What are the guideline sources, guidelines and references for Cryptorchidism ?
Guideline sources The following summarized guidelines for the evaluation and management of cryptorchidism are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2023; 2022), the European Thyroid Association (ETA 2018), the Canadian Urological Association (CUA 2017), and the American Urological Association (AUA 2014). 1 2 3 4 5 6 6 6 7 Definition Cryptorchidism, also known as undescended testis, is a common congenital abnormality among males that is characterized by the failure of one or both testes to permanently descend. 6 Epidemiology Cryptorchidism is caused due to a disruption in any phase of testicular descent triggered by hereditary, hormonal, anatomical, environmental, or social factors. 6 Disease course The disruption in any phase of testicular descent results in cryptorchidism, which causes an increased chance of inguinal hernia, torsion, and trauma that leads to psychological distress in parents. It may also lead to reduced fertility and testicular cancer in adult males. 6 Prognosis and risk of recurrence https://web.pathway.md/diseases/recR13KRftHx2eXVw 1/5 6/23/23, 3:37 AM Cryptorchidism Pathway g Orchiectomy for ASA 3 and ASA 4 is associated with 0.49% and 3.31% of mortality risk. 7 Guidelines 1. Diagnostic investigations Clinical history and physical examination: obtain a gestational history as part of the initial evaluation of boys with suspected cryptorchidism. B Evaluation for disorders of sex development: As per EAU 2022 guidelines, evaluate male neonates with bilateral non-palpable testes for possible disorders of sex development. B As per CUA 2017 guidelines, do not obtain routine karyotype or genetic testing in patients with cryptorchidism. D Show 2 more As per AUA 2014 guidelines, assess for the possibility of a disorder of sex development in patients with cryptorchidism and severe hypospadias. B Hormone testing: measure anti-M llerian hormone levels, and consider additional hormone testing, to evaluate for anorchia, in boys with bilateral, nonpalpable testes who do not have congenital adrenal hyperplasia. B Diagnostic imaging: As per CUA 2017 guidelines, do not obtain imaging as a standard adjunct to preoperative assessment of pediatric patients with cryptorchidism, as it is not cost-effective, and may delay referral and surgical treatment. D As per AUA 2014 guidelines, avoid ultrasound or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral, as these studies rarely assist in decision making. D Evaluation for central hypothyroidism: obtain screening for central hypothyroidism in infants with signs of congenital hypopituitarism, such as micropenis with undescended testes. A 2. Medical management Hormonal therapy: As per EAU 2022 guidelines: Do not offer hormonal therapy in patients with unilateral cryptorchidism, as it is of no benefit for future paternity. D Offer GnRH analogs at a typical dose of 1.2 mg/day in 3 divided doses for 4 weeks to preserve the fertility potential in patients with bilateral cryptorchidism. B As per CUA 2017 guidelines, do not offer hormonal therapy as first-line therapy in patients with cryptorchidism. D https://web.pathway.md/diseases/recR13KRftHx2eXVw 2/5 6/23/23, 3:37 AM Cryptorchidism Pathway As per AUA 2014 guidelines, avoid hormonal therapy to induce testicular descent, given low response rates and lack of evidence for long-term efficacy. D 3. Surgical interventions Orchidopexy, pre-pubertal: As per EAU 2022 guidelines, perform surgical orchidolysis and orchidopexy before the age of 12 months and by 18 months at the latest. B Show 2 more As per CUA 2017 guidelines, perform orchidopexy between 6 and 18 months of age. B Show 4 more As per AUA 2014 guidelines, perform scrotal or inguinal orchidopexy in prepubertal boys with palpable cryptorchid testes. B Orchidopexy (post-pubertal): consider offering unilateral or bilateral orchidopexy, if technically feasible, in patients with unilateral or bilateral undescended testis with biochemical hypogonadism and/or spermatogenic failure (infertility). C Surgical or laparoscopic exploration: As per EAU 2022 guidelines, perform a diagnostic laparoscopy to locate an intra-abdominal testicle. A As per CUA 2017 guidelines, consider performing laparoscopic exploration in uncertain cases or when tissue analysis is not consistent with atrophic testicular tissue. C As per AUA 2014 guidelines, consider