Maldescendus testis

Abstract

Maldescendus testis is a common congenital abnormality occurring in 2–5% of full-term boys at birth in the Western countries. By 3 months of age, the incidence rate spontaneously reduces to 1–2% in this group. The etiology of the disorder is not known, but normal hypothalamo-pituitary-gonadal axis is usually a prerequisite for normal descent of the testes. Abnormal sexual differentiation is associated with maldescent. However, the majority of boys with maldescended testes show no endocrine abnormalities after birth. Several defects in developmental genes, such as homeobox genes and Insl3, have been described to cause cryptorchidism in mice, and disturbances in the regulation of these genes or their mutations may explain etiology of a large part of human testicular maldescent in the future. Increased degeneration of germ cells can be observed in undescended testes after the first year, and therefore early treatment is recommended. Surgical treatment is the most effective and reliable method to bring testes into the scrotum, but hormone treatment with either hCG or GnRH analogues can be considered, particularly in cases where testes can be palpated in high scrotal position. The efficacy of hormone treatment is less than 20% and depends on the initial location of the testis. Nonpalpable testes rarely descend with hormone treatment. Both surgery and hormone treatment can have untoward effects. Treatment with hCG has been associated with an inflammation-like reaction in the testes and an increased rate of apoptosis of germ cells leading to a reduced adult size of the testes. Vascular complications can occur during surgery, particularly in staged orchidopexies. Men with a history of undescended testis have an increased risk of testicular cancer. Impaired fertility is another long-term risk associated to maldescended testes. Fertility potential may be improved by early treatment. Although our knowledge on cryptorchidism has increased considerably during the last decades, many questions remain to be answered: Is the incidence rate increasing? What is causing maldescent? Do hormones have any role in the treatment?