The undescended testis: diagnosis, treatment and long-term consequences.

SUMMARY Background:The late descent of a testicle into the scrotummay impair its development. Reduced fertility is the mainrisk of primary cryptorchidism even after timely treatment,as histopathological changes (Leydig cell hypoplasia)already become apparent in the first few months of life.There is evidence,however,that treatment is often delayed.Hormonal and surgical treatments complement each otherand should be provided before the child's first birthday. Methods: Selective literature search in PubMed (January2008) based on the following keywords:„cryptorchidism“,„maldescensus testis“,„etiology“,„therapy“,„semenquality“,„testicular cancer“. Particular attention was paidto the current S2 guidelines on cryptorchidism.Results/Discussion: Hormone therapy is the best initialtreatment in most cases,with a few exceptions. If this isunsuccessful,surgery should be performed without delay.The success of treatment depends on the initial position ofthe testicle. Treatment does not lessen the risk ofmalignancy. Parents must be informed about this risk. The undescended testicle is the most common genitalmalformation in boys. When diagnosed,it should betreated hormonally and/or surgically before the child's firstbirthday to minimize the risk of impaired fertility. Successfultreatment before age 13 appears not to lessen the risk of testicular cancer,but it does facilitate early detection byenabling physical examination of the testicle.Dtsch Arztebl Int 2009; 106(33): 527–32DOI:10.3238/arztebl.2009.0527