Review

Authors: Niklas Pakkasjärvi, Seppo Taskinen

Cryptorchidism presents with an incidence of 1-5% with potential long-term implications on future fertility and overall health. This review focuses on surgical treatment modalities, their impact on testicular development, and function while addressing the Nordic consensus statement as well as current European Association of Urology (EAU) and American Urological Association (AUA) guidelines. Congenital and acquired cryptorchidism present distinctive challenges in surgical management, with different implications for fertility. While congenital cryptorchidism entails a risk to fertility and warrants early intervention, both retractile testes and acquired cryptorchidism also pose risks to fertility potential, underscoring the importance of evaluating treatment options. Testicular location and the child's age form the basis of a practical classification system for undescended testicles. Early diagnosis by clinical examination enables timely treatment. Imaging is reserved for selected cases only. Following guidelines, orchidopexy is recommended between 6-12 months of age for congenital cryptorchidism. Evidence increasingly suggests the benefits of early surgery for promoting testicular health and fertility potential. Current surgical options range from open to laparoscopic techniques, with the choice largely determined by the location and accessibility of the undescended testicle. The advancement in laparoscopic approaches for non-palpable testes underscores the evolving landscape of surgical treatment. Sequential surgeries may be required depending on the mobility of the undescended testes. More research is needed to explore both the potential and limitations of hormonal therapy, which is secondary to surgical treatment and can selectively have a role as adjunct to surgery. Long-term follow-up is imperative to evaluate fertility outcomes, risk of testicular malignancy, and psychological impact. By integrating current guidelines with the latest evidence, this review intends to facilitate a comprehensive understanding of cryptorchidism, thereby optimizing patient management and outcomes.

Topics: Male; Child; Humans; Cryptorchidism; Testicular Neoplasms; Fertility; Research Design

PubMed: 38495791
DOI: 10.3389/fendo.2024.1327957

Authors: Kazuro Kikkawa, Yuko Ueda, Shimpei Yamashita...

OBJECTIVES

Ascending testis or acquired undescended testis develops in approximately 30% of cases of retractile testis, and orchiopexy is recommended for these cases. This study aimed at assessing the intraoperative anatomical findings of ascending testis and acquired undescended testis in search of better management for retractile testis.

METHODS

We retrospectively collected data of patients with confirmed diagnosis of retractile testis between February 2012 and November 2021. Orchiopexy was performed for cases with ascending testis and for patients with increasing difference of right and left testicular volume. The site of gubernaculum attachment and patent processus vaginalis were evaluated during surgery.

RESULTS

A total of 119 testes in 71 patients with retractile testis were included in this study. Sixteen retractile testes in 12 patients (17%) underwent orchiopexy. The weight at birth was significantly higher, and bilateral retractile testes were significantly more common in the follow-up group than in the surgical intervention group. In the surgical intervention group, the abnormal site of gubernaculum attachment was found in 12 out of 16 testes (75%), and patent PV was found in nine out of sixteen testes (56%). Sites of gubernaculum attachment in testes with patent PV were significantly higher than in sites with closed processus vaginalis, and all testes with patent processus vaginalis had abnormal site of gubernaculum attachment.

CONCLUSION

Patients with ascending testis and acquired undescended testis have clinical features and intraoperative abnormal findings similar to a cryptorchidism. Therefore, our surgical indication for retractile testis is considered appropriate.

PubMed: 37720542
DOI: 10.1155/2023/8764631

Authors: Jae Yeon Kim, Jae Min Chung, ...

BACKGROUND

It is quite difficult to distinguish retractile testis from gliding testis, which requires different treatment planning in the clinic setting. We evaluated practice patterns of urologists in Korea regarding the diagnosis and management of retractile and gliding testes.

METHODS

We mailed or e-mailed self-completion questionnaires consisting of 20 items to 106 urologists practicing in Korean hospitals concerning the diagnosis and treatment of cryptorchidism. We collected and analyzed the responses statistically.

RESULTS

Responses were received from 62 urologists. The response rate was 58.5%. Thirty-seven urologists (59.7%) actually felt they had difficulty in distinguishing retractile testis from gliding testis in the clinic setting. This rate was higher for non-pediatric urologists (78.1%) than for pediatric urologists (40.0%) ( = 0.006). In cases of infant retractile testis, only five urologists (8.1%) said that they would perform orchiopexy immediately, with 54 (87.1%) urologists saying they would do follow-up. In cases of preschool-age children with retractile testis, 17 urologists (27.4%) said that they would perform orchiopexy immediately with 41 (66.1%) urologists saying they would do follow-up. In cases of infant gliding testis, 37 urologists (59.7%) said that they would perform orchiopexy immediately with 24 (38.7%) urologists saying they would do a follow-up.

