Consequence of cryptorchidism: Relationship to etiology and treatment

Increased risk of infertility and testicular tumors after cryptorchidism is the basis for treatment. Over the past few decades the recommended age of therapy has become younger and younger, so that currently therapy is recommended before 2 years of age and as early as 6 months. Evidence indicates that treatment before 10 years of age reduces the incidence of testicular tumors among men who formerly had unilateral cryptorchidism to that of men without a history of cryptorchidism. However, the effect of the age of treatment among the bilateral group is unknown. Infertility after bilateral cryptorchidism is about six times greater than that of the general population, affecting about half of patients; it appears to be only two times greater among the unilateral group, affecting about 10% of patients. To date no effect of age of therapy has been demonstrated, although current studies have not been able to consider the underlying cause of the cryptorchidism. Data are not yet available to determine whether pretreatment testicular location or size is related to subsequent fertility. The current recommendation for treatment within the first 2 years of life is based on the progressive degeneration of germ cells within the persistently cryptorchid testis after the first year of life. This recommendation should stand, even though some testes may be i r r e t r i e v a b l y damaged before such early therapy, and others may suffer minimal or no detrimental effect after delayed treatment. Future information may identify specific causes of cryptorchidism and, hence, determination of which patients will benefit from early therapy.