World J Mens Health.  2014 Aug;32(2):110-115. 10.5534/wjmh.2014.32.2.110.

Clinical Characteristics and Treatment of Cryptorchidism in Adults: A Single Center Experience

• Jeong SC
• Lee S
• Ku JY
• Lee SD

• KMID: 2320802
• DOI: http://doi.org/10.5534/wjmh.2014.32.2.110

Abstract

PURPOSE
We evaluated the clinical and therapeutic characteristics of adult cryptorchidism, which have been difficult to establish, given the small number of patients presenting to outpatient clinics.
MATERIALS AND METHODS
A retrospective study of 20 adult patients with cryptorchid testis was performed. We analyzed their palpation of testis, location, surgical method, marital status, number of children, histologic findings, and semen analysis.
RESULTS
In 17 cases with unilateral cryptorchidism, the mean age at surgery was 31.1+/-12.5 years. Fourteen patients had a palpable, small cryptorchid testis. The location of the testis, as verified, was inguinal in 14, prepubic in 2, and intra-abdominal in 1, respectively. We performed orchiopexy in 14 out of 15 patients who sought to have this procedure. Four among 6 married patients had children. Testis biopsy was performed in 12 patients, and all showed abnormal histologic findings. Three among 4 patients, performed semen analysis, showed abnormal findings. In three cases of bilateral cryptorchidism, the mean age at surgery was 35.7+/-12.5 years. All of these patients had palpated cryptorchid testes in the inguinal area and sought to have a bilateral orchiopexy. Two patients have been married but had no children. All showed abnormal findings in both testis biopsy and semen analysis. No testicular neoplasm was detected during the duration of follow-up.
CONCLUSIONS
Most adult patients with cryptorchidism preferred orchiopexy to orchiectomy. However, most of patients showed abnormal histology of the testis and semen analysis. Therefore, orchiopexy with regular scrotal examination may be considered a suitable treatment options for adult cryptorchidism.

Keyword

Adult; Cryptorchidism; Orchiectomy; Orchiopexy

MeSH Terms

Adult*
Ambulatory Care Facilities
Biopsy
Child
Cryptorchidism*
Follow-Up Studies
Humans
Male
Marital Status
Orchiectomy
Orchiopexy
Palpation
Retrospective Studies
Semen Analysis
Testicular Neoplasms
Testis

Reference

1. Sijstermans K, Hack WW, Meijer RW, Van der Voort-Doedens LM. The frequency of undescended testis from birth to adulthood: a review. Int J Androl. 2008; 31:1–11.

2. Moradi M, Karimian B, Moradi A. Adult orchidopexy: a survey on necessity of intraoperative testicular biopsy. Nephrourol Mon. 2011; 3:196–200.

3. Barthold JS. Abnormalities of the testis and scrotum and their surgical management. In : Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 10th ed. Philadelphia: Saunders;2012. p. 3560–3574.

4. Lania C, Grasso M, Mantovani G, Hadjigeorgiou D, Annoni F, Rigatti P. Cryptorchidism: review and evaluation of the fertility of adult cryptorchids. J Androl. 1984; 125–127.

5. World Health Organization (WHO), Department of Reproductive Health and Research. WHO laboratory manual for the examination and processing of human semen. 5th edition [Internet]. Geneva: WHO;c2010. cited 2014 Jan 20. Available from: http://www.who.int/reproductivehealth/publications/infertility/9789241547789/en/.

6. Ahn H, Lee HE, Park K, Choi H. Reasons for delayed orchiopexies in a Korean tertiary care hospital. Korean J Urol. 2014; 55:69–73.

7. Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med. 2007; 356:1835–1841.

8. Toppari J, Kaleva M. Maldescendus testis. Horm Res. 1999; 51:261–269.

9. American Academy of Pediatrics, Section on Urology. Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. Pediatrics. 1996; 97:590–594.

10. Hutson JM, Hasthorpe S. Abnormalities of testicular descent. Cell Tissue Res. 2005; 322:155–158.

11. Farrer JH, Walker AH, Rajfer J. Management of the postpubertal cryptorchid testis: a statistical review. J Urol. 1985; 134:1071–1076.

12. Wood HM, Elder JS. Cryptorchidism and testicular cancer: separating fact from fiction. J Urol. 2009; 181:452–461.

13. Rogers E, Teahan S, Gallagher H, Butler MR, Grainger R, McDermott TE, et al. The role of orchiectomy in the management of postpubertal cryptorchidism. J Urol. 1998; 159:851–854.

14. Okuyama A, Nonomura N, Nakamura M, Namiki M, Fujioka H, Kiyohara H, et al. Surgical management of undescended testis: retrospective study of potential fertility in 274 cases. J Urol. 1989; 142:749–751.

15. Grasso M, Buonaguidi A, Lania C, Bergamaschi F, Castelli M, Rigatti P. Postpubertal cryptorchidism: review and evaluation of the fertility. Eur Urol. 1991; 20:126–128.

16. Frank JD. Recent advances in urology and andrology. Edinburgh: Churchill Living stone;1987. p. 269–278.

17. Raghavendran M, Mandhani A, Kumar A, Chaudary H, Srivastava A, Bhandari M, et al. Adult cryptorchidism: unrevealing the cryptic facts. Indian J Surg. 2004; 66:160–163.

18. Heaton ND, Davenport M, Pryor JP. Fertility after correction of bilateral undescended testes at the age of 23 years. Br J Urol. 1993; 71:490–491.

19. Shin D, Lemack GE, Goldstein M. Induction of spermatogenesis and pregnancy after adult orchiopexy. J Urol. 1997; 158:2242.

20. Lin YM, Hsu CC, Wu MH, Lin JS. Successful testicular sperm extraction and paternity in an azoospermic man after bilateral postpubertal orchiopexy. Urology. 2001; 57:365.