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If uncomplicated (i.e. if not part of an intersex problem): Cryptorchidism is a common problem which can be corrected with surgery or hormone therapy. Cryptorchidism refers to a developmental condition in which one or both testicles fail to descend into the scrotum. Many will descend normally in the first few months of life. Testes begin to descend into the scrotum at about 34 weeks gestation and 95% of newborn males have fully descended testicles at birth. If the testes have not descended by 6 months of life, it is unlikely that they will do so. The condition occurs in about 1 out of every 50-200 male births. The cause is unknown but may relate to a hormone imbalance just before and after birth.

Surgery or hormone therapy is recommended to maximize the child's chances for fertility, improve his physical appearance, and decrease the chance of injury to the testes. Since there is a slight risk of later malignancy associated with undescended testes successful hormone therapy or surgical placement into the scrotum offers the opportunity for examination of the testis. Surgery should be done early in childhood because of the changes that occur in undescended testicles due to higher body temperature when not in the scrotum. Treatment may decrease the chance of malignancy and increase the chance for fertility.

Surgery is usually performed at about 1 year of age, although may be successful later in childhood.

The surgical operation for undescended testes is called an orchidopexy, and usually performed as a day-case procedure.

USEFUL LINKS

Ambiguous genitalia: Chapter 8.

SUPPORT GROUPS

Anorchidism support group: http://freespace.virgin.net/asg.uk/ Institute of child health fact sheet: www.gosh.nhs.uk/factsheets/families/F040036/ index.html

Hypogonadotrophic hypogonadism (Kallmann syndrome): www.hypohh.net Laurence-Moon-Bardet-Biedl Society: www.lmbbs.org.uk Prader-Willi Association (UK) http://pwsa.co.uk Prader-Willi Association (USA) http://www.pwsausa.org

FURTHER READING

Kolon TF, Patel RP, Huff DS. Cryptorchidism: diagnosis, treatment, and long-term prognosis. Urol Clin North Am 2004; 31: 469-480, viii-ix.

Lee PA. Fertility in cryptorchidism. Does treatment make a difference? Endocrinol Metab Clin North Am 1993; 22; 479-490.

Leung AK, Robson WL. Current status of cryptorchidism. Adv Pediatr 2004; 51: 351-377.

Swerdlow AJ, Higgins CD, Pike MC. Risk of testicular cancer in cohort of boys with cryptorchidism. Br Med J1997; 314: 1507-1511.

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