Reproductive · Year 2 · from Reproductive
Case 3: Cryptorchidism
Clinical Image
Source: Wikipedia - Cryptorchidism - CC BY-SA 4.0
Case Presentation
A 9-month-old male infant is brought to the pediatric urology clinic after the pediatrician noted an empty right hemiscrotum at the 6-month well-child visit. The parents confirm the right testis has never been palpable in the scrotum. Physical examination confirms an empty right hemiscrotum with no palpable testis in the inguinal canal. The left testis is normally descended. Ultrasound localizes the right testis in the inguinal canal measuring 1.2 cm. Serum testosterone, FSH, and LH are not routinely indicated in unilateral cryptorchidism. The diagnosis is right cryptorchidism (undescended testis). Orchiopexy is scheduled, as surgical correction should be performed between 6-12 months of age to optimize fertility potential and facilitate testicular examination for tumor surveillance. The parents are counseled that cryptorchidism increases the risk of testicular cancer 3-8 fold even after surgical correction, and that the child will need education about testicular self-examination starting in adolescence.
Key Learning Points
- Cryptorchidism (undescended testis) is the most common congenital abnormality of the male genitalia, occurring in 1-3% of full-term male infants
- The testes normally descend by 32-36 weeks of gestation; most undescended testes will descend spontaneously by 3-6 months of age
- Orchiopexy should be performed by 12-18 months to preserve fertility potential, as the elevated temperature in an undescended position impairs spermatogenesis
- Cryptorchidism is associated with increased risk of infertility and testicular cancer (risk persists even after orchiopexy)