Management of an undescended testis (cryptorchidism) is important to optimize future fertility potential and decrease the risk of testicular malignancy and other complications. The management typically involves the following steps:
- Physical Examination: A careful physical exam is crucial to determine whether the testis is palpable or non-palpable. This assessment helps in planning further management.
- Imaging Studies: Imaging (such as ultrasound or MRI) is not routinely recommended but may be used in cases where the testis is non-palpable to help locate it or plan for surgery.
- Observation and Timing: In newborns, especially those born preterm, spontaneous descent can occur within the first few months of life. It’s common to wait until the infant is about 6 months old to allow time for potential spontaneous descent.
- Management of Bilateral Undescended Testes: This condition may be associated with hormonal or genetic issues and requires thorough evaluation, potentially including hormonal assessments and genetic counseling.
- Referral to Pediatric Urologist or Surgeon: Referral to a specialist is important for surgical management and complex cases.
- Hormonal Therapy: In some cases, hormonal therapy such as human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) may be used to stimulate testicular descent. However, its effectiveness is variable, and its use is somewhat controversial.
- Laparoscopy: If the testis is non-palpable, laparoscopy is often used both as a diagnostic and therapeutic tool. If the testis is found to be atrophic or severely abnormal, it may be removed.
- Orchiopexy: If the testis does not descend spontaneously, usually by 6 to 12 months of age, surgical correction is recommended. Orchiopexy is the surgical procedure to mobilize the testis and secure it within the scrotum. The timing of surgery is crucial – earlier surgery, typically before 18 months of age, is associated with better outcomes in terms of fertility and reducing the risk of malignancy.
- Monitoring and Long-Term Follow-Up: After orchiopexy, long-term follow-up is important to monitor testicular growth, position, and function. It is also essential to educate about the slightly increased risk of testicular cancer in adulthood, even after successful orchiopexy, and the possibility of reduced fertility.
Timely intervention is key in managing undescended testis to optimize testicular function and reduce the risk of future complications. The decision-making process should be individualized, taking into account the age of the child, bilateral versus unilateral cryptorchidism, and the presence of other urogenital anomalies.