Management of Cryptorchidism

Abstract

Treatment of the undescended testis is based on the premise that early intervention will prevent secondary degeneration of the testis. The issue remains controversial, with some studies suggesting that orchidopexy done later in childhood is not related to infertility. Puri and O’Donnell (1988) performed semen analysis on 142 men who had an orchidopexy when they were 7–13 years of age. They used WHO standards for semen analysis and found that the fertility potential was related to the original gonadal position: those testes nearest the scrotum had the best quality semen. There are some problems with this study, however, as less than half the eligible subjects were studied (Tamhne and Williams 1989). In addition, some of the patients probably had an acquired abnormality such as a retractile or ascending testis, in which the long-term follow-up suggests similar abnormalities in semen quality but to a less severe degree (Nistal and Paniagua 1984; Rasmussen et al. 1988). An extensive review of the literature on the effect of treatment has failed to show any significant improvement in fertility with orchidopexies between four and 14 years (Chilvers et al. 1986). Unfortunately, most of the 27 papers examined described surgery in adolescence rather than in infancy. At present it is not possible to find reliable human studies showing a successful outcome for surgery in infancy because it is only in recent years that orchidopexy has been performed in this age group and there is a long lag-time before fertility can be determined (20–30 years) or malignancy occurs (30–40 years).