CONCLUSION

More than half (59.7%) of Korean urologists revealed it challenging to distinguish retractile testis and gliding testis in the clinical setting. The more it was difficult to diagnose retractile testis with certainty, the more frequent surgical correction was chosen for treatment. Therefore, it is essential to prevent unnecessary surgical treatment by establishing a practical guideline.

Topics: Asian People; Child; Child, Preschool; Comprehension; Cryptorchidism; Humans; Infant; Male; Urologists

PubMed: 35347906
DOI: 10.3346/jkms.2022.37.e98

Review

Authors: Elke E Mau, Michael P Leonard

OBJECTIVE

To review the differences between normal, retractile, ectopic, ascended, and undescended testes and to describe the optimal way to perform a testicular examination to distinguish one from the other, as well as to demonstrate that ultrasound imaging is not necessary and to clarify when to consider specialist referral.

SOURCES OF INFORMATION

This paper is based on selected findings from a MEDLINE search on undescended testes and orchiopexy referrals, and on our experience at the Urology Clinic at the Children's Hospital of Eastern Ontario in Ottawa, including review of referrals to our clinic for undescended testes and the resultant findings of normal variants versus surgical cases. The MeSH headings used in our MEDLINE search included and .

MAIN MESSAGE

An is defined as the true absence of one testis (or both testes) from normal scrotal position. Ectopic and ascended testes will likewise be absent from the scrotum, the latter having been present at one point in development. Differentiating among testicular examination findings is important, as descended and retractile testes are managed conservatively, while prompt surgical intervention should be offered for ascended, ectopic, and undescended testes. Uncertainty surrounding the diagnosis of an undescended testis causes anxiety, might lead to unwarranted imaging, and might increase the wait list for specialty assessment. For this reason, avoidance of ultrasound in the evaluation of undescended testes was included in the recent Choosing Wisely Canada campaign. We seek to clarify the physical examination findings in the evaluation of possible undescended testes, the suggested referral parameters, and the subsequent management.

CONCLUSION

Undescended testes and their variants are common. As decision for referral is based on the primary care physician's physical examination findings, we clarify distinguishing between normal and abnormal findings on testicular examination to aid in appropriate referral for subspecialist evaluation. Consultation, if needed, should be sought at 6 months' corrected gestational age, or at detection if later than 6 months, without delay for ultrasound imaging, as surgical management is recommended for those patients with undescended, ectopic, or ascended testes.

Topics: Child; Child, Preschool; Cryptorchidism; Humans; Infant; Male; Orchitis; Physical Examination; Primary Health Care; Referral and Consultation; Scrotum; Testis; Ultrasonography

PubMed: 28615391
DOI: No ID Found

Authors: Kleber M Anderson, Suelen F Costa, Francisco J B Sampaio...

OBJECTIVES

To assess the incidence of anatomical anomalies in patients with retractile testis.

MATERIALS AND METHODS

We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p<0.05).

RESULTS

The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116).

CONCLUSIONS

Retractile testis is not a normal variant with a significant risk of patent processos vaginalis and epididymal anomalies.

Topics: Child; Child, Preschool; Cryptorchidism; Epididymis; Fetus; Gestational Age; Humans; Infant; Male; Prospective Studies; Testicular Hydrocele; Testis

PubMed: 27564294
DOI: 10.1590/S1677-5538.IBJU.2015.0538

Review

Authors: Grzegorz Jędrzejewski, Andrzej Paweł Wieczorek

Due to its noninvasiveness and high resolving power, ultrasound examination is the examination of choice for the imaging of the structures of the pediatric scrotum. It allows to reveal changes impossible to find in the course of a clinical examination. Its significance has increased over the past few years due to the technological developments. The introduction of transducers with frequency of 10-17 MHz has improved the resolution of pediatric testes images as well as the resolution of the inguinal canals images, which has been of particular importance for the evaluation of undescended, retractile and abdominal testes. New diagnostic tools have also been introduced, such as 3D imaging or elastography, whose application has helped provide valuable additional information for the evaluation of pediatric testes, for treatment monitoring, and for post-surgical follow-up examinations. 3D imaging facilitates a more accurate evaluation of the location of an undescended testicle, testicular volume, and vascularization. Elastography may be used for the evaluation of focal lesions, post-ischemic lesions, unclear fluid spaces, undescended testes, and following orchiopexy.

