{
"topic": "Cryptorchidism",
"slug": "cryptorchidism",
"category_id": 15443,
"passage_count": 14,
"source_chars": 11503,
"enough_material": true,
"references": [
{
"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition",
"author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.",
"pages": [
1077,
1078
]
},
{
"title": "Cover",
"author": "Vitalsource Download",
"pages": [
6901,
6902
]
},
{
"title": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online",
"author": null,
"pages": [
415,
586
]
},
{
"title": "Algorithms in Pediatrics",
"author": null,
"pages": [
647,
648,
699
]
},
{
"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
"author": null,
"pages": [
2160,
3337
]
},
{
"title": "Diagnostic Imaging: Pediatrics",
"author": "A. Carlson Merrow Jr. MD",
"pages": [
632
]
},
{
"title": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital)",
"author": null,
"pages": [
351
]
},
{
"title": "The Harriet Lane Handbook (The Johns Hopkins Hospital)",
"author": null,
"pages": [
351
]
}
],
"passages": [
{
"source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 1078",
"text": "The cause of most cases of cryptorchidism is not completely understood. Cryptorchidism can occur in an isolated fashion or associated with other findings. Abnormalities in the hypothalamic-pituitary-gonadal axis, intrinsic testicular development defects, and androgen biosynthesis or receptor defects predispose to cryptorchidism. The diagnosis of bilateral cryptorchidism in an apparently normal male newborn should never be made until the possibility that the child is a fully virilized female with potentially fatal salt-losing CAH has been considered. ## \u00bb **Clinical Findings** In infants between 2 and 6 months of age, measurement of LH, FSH, inhibin B, and testosterone can help determine whether testes are present. After this time, an HCG stimulation test can be done to confirm the presence or absence of functional abdominal testes. Ultrasonography, CT scanning, and MRI may detect testes in the inguinal region, but these studies are not completely reliable in finding abdominal testes."
},
{
"source": "Cover, p. 6901",
"text": "## **OVERVIEW** Cryptorchidism describes the failure of a testis to descend and maintain a scrotal position. Congenital cryptorchidism involves cases that are noted at birth. Acquired cryptorchidism, also known as testicular re-ascent, occurs when a previously descended testis is noted to have taken an extrascrotal position. These must be distinguished from a retractile testis, which moves easily in and out of the scrotal position but is able to be positioned and remain in the scrotum temporarily. Congenital cryptorchidism is estimated to occur in 1 in 50 term newborn males. The descent of the testis through the inguinal canal into the scrotum occurs around 28 weeks of gestation, which explains the higher incidence seen in premature newborns. Because spontaneous descent of the testis is unlikely to occur beyond 6 months of corrected age, it is important to note the gestational age at birth. Potential long-term risks of cryptorchidism include infertility and testicular germ cell tumors. ## **DIAGNOSIS**"
},
{
"source": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online, p. 415",
"text": "## **Cryptorchidism** During embryogenesis, the testes migrate from their original location near the kidney through the abdomen and descend into the scrotum. Cryptorchidism, or failure of the testes to descend into the scrotum, occurs in approximately 3% of infant males. Treatment of cryptorchidism is usually delayed until 6 to 12 months of age to allow the testicle to descend spontaneously. If there is failure of descent, an orchiopexy is **392** Zitelli and Davis\u2019 Atlas of Pediatric Physical Diagnosis  **----- Start of picture text -----**
A B C
D E
**----- End of picture text -----**
**Figure 9-32** Ambiguous genitalia. These cases include a true hermaphrodite **(A)** and congenital virilizing adrenal hyperplasia **(B-E)** . _(_ _**B-D,** Courtesy D. Becker, MD, Pittsburgh, Pa.)_"
},
{
"source": "Algorithms in Pediatrics, p. 648",
"text": "## **Associated Conditions** Cryptorchidism usually is an isolated finding. However, it may occur in association with endocrine disorders, genetic syndromes, and morphologic abnormalities, especially if it is bilateral. Associated conditions are shown in box 1. ## **Clinical Pearl** - Patients having undescended testis and hypospadias have high incidence of underlying disorders of sexual development. ## **CLINICAL FEATURES** Clinical features of cryptorchidism include an empty, hypoplastic, hypopigmented, and poorly developed rugae of scrotum or hemiscrotum. Inguinal fullness may be present. In approximately 10%, it is a bilateral condition. Bilateral UDT are more commonly associated with other conditions. Unilateral UDT is more common on left side. The most common location for an UDT is just outside the external ring (superficial inguinal pouch), followed by the inguinal canal (intracanalicular), and finally intra-abdominal. The testis is not palpable in 20% of patients with UDT."
