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The Undescended Testis and Other Forms of Cryptorchidism

  • Richard I. Silver
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

The undescended testis (UDT) and other forms of cryptorchidism represent a group of genital anomalies commonly treated by the urologist. Although these conditions might seem to be simple abnormalities of the testes, cryptorchidism has a number of subtle and complex issues that must be considered separately in each clinical scenario. Some forms of cryptorchidism require no intervention, others are amenable to medical therapy, and others represent absolute indications for surgery. Therefore, a thorough understanding of the proper diagnosis of each of these conditions is required to provide proper management. The forms of cryptorchidism and relevant clinical issues are the subjects of this chapter.

Keywords

Spermatic Cord Inguinal Canal Undescended Testis Testicular Torsion Internal Inguinal Ring 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Silver RI, Docimo SG. (1999) Cryptorchidism. In: Pediatric Urology Practice, Gonzales ET, Bauer SB, eds., Philadelphia: Lippincott Williams & Wilkins, pp. 499–522.Google Scholar
  2. 2.
    Munkelwitz R, Gilbert BR. (1998) Are boxer shorts really better? A critical analysis of the role of underwear type in male subfertility. J Urol 160: 1329–1333.PubMedCrossRefGoogle Scholar
  3. 3.
    Caesar RE, Kaplan GW. (1994) The incidence of the cremasteric reflex in normal boys. J Urol 152: 779–780.PubMedGoogle Scholar
  4. 4.
    Abeyaratne MR, Aherne WA, Scott JE. (1969) The vanishing testis. Lancet 2: 822–824.PubMedCrossRefGoogle Scholar
  5. 5.
    Kogan SJ, Gill B, Bennett B, et al. (1986) Human monorchism: a clinicopathological study of unilateral absent testes in 65 boys. J Urol 135: 758–761.PubMedGoogle Scholar
  6. 6.
    Turek PJ, Ewalt DH, Snyder HM 3rd, et al. (1994) The absent cryptorchid testis: surgical findings and their implications for diagnosis and etiology. J Urol 151: 718–720.PubMedGoogle Scholar
  7. 7.
    Jost A. (1953) Problems of fetal endocrinology: the gonadal and hypophyseal hormones. Recent Prog Horm Res 8: 379–418.Google Scholar
  8. 8.
    Atwell JD. (1985) Ascent of the testis: fact or fiction. Br J Urol 57: 474–477.PubMedCrossRefGoogle Scholar
  9. 9.
    Nef S, Parada LF. (1999) Cryptorchidism in mice mutant for Ins13. Nature Genetics 22: 295–299.PubMedCrossRefGoogle Scholar
  10. 10.
    Zimmermann S, Steding G, Emmen JM, et al. (1999) Targeted disruption of the Ins13 gene causes bilateral cryptorchidism. Mol Endocrinol 13: 681–691.PubMedCrossRefGoogle Scholar
  11. 11.
    Lim HN, Raipert-de Meyts E, Skakkebaek NE, et al. (2001) Genetic analysis of the INSL3 gene in patients with maldescent of the testis. Eur J Endocrinol 144: 129–137.PubMedCrossRefGoogle Scholar
  12. 12.
    Husmann DA, McPhaul MJ. (1991) Time-specific androgen blockade with flutamide inhibits testicular descent in the rat. Endocrinology 129: 1409–1416.PubMedCrossRefGoogle Scholar
  13. 13.
    Frey HL, Rajfer J. (1984) Role of the gubernaculum and intraabdominal pressure in the process of testicular descent. J Urol 131: 574–579.PubMedGoogle Scholar
  14. 14.
    Polascik TJ, Chan-Tack KM, Jeffs RD, et al. (1996) Reappraisal of the role of human chorionic gonadotropin in the diagnosis and treatment of the nonpalpable testis: a 10-year experience. J Urol 156: 804–806.PubMedCrossRefGoogle Scholar
  15. 15.
    Scorer CG. (1964) The descent of the testis. Arch Dis Child 39: 605–609.PubMedCrossRefGoogle Scholar
  16. 16.
    Scorer CG, Farrington GH. (1972) Congenital deformities of the testis and epididymis, New York: Appleton-Century-Crofts.Google Scholar
  17. 17.
    Gross RE, Jewett TC Jr. (1956) Surgical experiences from 1222 operations for undescended testis. JAMA 160: 634–641.CrossRefGoogle Scholar
  18. 18.
