24. Cryotorchidism

Diagnosis

· Thorough GU exam, including an attempt to "milk" inguinally located testes into the scrotum o If one or both testes are palpable in the scrotum or inguinal canal, re-examine at the next well-child exam o If neither testes are palpable at birth, obtain an ultrasound and karyotype promptly

When do we see increased risk?

↑ Risk in premature infants 30% vs. 5% in full-term infants

Complications

-inguinal hernia -TESTICULAR TOSION -TESTICULAR CANCER -testicular truama -subferility

Types

-palpable cryptorchid testis -non-palpable testis --ascending cryptorchidism

Complications

Complications of undescended testes are testicular cancer (in both descended and undescended testes) or infertility (which occurs in up to 75% of male children with bilateral cryptorchidism and in 50% of male children with unilateral cryptorchidism.)

What is Cryotorchidism?

Cryptorchidism is the failure of testes to descend - undescended testicle - (one or both)

Diagnosis

EXAM / PE in SUPINE position

What should happen if testicle is not dropped by 6 months and before 12 months?

If not descended by 6 months and before he is 12 months old surgery (orchiopexy) should be performed.

Describe ascending cryptorchidism.

Present in patients with previously documented normal testis position in the scrotum. The testis is noted to have ascended into the high portion of the scrotum of the inguinal canal.

Cryotorchidism is most common on what side?

Right

Treatment

Surgery after 6 months and before 2 years

Describe non-palpable testis.

Unable to be located / palpated in the scrotum, inguinal canal, or femoral or perineal regions despite through PE

Describe palpable cryptorchid testis.

Unable to be pulled into the scrotum or quickly returns to a higher position after being pulled into the scrotum

Etiolgy

Unknown

Treatment

o Undescended testes can be monitored for spontaneous descent over the first 4-6 months of life § If still non-palpable at 4-6 mo well-child exam, refer to urology/surgery for evaluation and possible orchiopexy § For absent testes, strongly consider a consultation with a specialist regarding labs for CAH § Complications of undescended testes include malignancy, subfertility, and testicular torsion. Therefore, the American Urologic Association suggests that these patients should perform monthly testicular self-examinations during adolescence