performing surgery within the next year in the absence of spontaneous testicular descent by 6 months (corrected for gestational age). B Orchiectomy: As per EAU 2023 guidelines, offer orchidectomy in adult patients with unilateral undescended testis and normal hormonal function/spermatogenesis. A As per CUA 2017 guidelines: Consider performing orchiectomy in < 50 years old postpubertal patients with hypotrophic/atrophic undescended testicles. C Offer orchiectomy as an option in patients with unilateral intra-abdominal or inguinal hypotrophic testes identified after puberty. B As per AUA 2014 guidelines, consider performing orchiectomy in patients with a normal contralateral testis meeting 1 of the following criteria: very short testicular vessels and vas deferens dysmorphic or very hypoplastic affected testis postpubertal age. C 4. Patient education https://web.pathway.md/diseases/recR13KRftHx2eXVw 3/5 6/23/23, 3:37 AM Cryptorchidism Pathway General counseling: As per EAU 2022 guidelines, inform the patient/caregivers about: the increased risk of later malignancy with an undescended testis in post-pubertal or older age; discuss removal in case of contralateral normal testis in a scrotal position B the increased risk of later malignancy with a failed or delayed orchidopexy; the earlier the treatment, the lower the risk of impaired fertility and testicular cancer B the reduced rates of fertility with unilateral undescended testis B the reduced rates of fertility and paternity with bilateral undescended testes. B As per CUA 2017 guidelines, inform the patient/caregivers that only one-third to two-thirds of males with bilateral cryptorchidism will be able to father a child. B As per AUA 2014 guidelines, counsel patients with a history of cryptorchidism and/or monorchidism and their parents regarding potential long-term risks, including infertility and testicular cancer. B 5. Preventative measures Prophylatic contralateral orchidopexy: decide on performing prophylactic orchidopexy based on informed discussion of options with the patient parents or legal guardian. B 6. Follow-up and surveillance Indications for specialist referral: refer infants with a history of cryptorchidism detected at birth who do not have spontaneous testicular descent by six months to an appropriate surgical specialist for timely evaluation. B Follow-up: As per EAU 2022 guidelines, obtain close follow-up on a yearly basis until puberty in patients with retractile testes instead of offering medical or surgical treatment. B As per CUA 2017 guidelines, consider offering observation in > 50 years old patients with hypotrophic/atrophic undescended testicles. C References 1. Kolon TF, Herndon CD, Baker LA et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014 Aug;192 2 337 45. Open 2. Persani L, Brabant G, Dattani M et al. 2018 European Thyroid Association ETA Guidelines on the Diagnosis and Management of Central Hypothyroidism. Eur Thyroid J. 2018 Oct;7 5 225 237. Open 3. Luis H Braga, Armando J Lorenzo, Rodrigo L P Romao. Canadian Urological Association-Pediatric Urologists of Canada CUA PUC guideline for the diagnosis, management, and followup of cryptorchidism. Can Urol Assoc J. 2017 Jul;11 7 E251 E260. Open https://web.pathway.md/diseases/recR13KRftHx2eXVw 4/5 6/23/23, 3:37 AM Cryptorchidism Pathway 4. Lisette A 't Hoen, Guy Bogaert, Christian Radmayr et al. EAU guidelines on Paediatric Urology. EAU. 2022 Mar. Open 5. A. Salonia, C. Bettocchi, J. Carvalho et al. EAU Guidelines on Sexual and Reproductive Health. EAU. 2023. Open 6. Luis H Braga, Armando J Lorenzo. Cryptorchidism: A practical review for all community healthcare providers. Jan-Feb 2017;11 1 2Suppl1 S26 S32.Jan-Feb 2017;11 1 2Suppl1 S26 S32. Open 7. Ankur Shah, Paul J Feustel, Jennifer Knuth et al. An updated mortality risk analysis of the post-pubertal undescended testis. 2018 Jul 24;13 1 E1 E6.2018 Jul 24;13 1 E1 E6. Open 8. American Urological Association. Choosing Wisely AUA recommendations. Choosing Wisely. 2017. Open 9. Ankur Shah, Paul J. Feustel, Jennifer Knuth et al. An updated mortality risk analysis of the post-pubertal undescended testis. Can Urol Assoc J. 2019 Jan; 13 1 E1 E6. Open 10. Luis H. Braga and Armando J. Lorenzo. Cryptorchidism: A practical review for all community healthcare providers. Can Urol Assoc J. 2017 Jan-Feb; 11 1 2Suppl1 S26 S32. Open https://web.pathway.md/diseases/recR13KRftHx2eXVw 5/5