    Hadziselimovic F. (1987) Cryptorchidism. In: Gillenwater JY, Grayhack JT, Howards, SS, et al., eds., Adult and Pediatric Urology, Chicago: Year Book Medical Publishers, pp. 2217–2244.Google Scholar
  19. 19.
    Marshall FF, Elder JS. (1982) Cryptorchidism and related anomalies. New York: Praeger, p. 118.Google Scholar
  20. 20.
    Hortling H, Chapelle A, Johansson CJ, et al. (1967) An endocrinologic follow-up study of operated cases of cryptorchism. J Clin Endocrinol Metab 27: 120–129.PubMedCrossRefGoogle Scholar
  21. 21.
    Bartone FF, Huseman CA, Maizels M, et al. (1984) Pitfalls in using human chorionic gonadotropin stimulation test to diagnose anorchia. J Urol 132: 563–567.PubMedGoogle Scholar
  22. 22.
    Jarow JP, Berkovitz GD, Migeon CJ, et al. (1986) Elevation of serum gonadotropins establishes the diagnosis of anorchism in prepubertal boys with bilateral cryptorchidism. J Urol 136: 277–279.PubMedGoogle Scholar
  23. 23.
    Lee MM, Donahoe PK, Silverman BL, et al. (1997) Measurements of serum mullerian inhibiting substance in the evaluation of children with nonpalpable gonads. N Engl J Med 336: 1480–1486.PubMedCrossRefGoogle Scholar
  24. 24.
    Byrd W, Bennett MJ, Can BR, et al. (1998) Regulation of biologically active dimeric inhibin A and B from infancy to adulthood in the male. J Clin Endocrinol Metab 83: 2849–2854.PubMedCrossRefGoogle Scholar
  25. 25.
    Smith EA, Woodard JR (2001) Prune-belly syndrome. In: Gearhart JP, Rink RC, Mouriquand PDE, eds., Pediatric Urology, Philadelphia: W.B. Saunders Company, pp. 577–592.Google Scholar
  26. 26.
    Gill WB, Schumacher GF, Bibbo M, et al. (1979) Association of diethylstilbestrol exposure in utero with cryptorchidism, testicular hypoplasia and semen abnormalities. J Urol 122: 36–39.PubMedGoogle Scholar
  27. 27.
    Whitehead ED, Leiter E. (1981) Genital abnormalities and abnormal semen analyses in male patients exposed to diethylstilbestrol in utero. J Urol 125: 47–50.PubMedGoogle Scholar
  28. 28.
    Stillman RJ. (1982) In utero exposure to diethylstilbestrol: adverse effects on the reproductive tract and reproductive performance and male and female offspring. Am J Obstet Gynecol 142: 905–921.PubMedGoogle Scholar
  29. 29.
    Colborn T, Dumanoski D, Myers JP. (1997) Our Stolen Future: Are We Threatening Our Fertility, Intelligence, and Survival? - A Scientific Detective Story. New York: Penguin.Google Scholar
  30. 30.
    Abrams HJ. (1975) Familial cryptorchidism [letter]. Urology 5: 849.PubMedCrossRefGoogle Scholar
  31. 31.
    Rezvani I, Rettig KR, DiGeorge AM. (1976) Inheritance of cryptorchidism. Pediatrics 58: 774–775.PubMedGoogle Scholar
  32. 32.
    Perrett LJ, O’Rourke DA. (1969) Hereditary cryptorchidism. Med J Australia 1: 1289–1290.PubMedGoogle Scholar
  33. 33.
    Corbus BC, O’Conor VJ. (1922) The familial occurrence of undescended testes. Surg Gynecol Obstet 34: 237–240.Google Scholar
  34. 34.
    Czeizel A, Erodi E, Toth J. (1981) Genetics of undescended testis. J Urol 126: 528–529.PubMedGoogle Scholar
  35. 35.
    Jones IR, Young ID. (1982) Familial incidence of cryptorchidism. J Urol 127: 508–509.PubMedGoogle Scholar
  36. 36.
    Dewald GW, Kelalis PP, Gordon H. (1977) Chromosomal studies in cryptorchidism. J Urol 117: 110–112.PubMedGoogle Scholar
  37. 37.
    Klugo R, Van Dyke DL, Weiss L. (1978) Cytogenic studies of cryptorchid testes. Urology 11: 255–256.PubMedCrossRefGoogle Scholar
  38. 38.
    Elder JS. (1992) Epididymal anomalies associated with hydrocele/hernia and cryptorchidism: implications regarding testicular descent. J Urol 148: 624–626.PubMedGoogle Scholar
  39. 39.