},
{
"source": "Cover, p. 6902",
"text": "Infants noted to have cryptorchidism at birth should be referred to an appropriate surgical specialist if spontaneous descent has not occurred by 6 months of corrected age. A diagnosis of congenital adrenal hyperplasia (CAH) should be considered for newborns with bilateral nonpalpable undescended testes. Furthermore, cryptorchidism (unilateral or bilateral) associated with hypospadias, especially for severe cases, may represent DSD and requires appropriate evaluation. Hormonal therapy for inducing testicular descent is not recommended as it has not been proven to be effective long-term. Congenital cryptorchidism is ideally surgically corrected with orchiopexy between 6 and 18 months of age, in order to maximally preserve spermatogenesis. For cases diagnosed after this age, orchiopexy prior to puberty has been demonstrated to reduce the risk of future testicular malignancy. Patients with palpable testes can be managed with an inguinal or scrotal orchiopexy approach. Those with a nonpalpable testis undergo a"
},
{
"source": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online, p. 586",
"text": "Cryptorchidism occurs in approximately 33% of premature and 3% of full-term boys. Observing gradual testicular descent over several weeks in a premature infant is not unusual. Cryptorchidism is associated with many syndromes but rarely with urinary tract anomalies. The exception is true congenital monorchism, which may be associated with ipsilateral renal agenesis. Renal ultrasound is indicated. In most cases of an absent testis, however, spermatic structures are present, which indicate that the testis was formed but subsequently atrophied due to a prenatal event. In these cases, concern for ipsilateral renal agenesis is minimal. Conversely, ultrasound examination of the lower quadrant and inguinal canal to search for a nonpalpable testis is not indicated and is a highly unreliable examination. Hypospadias associated with even unilateral cryptorchidism should raise the question of intersex anomalies, and karyotype should be determined in the neonate (Fig. 14-6). When bilateral nonpalpable testes are present"
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 3337",
"text": "chemicals. Although cryptorchidism usually is considered to be congenital, some older males have a scrotal testis that \u201cascends\u201d to a low inguinal position and therefore requires an orchiopexy. In addition, 1\u20132% of neonatal and young males undergoing hernia repair develop secondary cryptorchidism from scar tissue along the spermatic cord."
},
{
"source": "Diagnostic Imaging: Pediatrics, p. 632",
"text": "- \u2022 Cryptorchidism - Potter facies if oligohydramnios ## **Demographics** - 95-99% male - 1 in 30,000 to 40,000 live births ## **Natural History & Prognosis** - Variable renal impairment & pulmonary hypoplasia determine prognosis - Many survivors but with chronic health issues - \u25cbGenitourinary: 100% - \u25cbCardiovascular: 10% - \u25cbOrthopedic: 20% - \u25cbGastrointestinal - Urachal anomalies common - Empty scrotum (cryptorchidism) - Deficient abdominal wall musculature ## **Nuclear Medicine Findings** - Delayed drainage of ureters common ## **DIFFERENTIAL DIAGNOSIS** ## **Posterior Urethral Valves** - \"Keyhole\" bladder with high-grade obstruction of posterior urethra by valve tissue in males ## **Severe Vesicoureteral Reflux** - May be associated with megacystis but typically isolated ## **Primary Megaureter** - Adynamic distal ureter with proximal dilation ## **Cloacal Anomaly**"
},
{
"source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 1077",
"text": "## **3. Cryptorchidism** Cryptorchidism (undescended testis) affects 2%\u20134% of fullterm male newborns and up to 30% of premature infants. After 6 months of age, spontaneous descent occurs only very rarely. Consequently, intervention is typically considered beginning at this time. Infertility and testicular malignancy are major risks of untreated cryptorchidism. Fertility is impaired by **1045** **ENDOCRINE DISORDERS** approximately 33% and 66% after unilateral and bilateral cryptorchidism, respectively. The cancer risk for adults after cryptorchidism in childhood is reported to be 5\u201310 times greater than normal. However, histologic changes clearly occur as early as age 6 months in children with undescended testes."
