Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_43
© Springer International Publishing Switzerland 2014
Cryptorchidism
(1)
Department of Pediatric Urology, Janet Weis Children’s Hospital, 100 N. Academy Av. MC 13-16, Danville, PA 17822, USA
(2)
Department of Pediatric Surgery, Janet Weis Children’s Hospital Geisinger Medical Center, 100 N. Academy Av. MC 21-70, Danville, PA 17822, USA
Abstract
Cryptorchidism or undescended testis is one of the most common congenital abnormalities seen in pediatric urology. It has been studied extensively but etiology still remains unclear
Cryptorchidism or undescended testis is one of the most common congenital abnormalities seen in pediatric urology. It has been studied extensively but etiology still remains unclear.
1.
Pathophysiology:
(a)
Incidence:
(i)
Up to 45 % incidence in pre-term males.
(ii)
Approximately 1–4 % incidence in full-term infants.
(iii)
At 6-months-old, incidence is approximately 1 %.
(b)
Most UDT will descend within the first year of life; those that descend will not require operative treatment.
(c)
UDT is usually unilateral.
(d)
Primary or congenital non-syndromic variant most common.
(e)
Secondary UDT is after prior inguinal surgery.
(f)
Anatomic location: may be located anywhere along the in-utero path of migration from the retroperitoneum to the high scrotum.
(i)
Intraabdominal (nonpalpable UTD).
(ii)
Annular: at the level of the internal ring.
(iii)
Cannilicular: within the inguinal canal (most common).
(iv)
High scrotal or retractile testis.
(v)
Ectopic locations:
1.
Perineal.
2.
Femoral.
3.
Penopubic.
(g)
Pathogenesis:
(i)
Unilateral UDT:
1.
Usually developmentally abnormal testicles.
2.
May never achieve spermatogenesis if not treated operatively early in life. However, the paternity rate of men with unilateral UDT approaches the normal population.
3.
Have a shortened vascular supply.
4.
More prone to develop malignancy later in life. Risk of malignancy of the UDT is upward of 60 times greater than normal. Orchidopexy does not prevent this risk, but allows for easier testicular examination and potentially earlier detection of a testicular mass. Intraabdominal (non-palpable) UDT has the highest risk of premalignant degeneration. The most frequent tumor type is a seminoma. Non-seminomatous germ cell tumors are most common in those UDT that have undergone orchidopexy. Interestingly, as many as 15 % of cancers that arise in patients with UDT do so in the normally descended testicle.
(ii)
Bilateral UDT:
1.
Likely due to a hormonal deficiency preventing in-utero descent.
2.
May be associated with an anatomic anomaly that is responsible for the UDT.
3.
Patients with bilateral UDT have fertility rates of only 50–65 %, even after early orchidopexy.
(h)
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Associated conditions:
(i)
Defects of androgen synthesis or receptors.
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