    Marshall FF, Shermeta DW. (1979) Epididymal abnormalities associated with undescended testis. J Urol 121: 341–343.PubMedGoogle Scholar
  40. 40.
    Heath AL, Man DW, Eckstein HB. (1984) Epididymal abnormalities associated with maldescent of the testis. J Pediatr Surg 19: 47–49.PubMedCrossRefGoogle Scholar
  41. 41.
    Gill B, Kogan S, Starr S, et al. (1989) Significance of epididymal and ductal anomalies associated with testicular maldescent. J Urol 142: 556–558.PubMedGoogle Scholar
  42. 42.
    Koff WJ, Scaletscky R. (1990) Malformations of the epididymis in undescended testis. J Urol 143: 340–343.PubMedGoogle Scholar
  43. 43.
    Rajfer J, Walsh PC. (1976) The incidence of intersexuality in patients with hypospadias and cryptorchidism. J Urol 116: 769–770.PubMedGoogle Scholar
  44. 44.
    Kaefer M, Diamond D, Hendren WH, et al. (1999) The incidence of intersexuality in children with cryptorchidism and hypospadias: stratification based on gonadal palpability and meatal position. J Urol 162: 1003–1006.PubMedCrossRefGoogle Scholar
  45. 45.
    Koff SA. (1991) Does compensatory testicular enlargement predict monorchism? J Urol 146: 632–633.PubMedGoogle Scholar
  46. 46.
    Mininberg DT, Rodger JC, Bedford JM. (1982) Ultrastructural evidence of the onset of testicular pathological conditions in the cryptorchid human testis within the first year of life. J Urol 128: 782–784.PubMedGoogle Scholar
  47. 47.
    Reinberg Y, Manivel JC, Fraley EE. (1989) Carcinoma in situ of the testis. J Urol 142: 243–247.PubMedGoogle Scholar
  48. 48.
    Batata MA, Whitmore WF Jr, Chu FC, et al. (1980) Cryptorchidism and testicular cancer. J Urol 124: 382–387.PubMedGoogle Scholar
  49. 49.
    Campbell HE. (1942) Incidence of malignant growth of the undescended testicle: a critical and statistical study. Arch Surg 44: 353–369.CrossRefGoogle Scholar
  50. 50.
    Martin DC. (1982) Malignancy in the cryptorchid testis. Urol Clin N Am 9: 371–376.Google Scholar
  51. 51.
    Riegler HC. (1972) Torsion of intra-abdominal testis: an unusual problem in diagnosis of the acute surgical abdomen. Surg Clin N Am 52: 371–374.PubMedGoogle Scholar
  52. 52.
    Duncan ND, Gabay L, Coard KC, et al. (1997) Torsion of an intra-abdominal testicle in a neonate. Case report and review of the literature. West Indian Medical J 46: 126–127.Google Scholar
  53. 53.
    Hrebinko RL, Bellinger MF. (1993) The limited role of imaging techniques in managing children with undescended testes. J Urol 150: 458–460.PubMedGoogle Scholar
  54. 53a.
    Wolverson MK, Houttin E, Heiberg E, Sundaram M, Sheilds JB. (1983) Comparison of computed tomography with high-resolution real-time ultrasound in the localization of the impalpable undescended testis. Radiology 146: 133–136.PubMedGoogle Scholar
  55. 53b.
    Lee JK, Glazer HS. (1982) Computed tomography in the localization of the nonpalpable testis. Urol Clin N Am 9: 397–404.Google Scholar
  56. 53c.
    Rajfer J, Tauber A, Zinner N, Naftulin E, Worthen N. (1983) The use of computerized tomography scanning to localize the impalpable testis. J Urol 129: 972–974.PubMedGoogle Scholar
  57. 53d.
    Maghnie M, Vanzulli A, Paesano P, Bragheri R, Palladini G, Preti P, et al. (1994) The accuracy of magnetic resonance imaging and ultasonography compared with surgical findings in the localization of the undescended testis. Arch Ped Adol Med 148: 699–703.CrossRefGoogle Scholar
  58. 54.
    Cain MP, Garra B, Gibbons MD. (1996) Scrotal-inguinal ultrasonography: a technique for identifying the nonpalpable inguinal testis without laparoscopy. J Urol 156: 791–794.PubMedCrossRefGoogle Scholar
  59. 55.
