Advertisement
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
Advertisement

Purpose:

We dissected prevailing assumptions about cryptorchidism and reviewed data that support and reject these assumptions.

Materials and Methods:

Five questions about cryptorchidism and the risk of testicular cancer were identified because of their implications in parent counseling and clinical management. Standard search techniques through MEDLINE® were used to identify all relevant English language studies of the questions being examined. Each of the 5 questions was then examined in light of the existing data.

Results:

The RR of testicular cancer in a cryptorchidism case is 2.75 to 8. A RR of between 2 and 3 has been noted in patients who undergo orchiopexy by ages 10 to 12 years. Patients who undergo orchiopexy after age 12 years or no orchiopexy are 2 to 6 times as likely to have testicular cancer as those who undergo prepubertal orchiopexy. A contralateral, normally descended testis in a patient with cryptorchidism carries no increased risk of testis cancer. Persistently cryptorchid (inguinal and abdominal) testes are at higher risk for seminoma (74%), while corrected cryptorchid or scrotal testicles that undergo malignant transformation are most likely to become nonseminomatous (63%, p <0.0001), presumably because of a decreased risk of seminoma.

Conclusions:

Orchiectomy may be considered in healthy patients with cryptorchidism who are between ages 12 and 50 years. Observation should be recommended in postpubertal males at significant anesthetic risk and all males older than 50 years. While 5% to 15% of scrotal testicular remnants contain germinal tissue, only 1 case of carcinoma in situ has been reported, suggesting that the risk of malignancy in these remnants is extremely low.