PubMed: 26672775
DOI: 10.15557/JoU.2013.0045

Authors: Jae Jun Bae, Bum Soo Kim, Sung Kwang Chung...

PURPOSE

Retractile testis is considered to be a variant of normal testis in prepubertal boys. There is no agreed-upon management of retractile testis. The aim of this study was to provide data on the long-term outcomes of patients with retractile testis.

MATERIALS AND METHODS

This study retrospectively reviewed the medical record of 43 boys who were referred for suspected undescended or retractile testis and were finally diagnosed with retractile testis between January 2001 and December 2008. All boys were biannually examined by a pediatric urologist to evaluate the presence of retractile, descended, or undescended testis and testicular volume.

RESULTS

Of 43 boys, there were 22 boys with unilateral retractile testis (51.1%) and 21 boys with bilateral retractile testis (48.9%). Their mean age was 3.0±2.7 years and the follow-up duration was 4.4±1.7 years. Of 64 retractile testes, 29 (45.3%) succeeded in descending, 26 (40.6%) remained retractile, and 9 (14.1%) became undescended testis or of a decreased size requiring orchiopexy. The mean initial diagnostic age of the patients who underwent orchiopexy was 1.3±0.9 years; meanwhile, the mean initial diagnostic age of those who went on to have normal testis was 4.3±3.3 years (p=0.009). The mean follow-up duration was 3.6±1.5 years in the orchiopexy group, 4.0±1.4 years in the descended testis group, and 5.1±1.8 years in group with remaining retractile testis.

CONCLUSIONS

Retractile testis has a risk of requiring orchiopexy. The risk is higher in the population diagnosed at a younger age. Boys with retractile testis should be observed periodically until the testis is descended in the normal position.

PubMed: 23061004
DOI: 10.4111/kju.2012.53.9.649

Authors: Erik Van Laecke

Topics: Male; Humans; Cryptorchidism; Muscle Spasticity; Cerebral Palsy

PubMed: 37408102
DOI: 10.1111/dmcn.15696

Review

Authors: Hugo Fabiano Fernandes Novaes, José Abraão Carneiro Neto, Antonio Macedo...

OBJECTIVE

To conduct a systematic review on single scrotal incision orchiopexy.

MATERIALS AND METHODS

A search was performed using Pubmed, through which 16 articles were selected out of a total of 133. The following conditions were considered exclusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic approach, retractile testes, or patients with previous testicular or inguinal surgery.

RESULTS

A total of 1558 orchiopexy surgeries initiated with a transcrotal incision were analyzed. Patients' ages ranged between 5 months and 21 years. Thirteen studies used high scrotal incisions, and low scrotal incisions were performed in the remainder of the studies. In 55 cases (3.53%), there was a need for inguinal incision. Recurrence was observed in 9 cases, testicular atrophy in 3, testicular hypotrophy in 2, and surgical site infections in 13 cases. High efficacy rates were observed, varying between 88% and 100%.

CONCLUSIONS

Single scrotal incision orchiopexy proved to be an effective technique and is associated with low rates of complications.

Topics: Adolescent; Child; Child, Preschool; Cryptorchidism; Humans; Infant; Male; Orchiopexy; Recurrence; Scrotum; Treatment Outcome; Young Adult

PubMed: 23849581
DOI: 10.1590/S1677-5538.IBJU.2013.03.02

Review

Authors: Luis H Braga, Armando J Lorenzo

Cryptorchidism is one of the most common congenital anomalies of the male genitalia, occurring in 1% of boys by the age of one year. Even though the etiology of cryptorchidism is multifactorial, management has evolved with the clear recognition that hormonal treatment is not effective and surgery between 6-18 months of age leads to better testicular outcomes. Diagnostic laparoscopy is considered the standard approach for management of non-palpable testes, and can be combined with one or two-stage orchidopexy, with up to 80-90% success rates. This review discusses the natural history of retractile testicles, indications for hormonal treatment and orchidectomy, ultrasound's role as a diagnostic tool, risks of infertility and testicular cancer, and surgical techniques for inguinal and intra-abdominal testes.

PubMed: 28265313
DOI: 10.5489/cuaj.4343