    Skandalakis JE, Colborn GL, Pemberton LB, et al. (1991) The surgical anatomy of the inguinal area–part 2. Contemp Surg 38: 28–38.Google Scholar
  60. 56.
    Prentiss RJ, Weickgenant CJ, Moses JJ, et al. (1960) Undescended testis: surgical anatomy of spermatic vessels, spermatic surgical triangles, and lateral spermatic ligament. J Urol 83: 686–692.PubMedGoogle Scholar
  61. 57.
    Witus WS, Sloss JH, Valk WL. (1959) Inguinal node metastases from testicular tumors developing after orchiopexy. J Urol 81: 669–671.PubMedGoogle Scholar
  62. 58.
    Bevan AD. (1899) Operation for undescended testicle and congenital inguinal hernia. JAMA 33: 773–777.CrossRefGoogle Scholar
  63. 59.
    Skandalakis J. Gray SW. (1993) Embryology for Surgeons: The Embryological Basis for the Treatment of Congenital Anomalies, 2nd ed, Philadelphia: Lippincott, Williams & Wilkins.Google Scholar
  64. 60.
    Huff DS, Snyder HM, Rusnack SL, et al. (2001) Hormonal therapy for the subfertility of cryptorchidism. Horm Res 55: 38–40.PubMedCrossRefGoogle Scholar
  65. 61.
    Vinardi S, Magro P, Manenti M, et al. (2001) Testicular function in men treated in childhood for undescended testes. J Pediatr Surg 36: 385–388.PubMedCrossRefGoogle Scholar
  66. 62.
    Rogers E, Teahan S, Gallagher H, et al. (1998) The role of orchiectomy in the management of postpubertal cryptorchidism. J Urol 159: 851–854.PubMedCrossRefGoogle Scholar
  67. 63.
    Fowler R, Stephens FD. (1959) The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Z J Surg 29: 92–106.PubMedCrossRefGoogle Scholar
  68. 64.
    Bloom DA. (1991) Two-step orchiopexy with pelviscopic clip ligation of the spermatic vessels. J Urol 145: 1030–1033.PubMedGoogle Scholar
  69. 65.
    Koff SA, Sethi PS. (1996) Treatment of high undescended testes by low spermatic vessel ligation: an alternative to the Fowler-Stephens technique. J Urol 156: 799–803.PubMedCrossRefGoogle Scholar
  70. 66.
    Docimo SG, Moore RG, Adams J. et al. (1995) Laparoscopie orchiopexy for the high palpable undescended testis: preliminary experience. J Urol 154: 1513–1515.PubMedCrossRefGoogle Scholar
  71. 67.
    Peters CA. (1996) Complications in pediatric urological laparoscopy: results of a survey. J Urol 155: 1070–1073.PubMedCrossRefGoogle Scholar
  72. 68.
    Bukowski TP, Wacksman J, Billmire DA. et al. (1995) Testicular autotransplantation: a 17-year review of an effective approach to the management of the intra-abdominal testis. J Urol 154: 558–561.PubMedCrossRefGoogle Scholar
  73. 69.
    Redman JF. (1977) The staged orchiopexy: a critical review of the literature. J Uro1 117: 1 13–114.Google Scholar
  74. 70.
    Gheiler EL, Barthold JS, Gonzalez R. (1997) Benefits of laparoscopy and the Jones technique for the nonpalpable testis. J Urol 158: 1948–1951.PubMedCrossRefGoogle Scholar
  75. 71.
    Cartwright PC, Velagapudi S, Snyder HM, et al. (1993) A surgical approach to reoperative orchiopexy. J Urol 149: 817–818.PubMedGoogle Scholar
  76. Farrer JH, Walker AH. Rajfer J. (1985) Management of the postpubertal crypt-orchid testis: a statistical review. J Urol 134:1071–1076.Google Scholar
  77. 73.
    Ferro F, Caterino S, Lais A. (1991) Testicular prosthesis in children: a simplified insertion technique. Eur Urol 19: 230–232.PubMedGoogle Scholar
  78. 74.
    Docimo SG. (1995) The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol 154: 1148–1152.PubMedCrossRefGoogle Scholar
  79. 75.
    Baker LA, Docimo SG, Surer I, et al. (2001) A multi-institutional analysis of laparoscopic orchidopexy. BJU Int 87: 484–489.PubMedCrossRefGoogle Scholar
  80. 76.
    Chang B, Palmer LS, Franco I. (2001) Laparoscopic orchidopexy: a review of a large clinical series. BJU Int 87: 490–493.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2003

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  • Richard I. Silver

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