Linthicum, MD, May 14, 2014 — Discontinuing the use of ultrasound or other imaging modalities in the evaluation of boys with cryptorchidism, and no longer utilizing hormonal therapy to induce testicular descent are just two of 16 new clinical practice guideline statements on Cryptorchidism released today by the American Urological Association (AUA). This new clinical practice guideline, which will be presented during the 2014 AUA Annual Meeting in Orlando, FL, offers physicians and non-physician providers a consensus of principles and treatments plans for the management of cryptorchidism.
Cryptorchidism or undescended testis (UDT) is one of the most common pediatric conditions of the male endocrine glands and the most common genital condition at birth. Today’s standard of treatment in the United States is orchidopexy, or the surgical repositioning of the testis within the scrotal sac, while hormonal therapy, once a more accepted treatment option, has now fewer advocates for being as effective. Primary reasons for treatment of cryptorchidism include increased risks for fertility problems, testicular cancer, and testicular torsion or associated inguinal hernia.
Specific evaluation and treatment statements within the guideline include:
- Providers should obtain gestational history at initial evaluation of boys with suspected cryptorchidism.
- Primary care providers should palpate testes for quality and position at each recommended well-child visit.
- Providers should refer infants with a history of cryptorchidism (detected at birth) who do not have spontaneous testicular descent by six months (corrected for gestational age) to an appropriate surgical specialist for timely evaluation.
- Providers should refer boys with the possibility of newly diagnosed (acquired) cryptorchidism after six months (corrected for gestational age) to an appropriate surgical specialist.
- Providers must immediately consult an appropriate specialist for all phenotypic male newborns with bilateral, nonpalpable testes for evaluation of a possible disorder of sex development.
- Providers should not perform ultrasound or other imaging - modalities in the evaluation of boys with cryptorchidism prior to referral as these studies rarely assist in decision making.
- Providers should assess the possibility of a disorder of sex development when there is increasing severity of hypospadias with cryptorchidism.
- In boys with bilateral, nonpalpable testes who do not have congenital adrenal hyperplasia providers should measure Müllerian Inhibiting Substance (MIS or Anti- Müllerian Hormone [AMH]) level), and consider additional hormone testing, to evaluate for anorchia.
- In boys with retractile testes, providers should assess the position of the testes at least annually to monitor for secondary ascent.
- Providers should not use hormonal therapy to induce testicular descent as evidence shows low response rates and lack of evidence for long-term efficacy.
- In the absence of spontaneous testicular descent by six months (corrected for gestational age), specialists should perform surgery within the next year.
- In prepubertal boys with palpable, cryptorchid testes, surgical specialists should perform scrotal or inguinal orchidopexy.
- In prepubertal boys with nonpalpable testes, surgical specialists should perform examination under anesthesia to reassess for palpability of testes. If nonpalpable, surgical exploration and, if indicated, abdominal orchidopexy should be performed.
- At the time of exploration for a nonpalpable testis in boys, surgical specialists should identify the status of the testicular vessels to help determine the next course of action.
- In boys with a normal contralateral testis, surgical specialists may perform an orchiectomy (removal of the undescended testis) if a boy has a normal contralateral testis and either very short testicular vessels and vas deferens, dysmorphic or very hypoplastic testis, or postpubertal age.
- Providers should counsel boys with a history of cryptorchidism and/or monorchidism and their parents regarding potential long-term risks and provide & education on infertility and cancer risk.
“Undescended testis is a relatively common condition that occasionally resolves without any intervention by the time a child is six months old,” said Julia S. Barthold, MD, who served as vice chair on the panel that developed the guideline. “Diagnosis and treatment of undescended testis has significantly evolved over the past half century and these new guidelines provide the best-available clinical direction for determining whether a testicle is present or absent and the most effective treatment methods.”
NOTE TO REPORTERS: Experts are available to discuss this study. To arrange an interview with an expert, please contact the AUA Communications Office at 410-689-3932 or e-mail cfrey@AUAnet.org.
About the American Urological Association: The 109th Annual Meeting of the American Urological Association takes place May 16 – 21 at the Orange County Convention Center in Orlando, FL.
Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 20,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health policy.
Christine Frey, AUA