title: [Modern management of cryptorchidism: which evidences?].
abstract: The term cryptorchidism is related to the failure of the migration of the testis to the scrotum. In most cases, testis are retained along the physiological route through the inguinal canal. In 1% of cases the gubernaculum testis is abnormally fixed (testicular ectopy).In 20% of cases, one testis is not clinically palpable. The US has a sensitivity of 45% and a specificity of 78% in detecting intra-abdominal testis. Consequently, laparoscopy should be considered the gold-standard in these cases.Hormonal therapy has been considered in order to aid testicular descent, without or before surgery. Recent data suggest that these strategies seem to have a success rate 10% higher than placebo, while surgery alone is effective in 33-100% of cases.Several histological studies showed microscopic damages due to cryptorchidism since age of 6-9 months. Some Authors suggest that up to 40% retained testis completely lose their own germinal cells pool at the age of two years. Consequently guide-lines suggest that surgery should be proposed at the age of 6-18 months.Cancer relative risk associated to cryptorchidism is calculated to be 1.5-7.5% higher than in general population and lower than what is traditionally estimated (15-33%). Moreover, this risk increases 2.9-32.0 times when surgery is performed after the age of 10-11 years.
authors.affiliation: U.O.C. Urologia e Andrologia, Dipartimento Nefrologia-Urologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Caione
authors.forename: Roberto
authors.initials: R
authors.lastname: Tambucci
mesh_terms: D000328:Adult; D000367:Age Factors; D002648:Child; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D003456:Cryptorchidism / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D019468:Disease Management; D004198:Disease Susceptibility; D061345:Early Medical Intervention; D019317:Evidence-Based Medicine; D006065:Gonadotropins, Pituitary / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007248:Infertility, Male / Q000209:etiology / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods; D008297:Male; D056126:Orchiopexy; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013736:Testicular Neoplasms / Q000209:etiology / Q000517:prevention & control; D014463:Ultrasonography
chemical_list: D006063:Chorionic Gonadotropin; D006065:Gonadotropins, Pituitary