},
{
"source": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital), p. 351",
"text": "- (3) Daily electrolytes until salt- wasting CAH is ruled out - (4) Further testing as needed to evaluate for more rare forms of CAH: DHEA, 17- hydroxypregnenolone, 11- deoxycortisol, cortisol, ACTH - b. Imaging: Options include genitogram (contrast study of the urogenital sinus and internal duct structures) or voiding cysto- urethrogram (VCUG), pelvic and abdominal US, and pelvic magnetic resonance imaging (MRI) to evaluate internal anatomy. - c. Care should be taken to avoid premature gender/sex designation, completion of birth certificate, and naming of infant. ## **E. Cryptorchidism[50]** ## 1. **Epidemiology and clinical course:** - a. Can be present at birth (congenital) or after birth (acquired). Congenital rate is 1% to 4.6% of males born >2.5 kg. - b. Increased risk with preterm birth or low birthweight. - c. About 1/3 to 1/2 of cryptorchid testicles descend spontaneously, usually by age 3 months."
},
{
"source": "The Harriet Lane Handbook (The Johns Hopkins Hospital), p. 351",
"text": "- (3) Daily electrolytes until salt- wasting CAH is ruled out - (4) Further testing as needed to evaluate for more rare forms of CAH: DHEA, 17- hydroxypregnenolone, 11- deoxycortisol, cortisol, ACTH - b. Imaging: Options include genitogram (contrast study of the urogenital sinus and internal duct structures) or voiding cysto- urethrogram (VCUG), pelvic and abdominal US, and pelvic magnetic resonance imaging (MRI) to evaluate internal anatomy. - c. Care should be taken to avoid premature gender/sex designation, completion of birth certificate, and naming of infant. ## **E. Cryptorchidism[50]** ## 1. **Epidemiology and clinical course:** - a. Can be present at birth (congenital) or after birth (acquired). Congenital rate is 1% to 4.6% of males born >2.5 kg. - b. Increased risk with preterm birth or low birthweight. - c. About 1/3 to 1/2 of cryptorchid testicles descend spontaneously, usually by age 3 months."
},
{
"source": "Algorithms in Pediatrics, p. 647",
"text": "## **TERMINOLOGY** - Cryptorchidism: cryptorchidism, by definition, means absence of one or both testis in the scrotum - True UDT: the testis, which has failed to descend along its normal pathway from the retroperitoneum to the scrotum, is known as true UDT. If the testis remains in abdominal cavity then it is known as abdominal UDT; if it comes out of internal ring and goes back to the abdomen, then it is known as emergent UDT; if it is in inguinal canal, then it is known as intracanalicular UDT; if it is just outside the external ring, then it is known as suprascrotal UDT."
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2160",
"text": "## **Epidemiology** Cryptosporidiosis is associated with diarrheal illness worldwide and is more prevalent in developing countries and among children younger than 2 years of age. It has been implicated as an etiologic agent of persistent diarrhea in the developing world and as a cause of significant morbidity and mortality from malnutrition, including permanent effects on growth. Risk factors for infection include animal contact, diarrhea in a household member, open defecation/lack of toilet facilities, and poor drinking water quality."
},
{
"source": "Algorithms in Pediatrics, p. 699",
"text": "6. Smoker AL. On top of cradle cap. J Fam Health Care. 2007;17(4):134-6. **674** [Figure OCR, page 699, figure 3] KEY POINTS. \u00ae Seborrheic dermatitis (SD) is physiological in infants below 3 months of age @ Cradle cap is the most common presentation @ |t is a non-itchy condition characterized by greasy yellow scales in seborrheic areas & self-limiting course \u00a9 Psoriasis, intertrigo, pityriasisrosea, and rosacea are close mimickers for adolescent SD @ Antifungals and topical steroids form the main stay of treatment. ## **SECTION 17: OPHTHAlMOlOgY** ## **CHAPTER** ## **140** ## **Approach to Red Eye in Children**  _Suma Ganesh, Priyanka Arora_ ## **INTRODUCTION**"
}
]
}