Treatment of cryptorchidism

The ideal age for preserving fertility is 12 to 24 months after birth. Spontaneous descent of the testes can be accomplished within the first 3 months of life. Decisive treatment of undescended testes should be accomplished between 6 and 12 months after birth, which is the optimal time to perform testicular descent fixation.

1. Hormonal therapy

Cryptorchidism can be associated with hypothalamic-pituitary-gonadal axis abnormalities, and hormonal therapy is with HCG, LHRH, or a combination of both. Guidelines recommend βHCG for preprocedure in nonpalpable cryptorchid testes or in some redo cases, where it increases testicular blood supply and facilitates surgery.

2. Surgery

For those who have not descended to the scrotum by 6 months after birth, early surgery is indicated. For adolescent cryptorchidism patients, once found in time to perform testicular descent fixation, if the testicle is found to have atrophied or can not descend into the scrotum, if necessary, orchiectomy can be performed.

(1) Open surgery testicular descent fixation The testicular descent fixation is performed in patients with palpable cryptorchidism. Generally into the inguinal approach, an oblique incision in the groin, free spermatic cord, ligation of unclosed sheath or hernia sac, tension-free placement of the testicle in the scrotum fixed.

(2) Laparoscopic surgery Indications: all nonpalpable testes; diagnosis of suspected interstitiality; biopsy or intraperitoneal high-grade orchiectomy. Contraindications: acute infection, coagulation abnormalities, previous history of abdominal surgery, suspected peritoneal adhesions.

(3) Autologous testicular transplantation For high cryptorchidism. The testicular vessels are ligated, the testis is moved free into the scrotum, and the testicular vessels are anastomosed to the inferior abdominal wall artery. This is not widely used and is not recommended as a routine surgical procedure.