References

  • 1 Cryptorchidism: a prospective study of 7500 consecutive male births, 1984–8: John Radcliffe Hospital Cryptorchidism Study Group. Arch Dis Child1992; 67: 892. Google Scholar
  • 2 : Prevalence and natural history of cryptorchidism. Pediatrics1993; 92: 44. Crossref, MedlineGoogle Scholar
  • 3 : Apparent doubling of frequency of undescended testis in England and Wales in 1962–81. Lancet1984; 2: 330. Google Scholar
  • 4 : The true incidence of cryptorchidism in Denmark. J Urol2008; 179: 314. LinkGoogle Scholar
  • 5 : Interpreting the international trends in testicular seminoma and nonseminoma incidence. Nat Clin Pract Urol2006; 3: 532. Google Scholar
  • 6 : Increasing incidence of testicular cancer worldwide: a review. J Urol2003; 170: 5. LinkGoogle Scholar
  • 7 : Impact of exposure to endocrine disrupters in utero and in childhood on adult reproduction. Best Pract Res Clin Endocrinol Metab2002; 16: 289. Google Scholar
  • 8 : Cryptorchidism and testicular tumorigenesis. Surgery1968; 63: 919. Google Scholar
  • 9 : Germinal cell tumors of the testis after orchiopexy. J Urol1979; 121: 422. LinkGoogle Scholar
  • 10 : Clinical epidemiology of testicular germ cell tumors. World J Urol2004; 22: 2. Google Scholar
  • 11 : Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular cancer. J Urol2007; 178: 1440. LinkGoogle Scholar
  • 12 : Practical Treatise on the Diseases of the Testis and of the Spermatic Cord and Scrotum. Philadelphia: Blanchard and Lee1856. Google Scholar
  • 13 : Abnormalities of the testis and scrotum: surgical management. In: Campbell-Walsh Urology. Edited by . Philadelphia: WB Saunders Co2006. chapt 127. Google Scholar
  • 14 : Pediatric andrology. In: Adult and Pediatric Urology. Edited by . Philadelphia: Lippincott Williams & Wilkins2002: 2572. Google Scholar
  • 15 : Cryptorchidism. In: Pediatric Urology. Edited by . Philadelphia: WB Saunders Co2001. chapt 46. Google Scholar
  • 16 : Incidence and nature of tumors in ectopic testes. Surg Gynecol Obstet1940; 71: 731. Google Scholar
  • 17 : Incidence of malignant growth of the undescended testis. Arch Surg1942; 44: 353. Google Scholar
  • 18 : Risk factors in past histories and familial episodes related to development of testicular germ cell tumor. Int J Urol2004; 11: 640. Google Scholar
  • 19 : Genital anomalies and risk for testicular cancer in Danish men. Epidemiology1996; 7: 14. Google Scholar
  • 20 : Neoplasms of the testis. In: Campbell-Walsh Urology, 9th ed. Edited by . Philadelphia: WB Saunders Co2006. chapt 29. Google Scholar
  • 21 : The probability of developing cancer. Am J Epidemiol1977; 106: 6. Google Scholar
  • 22 : Testicular neoplasia in undescended testes of cryptorchid boys—does surgical strategy have an impact on the risk of invasive testicular neoplasia?. Turk J Pediatr2004; 46: 35. Google Scholar
  • 23 : Risk of testicular cancer in cohort of boys with cryptorchidism. BMJ1997; 314: 1507. Google Scholar
  • 24 : Risk factors for testicular germ cell tumours by histological tumour type: United Kingdom Testicular Cancer Study Group. Br J Cancer1999; 80: 1859. Google Scholar
  • 25 : Testicular cancer, cryptorchidism, inguinal hernia, testicular atrophy, and genital malformations: case-control studies in Denmark. Cancer Causes Control1996; 7: 264. Google Scholar
  • 26 : Occurrence of testicular cancer in patients operated on for cryptorchidism and inguinal hernia. J Urol1991; 146: 1291. LinkGoogle Scholar
  • 27 : Testicular cancer risk among young men: role of cryptorchidism and inguinal hernia. J Natl Cancer Inst1985; 74: 377. Google Scholar
  • 28 : Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med2007; 356: 1835. Google Scholar
  • 29 : Management of cryptorchidism and risk of testicular cancer. Am J Epidemiol2003; 157: 602. Google Scholar
  • 30 : Cryptorchidism, orchiopexy, and the risk of testicular cancer. Am J Epidemiol1988; 127: 1013. Google Scholar
  • 31 Aetiology of testicular cancer: association with congenital abnormalities, age at puberty, infertility, and exercise: United Kingdom Testicular Cancer Study Group. BMJ1994; 308: 1393. Google Scholar
  • 32 : The undescended testis in adult life. Br J Urol1985; 57: 181. Google Scholar
  • 33 : Malignant degeneration of cryptorchid testes following orchiopexy. J Urol1974; 112: 354. LinkGoogle Scholar
  • 34 : Testicular tumours in maldescended testes. Can J Surg1981; 24: 353. Google Scholar
  • 35 : Cryptorchidism and testicular cancer. J Urol1980; 124: 382. LinkGoogle Scholar
  • 36 : Cryptorchidism in Scotland. BMJ1987; 295: 1235. Google Scholar
  • 37 : Perinatal correlates of specific histological types of testicular cancer in patients below 35 years of age: a case-cohort study based on midwives' records in Denmark. Int J Cancer1998; 78: 140. Google Scholar
  • 38 : Retractile testis—is it really a normal variant?. J Urol2006; 175: 1496. LinkGoogle Scholar
  • 39 : The role of orchiectomy in the management of postpubertal cryptorchidism. J Urol1998; 159: 851. LinkGoogle Scholar
  • 40 : The incidence of carcinoma in situ in the undescended testis. Int Urol Nephrol1987; 19: 321. Google Scholar
  • 41 : Management of the postpubertal cryptorchid testis: a statistical review. J Urol1985; 134: 1071. LinkGoogle Scholar
  • 42 : Management of the postpubertal patient with cryptorchidism: an updated analysis. J Urol2002; 167: 1329. LinkGoogle Scholar
  • 43 : A new management algorithm for impalpable undescended testis with gadolinium enhanced magnetic resonance angiography. J Urol1999; 162: 998. LinkGoogle Scholar
  • 44 : Magnetic resonance angiography for the nonpalpable testis: a cost and cancer risk analysis. J Urol2005; 173: 1745. LinkGoogle Scholar
  • 45 : Paternity after bilateral cryptorchidism: A controlled study. Arch Pediatr Adolesc Med1997; 151: 260. Google Scholar
  • 46 : Testis histopathology in boys with cryptorchidism correlates with future fertility potential. J Urol2003; 169: 659. LinkGoogle Scholar
  • 47 : Laparoscopic and histologic evaluation of the inguinal vanishing testis. Urology1998; 52: 866. Google Scholar
  • 48 : Laparoscopy for impalpable testes: significance of the patent processus vaginalis. J Urol1994; 152: 776. LinkGoogle Scholar
  • 49 : Is the vanished testis always a scrotal event?. BJU Int2001; 87: 480. Crossref, MedlineGoogle Scholar
  • 50 : Laparoscopy for nonpalpable testes in childhood: is inguinal exploration also necessary when vas and vessels exit the inguinal ring?. J Urol1992; 148: 635. LinkGoogle Scholar
  • 51 : The absent cryptorchid testis: surgical findings and their implications for diagnosis and etiology. J Urol1994; 151: 718. LinkGoogle Scholar
  • 52 : Histological evaluation of the testicular nubbins in patients with nonpalpable testis: assessment of etiology and surgical approach. Pediatr Surg Int2007; 23: 41. Google Scholar
  • 53 : Histologic evaluation of the testicular remnant associated with the vanishing testis syndrome: is surgical management necessary?. Urology2007; 70: 1204. Google Scholar
  • 54 : Clinical and histological significance of the testicular remnant found on inguinal exploration after diagnostic laparoscopy in the absence of a patent processus vaginalis. J Urol2005; 174: 1584. LinkGoogle Scholar
  • 55 : Exploration for testicular remnants: implications of residual seminiferous tubules and crossed testicular ectopia. J Urol2003; 169: 1486. LinkGoogle Scholar
  • 56 : Histological evaluation of the testicular nubbin in the vanishing testis syndrome. J Urol1998; 160: 1161. LinkGoogle Scholar
  • 57 : The remnant orchiectomy. J Urol1996; 155: 712. LinkGoogle Scholar
  • 58 : Influence of prior orchiopexy on stage and prognosis of testicular cancer. Eur Urol1991; 19: 201. Google Scholar
  • 59 : Clinical experiences of germ cell tumor in cryptorchid testis. Kaohsiung J Med Sci1999; 15: 32. Google Scholar

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, and Vattikuti Urology Institute, Henry Ford Hospital and Children's Hospital of Michigan, Detroit (JSE), Michigan