1. True Undescended Testes

• the testes are found within the normal path of descent with a patent processus vaginalis
• testis may be found intra-abdominally or intracanicular (within the inguinal canal)

2. Maldescended Testes

• testes have descended through the inguinal canal but are positioned in the subcutaneous tissue outside the scrotum

1. Infertility

• with unilateral cryptorchidism, the rate of infertility is similar to that of the general population
• almost all adults with uncorrected bilateral cryptorchidism will be infertile and even those with bilateral cryptorch-idism corrected in childhood will be infertile in 67% of cases
• an undescended testis is histiologically normal at birth with failure of development and atrophy detected by the end of the 1st year of life; by the 2nd year of life the number of germ cells is significantly reduced

2. Tumor

• 20-44% increase in risk of developing a malignant testicu-lar tumor in the 3rd to 4th decades of life
• seminoma is the most common tumor developing in undes-cended testes (in 60% of cases)
• greatest risk is in those with uncorrected intra-abdominal cryptorchidism and in those with surgical correction during or after puberty
• there is a decreased incidence of tumors in those with surgical correction occurring before 8 years of life

3. Indirect Inguinal Hernia

• always present with true undescended testes and common with ectopic testes

4. Torsion

• increased risk with cryptorchid testis +/- infarction

1. Human Chorionic Gonadotropin (hCG) Stimulation

• used to confirm the absence or presence of testicular tissue in patients with bilateral nonpalpable testes - an increase in testosterone levels after hCG stimulation indicates functioning testicular tissue

2. Gonadotrophins

• high FSH and LH indicate a congenitally anorchid patient as there is a lack of negative feedback by testesterone - low or normal FSH and LH levels may indicate functioning gonadal tissue

1. Human Chorionic Gonadotropin (hCG)

• used to induce testicular descent
• best response in those with bilateral cryptorchidism with the testes near the scrotum (not recommended for unilateral cryptorchidism)
• success rate <10%

1. Surgical Exploration

• not indicated in congenitally anorchic patients where the basal FSH and LH levels are elevated and there is a lack of rise of testosterone with hCG stimulation
• indicated if the basal FSH and LH levels are low (indica-ting negative feedback by testosterone)

2. Orchiopexy

• indications:
  • unilateral and bilateral cryptorchidism where the testes are palpable
  • when the testis is not palpable but located intra-abdominally immediately inside the internal inguinal ring
• best performed towards the end of the first year of life or early in the 2nd year of life
• irreversible degenerative changes may occur without cor-rection by two years of age
• anchors the testis to the scrotum with repair of the accompanying indirect inguinal hernia
• does not eliminate the risk of future malignancy

3. Orchiectomy

• indications:
  • intra-abdominal testis
  • severely atrophied testis
  • bilateral cryptorchidism where the testes are not palpable
• testicular prostheses are available