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Cryptorchidism – Undescended Testicle: Symptoms and Diagnostic Workup

• Cryptorchidism: Definition and Causes
• Cryptorchidism: Signs, Symptoms and Diagnostik Workup
• Cryptorchidism: Hormonal Treatment and Surgery

Signs and Symptoms of Cryptorchidism

• Missing testicle(s)
• incomplete descent or ectopic testicle(s)
• Hydrocele testis (open Proc. vaginalis)
• Inguinal hernia

Diagnostic Workup in Cryptorchidism

Palpation:

Palpation (search for a missing testis) should be done either in a relaxed supine position, while sitting (infants) or while standing (children). 80% of nondescended testes are palpable. For nonpalpable testes, 20% are missing, 30% are atrophic inguinal testes and 50% are abdominal testes.

Imaging:

Testicular ultrasound imaging with a high-resolution linear array transducer is suitable for the location of the non-descended testis in the inguinal canal. Anesthesia is necessary for an abdominal MRI in infants; this examination is only necessary for special questions (concomitant malformations?).

Laboratory tests:

Laboratory tests are particularly indicated for bilateral nonpalpable testes.

FSH:

An elevated FSH before puberty is a sign for bilateral missing testes.

HCG stimulation test:

An HCG stimulation test is indicated for bilateral nonpalpable testes: serum testosterone is measured before and 32 h after administration of 5000 IU HCG. An increase of testosterone proves the existence of dystopic testicle(s).

Inhibin:

Inhibin is a testicular peptide hormone, which can predict testicular damage. Not yet in clinical routine.

Diagnostic laparoscopy:

Diagnostic laparoscopy is indicated if abdominal testes are suspected. When laparoscopy is able to identify testicular vessels and ductus deferens at the deep inguinal ring, an abdominal testis is not possible and inguinal exposure of the non-descended testis is done. If blind-ending testicular vessels are identified, the blind end is removed. If no testicular vessels are identified, the path of descent up to the lower pol of the kidney has to be searched.

References

Kolon u.a. 2004 KOLON, T. F. ; PATEL, R. P. ; HUFF, D. S.: Cryptorchidism: diagnosis, treatment, and long-term prognosis.
In: Urol Clin North Am
31 (2004), Nr. 3, S. 469–80, viii-ix

M. Ritzen, A. Bergh, R. Bjerknes, P. Christiansen, D. Cortes, S. E. Haugen, N. Jörgensen, C. Kollin, S. Lindahl, G. Läckgren, K. M. Main, A. Nordenskjöld, E. R.-D. Meyts, O. Söder, S. Taskinen, A. Thorsson, J. Thorup, J. Toppari, und H. Virtanen. Nordic consensus on treatment of undescended testes.
Acta Paediatr, 96 (5): 638–643, May 2007.

A. V. Thorsson, P. Christiansen, und M. Ritzen. Efficacy and safety of hormonal treatment of cryptorchidism: current state of the art.
Acta Paediatr, 96 (5): 628–630, May 2007.

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