Congenital cryptorchidism: testes that are extrascrotal from the time of birth
    • Acquired cryptorchidism: testes are intrascrotal at birth but subsequently identified in an extrascrotal position
      • Classified as ascending vs. entrapped
        • Ascending: spontaneous change from an intrascrotal to an extrascrotal position occurs at some point after birth
        • Entrapped: change from an intrascrotal to an extrascrotal position occurs after prior inguinal surgery
  • Retractile testis: testis that is initially extrascrotal on examination or moves easily out of scrotal position, (often associated with a vigorous cremasteric reflex), but that can be manually replaced in stable, dependent scrotal position and remain there without tension at least temporarily
• Atrophic testis: testis that suffers significant volume loss due to
  1. Prior inguinal or testicular surgery OR
  2. Due to prolonged location in an extrascrotal position OR
  3. Primary developmental failure
• Vanished testis: testis was present initially but disappeared during development most likely due to spermatic cord torsion or vascular accident.

Background

• Epidemiology
  • Most common genital disorder identified at birth

Diagnosis and Evaluation

Cryptorchid testes may be (4):

• Prescrotal (above or at the scrotal inlet),
• In the superficial inguinal pouch (distal and lateral to the external inguinal ring, anterior to the rectus muscle), at the external ring (or prepubic),
• Within the inguinal canal
• Ectopic
  • Most commonly perineal
  • Abdominal
    • "Peeping" through or proximal to the internal inguinal ring
    • Near the bladder, iliac vessels or kidney

Management

• Reasons for treatment
  1. Increased risks of impairment of fertility potential
  2. Testicular malignancy
  3. Torsion
  4. Associated inguinal hernia
• Orchidopexy/orchiopexy
  • Current standard of therapy in the United States
  • Refers to surgical repositioning of the testis within the scrotal sac

References

• Kolon, Thomas F., et al. "Evaluation and treatment of cryptorchidism: AUA guideline." The Journal of urology 192.2 (2014): 337-345.