Evaluation and management of the infant with cryptorchidism

TY - JOUR

T1 - Evaluation and management of the infant with cryptorchidism

AU - Hutson, John M

AU - Thorup, Joergen

PY - 2015/8/1

Y1 - 2015/8/1

N2 - PURPOSE OF REVIEW: Normal testicular descent is now recognized to occur in two steps with the first, transabdominal stage controlled by insulin-like hormone 3. The second, inguinoscrotal stage is controlled by androgens, mostly indirectly via the genitofemoral nerve, which appears to direct the migration of the gubernaculum to the scrotum. Undescended testis (UDT) is multifactorial, with only some of the genes identified. This review highlights recent developments that are leading to changes in practice.RECENT FINDINGS: There is an emerging consensus among pediatric surgeons and urologists about the management of UDT with recommendations that the diagnosis of congenital UDT should be confirmed at 3-6 months of age and orchidopexy done at 6-12 months of age. With the recommendations for early surgery, recent studies focus on the complications of orchidopexy, to determine whether this is higher in infants than older children. In addition, there is general acceptance of the existence of 'acquired' UDT, which develops after about 2 years of age, but treatment for this group remains controversial.SUMMARY: Evaluation of children with UDT now needs to be separated into the assessment of possible congenital UDT in infants at 0-6 months, for orchidopexy before 12 months, and preschool boys, who may be developing acquired UDT.

AB - PURPOSE OF REVIEW: Normal testicular descent is now recognized to occur in two steps with the first, transabdominal stage controlled by insulin-like hormone 3. The second, inguinoscrotal stage is controlled by androgens, mostly indirectly via the genitofemoral nerve, which appears to direct the migration of the gubernaculum to the scrotum. Undescended testis (UDT) is multifactorial, with only some of the genes identified. This review highlights recent developments that are leading to changes in practice.RECENT FINDINGS: There is an emerging consensus among pediatric surgeons and urologists about the management of UDT with recommendations that the diagnosis of congenital UDT should be confirmed at 3-6 months of age and orchidopexy done at 6-12 months of age. With the recommendations for early surgery, recent studies focus on the complications of orchidopexy, to determine whether this is higher in infants than older children. In addition, there is general acceptance of the existence of 'acquired' UDT, which develops after about 2 years of age, but treatment for this group remains controversial.SUMMARY: Evaluation of children with UDT now needs to be separated into the assessment of possible congenital UDT in infants at 0-6 months, for orchidopexy before 12 months, and preschool boys, who may be developing acquired UDT.

KW - Child, Preschool

KW - Cryptorchidism

KW - Humans

KW - Infant

KW - Male

KW - Orchiopexy

KW - Practice Guidelines as Topic

KW - Testis

KW - Treatment Outcome

U2 - 10.1097/MOP.0000000000000237

DO - 10.1097/MOP.0000000000000237

M3 - Review

C2 - 26087417

SN - 1040-8703

VL - 27

SP - 520

EP - 524

JO - Current Opinion in Pediatrics

JF - Current Opinion in Pediatrics

IS - 4

ER -