Cryptorchidism (Undescended Testicle): Natural History & Management

Cryptorchidism = failure of testicular descent into scrotum. Prevalence: 3% term, 30% preterm males.

Natural History

• 75% descend spontaneously by 6 months (corrected age).
• 1% persist beyond 1 year → true cryptorchidism.
• Left side more common; bilateral in 10–20%.

Risks of Persistent Cryptorchidism

• Infertility: Impaired spermatogenesis (temperature-dependent).
• Malignancy: 2.5–8× increased testicular cancer risk (seminoma); orchiopexy before puberty reduces but not eliminates risk.
• Torsion: 10× higher risk.
• Inguinal hernia: Patent processus vaginalis.
• Psychosocial: Body image.

Management

• Orchiopexy at 6–18 months (ideally 6–12 mo) — preserves fertility potential, allows early cancer surveillance.
• Laparoscopic if nonpalpable (intra-abdominal).
• Hormonal therapy (hCG/GnRH) — low success, not standard.

Follow-Up

• Self-exam education from adolescence.
• Annual clinician exam.
• Long-term cancer risk persists; early detection curative.

Do not "wait and see" beyond 6–12 months. Timely surgery optimizes outcomes.