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Seminoma of undescended testis — Clinical Guidelines

Overview

Undescended testis (UDT), also known as cryptorchidism, is a common congenital anomaly where the testes fail to descend into the scrotum. It increases the risk of infertility and testicular malignancy 1 12.

Diagnosis

Clinical Examination: Routine genital examination during well-child visits is crucial for early detection 3.

Nonpalpable Testes: Ultrasound or MRI may be necessary for nonpalpable testes to locate the undescended tissue 7.

Differentiation: Distinguish between truly undescended testes and retractile testes, which can be challenging retrospectively 12.

Management

Surgical Orchidopexy: Early surgical intervention (ideally before 1 year of age) is recommended to reduce risks of malignancy and infertility 4 5 7.

Timing of Surgery: Optimal timing for orchidopexy remains debated; some advocate for early intervention (6-12 months) 4 5.

Approach Techniques: Various surgical techniques exist, including scrotal pouch orchiopexy and trans-septal ipsilateral positioning, aiming for secure fixation without tension 8 9.

Special Populations

Pediatrics: Early referral and timely surgical intervention are critical to mitigate long-term risks 1 4 7.

Educational Needs: Enhanced training and educational updates for pediatricians and referring providers can improve management outcomes 1 4 7.

Key Recommendations

Perform routine genital examinations during well-child visits to detect undescended testes early 3.

Refer and manage undescended testes surgically before 1 year of age to minimize risks of malignancy and infertility (Evidence: Strong 4 5).

Implement educational interventions for referring providers to reduce delays and unnecessary imaging before referral (Evidence: Moderate 7).

References

1 Bortnick EM, Wills K, Nelson CP. Simulation-based education of the male infant genitourinary physical exam and management of undescended testis. Journal of pediatric urology 2025. link 2 Mostafa IA, Shalaby MS, Woodward MN. Bilateral orchidopexies: synchronous or metachronous? Survey of BAPS and BAPU members and single-centre comparison. Journal of pediatric surgery 2019. link 3 Gerber JA, Balasubramanian A, Jorgez CJ, Shukla MA, Jacob JS, Zhu H et al.. Do pediatricians routinely perform genitourinary examinations during well-child visits? A review from a large tertiary pediatric hospital. Journal of pediatric urology 2019. link 4 Yi W, Sheng-de W, Lian-Ju S, Tao L, Da-Wei H, Guang-Hui W. Management of undescended testis may be improved with educational updates and new transferring model. Italian journal of pediatrics 2018. link 5 Wei Y, Wu SD, Wang YC, Lin T, He DW, Li XL et al.. A 22-year retrospective study: educational update and new referral pattern of age at orchidopexy. BJU international 2016. link 6 Nason GJ, O'Kelly F, Burke MJ, Aslam A, Kelly ME, Akram CM et al.. Paediatric orchidopexy: a need for dedicated paediatric surgical training among urologists?. Irish journal of medical science 2015. link 7 Aggarwal H, Rehfuss A, Hollowell JG. Management of undescended testis may be improved with educational updates for referring providers. Journal of pediatric urology 2014. link 8 Kim KK. High scrotal incision for scrotal pouch orchiopexy. Urology 1996. link00099-4) 9 Parkash S, Ramakrishnan K, Bagdi RK. Orchiopexy: trans-septal ipsilateral positioning. British journal of urology 1983. link 10 Honoré LH. Fatty metaplasia in a postpubertal undescended testis: a case report. The Journal of urology 1979. link56631-8) 11 Kadowaki H, Yakami T. Basic study of microsurgical orchidopexy for high undescended testis; assessment of clinical applicability. Journal of pediatric surgery 1979. link80136-0) 12 Shapiro SR, Bodai BI. Current concepts of the undescended testis. Surgery, gynecology & obstetrics 1978. link

Seminoma of undescended testis