Bilateral Cryptorchidism

The mother of a 2-year-old boy was concerned because his scrotum appeared flat and empty. (She had noticed this earlier but thought it was normal for her child's age.) On examination, the testicles were not palpable in the scrotum. They were found in the inguinal area and could not be manipulated into the scrotum. Bilateral orchidopexy was performed, and the postoperative course was uneventful.

Cryptorchid testes fail to descend completely to the lower scrotum; they can be found anywhere from an intraabdominal position within the perironeal cavity to just distal to the external inguinal ring. It is crucial to distinguish a cryptorchid testis from a retractile or ectopic testis. A retractile testis occupies a position outside the scrotum but can be manipulated into the scrotum, where it remains without tension. An exaggerated cremasteric reflex is suspected to be the cause. An ectopic testis is one that has emerged through the external inguinal ring and then takes an abnormal course; it is located most commonly in the superficial inguinal pouch.

The incidence of cryptorchidism in full-term infants has been estimated at 3.4%; it is higher in premature infants. An undescended testis is more prone to torsion; there is also an increased incidence of an associated indirect inguinal hernia. An undescended testis is 20 to 40 times more likely to become malignant than a descended one. The risk of malignancy in an intra-abdominally situated testis is 6 times greater than in a cryptorchid testis in patients with unilateral cryptorchidism and 75% of patients with bilateral cryptorchidism. This is because the higher-than-normal temperature that exists in the undescended testis is detrimental to tubular development and the subsequent production of spermatozoa.

Orchidopexy at an early age results in a greater probablility of fertility in adulthood and a decreased risk of malignancy. It also makes the testis accessible to examination and facilitates early detection of malignancy, should this develop. This procedure can be done as early as the first to second year of life.