[Cryptorchidism: diagnosis and treatment].
Cryptorchidism corresponds to the extra-scrotal position of the testis, and can be found in 3% of the term newborns and 0.5 to 1.0% of adults. It is usually an isolated clinical feature, but in around 10% of the cases can be associated to hypothalamic-pituitary dysfunction and genetic or embryonic disorders. The presence of additional genital abnormalities, such as hypospadia or micropenis, increases the probability of the diagnosis of an intersex condition. Detailed description of the testicular anatomic position is essential to adequate diagnosis, treatment and prognostic evaluation. The diagnosis of cryptorchidism is made by clinical examination. The complementary exams, such as image analysis, add limited information on the diagnosis. Gonadotropins and testicular hormones measurement can be useful if the hypothalamic-pituitary-gonadal axis is activated, as observed during the first 6 months of life or during puberty. Clinical treatment is indicated in patients with retained testis or in severely retractile testis. In these cases, human chorionic gonadotropin is employed at a dose of 50 IU/kg/week for 6 consecutive weeks. Clinical treatment cannot be used in cases of confirmed inguinal hernia, varicocele or spermatic cord cysts. Surgical correction is indicated after failure of clinical treatment or for ectopic testes. The long-term prognosis of cryptorchidism seems to be related to the precocity of the therapy. Therefore, recognition and treatment of cryptorchid testes should be done during the first 2 years of life, potentially improving the risks of infertility and gonadal neoplasia.
Longui
Carlos Alberto
CA
Departamento de Pediatria, Faculdade de Ciências Médicas, Santa Casa de São Paulo, SP. fisiolab@santacasasp.org.br
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000175:diagnosis* / Q000628:therapy*; D003663:Decision Trees; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male