Definition

Cryptorchidism is the condition in which one (unilateral) or both (bilateral) testes are not fully descended into a scrotal position. In recent studies of a large cohort of men constituting the Children's Hospital of Pittsburgh cryptorchid group (2,3), 86% had a history of unilateral and only 14% had bilateral cryptorchidism. Composite data from earlier reports (4) also revealed that 77% of patients had unilateral cryptorchidism (46% were right sided and 31% were on the left).

The etiology of the term derives from the Greek word kryptos, meaning hidden, and orchis, meaning testis. In fact, cryptorchid testes may or may not be completely hidden, because they may be visible or palpable. Undescended testes may be palpated at various locations along the usual path of descent or at ectopic locations that deviate from that path (see Fig. 1). The undescended testis is evidence for a developmental defect that may involve genetic, hormonal, or anatomic problems, resulting in failure of the testis(es) to descend into the scrotum. Cryptorchidism is a physical finding, and, although the control of testicular descent is not well understood, there are numerous proposed etiologies. Furthermore, the differentiation of the truly cryptorchid testis from the temporary but easy retraction of the descended testis may be difficult during childhood. On the other hand, although the term cryptorchidism implies that the testis is present but hidden, the nonpalpable testis may instead be absent.

Table 1

Prevalence of Cryptorchidism in Relation to Age and Gestational Age

At birth

Overall

Bilateral

Unilateral

Related to birth and gestational age

At S mo of age

Overall

3 mo from estimated date of birth

Based on birth weight <2000 g 2000-2500 g >2500 g

In a prepubertal male, confirming that a testis is cryptorchid may require more than a single physical examination. It has been demonstrated that interobserver variation is a substantial bias in diagnosing undescended testes (5). From 6 mo of age, the cremasteric reflex is active and the testes retract readily into the upper scrotum or even to the external inguinal ring if a boy is anxious, nervous, or cold, all of which are common occurrences during a medical examination. Because boys with normal testicular descent may have retractile testes, particularly during the mid-childhood years when the cremasteric reflex is most pronounced (6), it is important to verify cryptorchidism and to exclude a retractile testis before considering treatment.

The major detrimental effects of the undescended testis are an increased risk of infertility and malignancy. Although concerns that detrimental psychological effects relating to body image may occur as a consequence of lack of testes in the scrotum have been raised (7), a study that focused on gender identity development and sexual behavior identified no problems (8). When given the choice, most young men choose to have two scrotal testes, even if one or both are synthetic, whereas older men often decline this option.

Cryptorchidism is one of the most frequent developmental abnormalities of human men. However, there is considerable variation in the reported prevalence of cryptorchidism in newborns, ranging from 2% to 5% in full-term infants (9-15). In premature infants, the prevalence is as high as 21%, with lower values as gestational age and birth weight increase. The prevalence of cryptorchidism changes considerably between birth and 3 mo of age (see Table 1); at 3 mo it is approx 1% (14), with a slight decline to 0.8% at 9 mo (12).

There is a greater chance of spontaneous testicular descent during early infancy among cryptorchid babies who weigh less than 2500 g at birth or who are born at less

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