PANCE Blueprint Genitourinary (5%)

Cryptorchidism (ReelDx + Lecture)

VIDEO-CASE-PRESENTATION-REEL-DX

Undescended testicles

Patient will present as  a one-year-old child who is brought to your office for his 12-month visit. You note that the boy's testicles are inappreciable on the exam. The medical record reports that the child's testicles had been examined at two previous visits. The mother is very concerned and asks if her son will need surgery.

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

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

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

Thorough GU exam, including an attempt to "milk" inguinally located testes into the scrotum

  • If one or both testes are palpable in the scrotum or inguinal canal, re-examine at next well-child exam
  • If neither testes are palpable at birth, obtain ultrasound and karyotype promptly

Undescended testes can be monitored for spontaneous descent over the first 6 months of life

  • If still non-palpable at 6 mo well-child exam, refer to urology/surgery for evaluation and possible orchiopexy
  • For absent testes, strongly consider consultation with a specialist regarding labs for CAH
Question 1
At what age is it necessary to perform orchiopexy in a child affected with cryptorchidism?
A
6-12 months
B
36-48 months
C
5 years
D
7 years
E
Orchiopexy is not necessary
Question 1 Explanation: 
Either one or both testes may be absent from the scrotum at birth in about one in five premature or low-birth-weight male infants and in 3% to 6% at full-term infants. Cryptorchidism is found in 1% to 2% of male children after 1 year of age but can be confused with retractile testes that is associated with a strong cremasteric reflex, which requires no treatment. Orchiopexy is recommended between 6m-12m of age to decrease the risk of torsion, testicular cancer and infertility which occurs in up to 75% of male children with bilateral cryptorchidism and in 50% of male children with unilateral cryptorchidism. It is not clear, however, whether such early orchiopexy improves ultimate fertility. Some patients have underlying hypogonadism. Cryptorchidism is also associated with testicular carcinoma mainly in the undescended testicle and particularly with intra-abdominal malposition; however, up to 10% of cancers can occur on the unaffected side.
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