Consequences

Consequences

Infertility Men with undescended testes may have reduced fertility , even after orchidopexy . /uni25CF The infertility rate for unilateral cases is not believed to be very di ff erent from the general population. /uni25CF The fertility reduction after orchidopexy for bilateral cryptorchidism is about 38%. /uni25CF Patients with bilateral undescended testes who receive orchidopexies as adults are almost always infertile and azoospermic; but there are reports of pregnancies achieved through sperm retrieval and assisted reproduction in this group. /uni25CF The recommendation for early surgery is due to degener ation of spermatogenic tissue and reduced spermatogonia counts after the second year of life in patients with untreat ed undescended testes. Malignancy Overall, the risk of testicular cancer if orchidopexy is done before puberty is around two to three times that of the general population. It is five to six times higher when orchidopexy is done after puberty . The risk of cancer does not seem to be di ff erent when orchidopexy is done early in infancy compared with later in childhood. undescended testes is seminoma. /uni25CF The peak age range for this tumour is 15–45 years. /uni25CF In contrast, after orchidopexy , seminomas represent only 30% of testicular tumours in previously undescended tes - tes. /uni25CF It is treatable if caught early , so boys who had an orchidopexy as infants should be taught testicular self- examination. Hernia Around 90% of boys with an undescended testis have a patent processus vaginalis although the incidence of a clinically apparent hernia is much lower. Testicular torsion The undescended testis is more prone to testicular torsion, largely as a consequence of a developmental abnormality between the testis and its mesentery . Summary box 86.1 Undescended testis /uni25CF /uni25CF /uni25CF /uni25CF

Testes that are absent from the scrotum after 3 months of age are unlikely to descend Histological changes in the testis can be seen from 1 year of age An incompletely descended testis tends to atrophy as puberty approaches Boys with undescended testes are at greater risk of infertility, testicular malignancy, hernia and torsion