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Management of cryptorchidism in children: guidelines
Christophe Gapany1, Peter Frey, Françoise Cachat
1Service of Pediatric surgery, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, Lausanne, Switzerland. Christophe.Gapany@chuv.ch
Insights
This study provides clinical guidelines for cryptorchidism (undescended testes) management in pre-pubertal boys. Early clinical diagnosis and surgical orchiopexy at 6-12 months are recommended, with further assessment for non-palpable testes.
Area of Science:
- Pediatric Surgery
- Urology
- Endocrinology
Background:
- Cryptorchidism, or undescended testes, is a common congenital anomaly in male infants.
- Effective management is crucial for fertility and reducing risks of malignancy.
Purpose of the Study:
- To establish evidence-based clinical guidelines for the comprehensive management of cryptorchidism in pre-pubertal boys.
- Guidelines cover diagnosis, surgical treatment, and long-term follow-up.
Main Methods:
- Systematic review of medical literature since 1966, focusing on articles post-1988.
- Utilized validated search strategies across multiple databases (Medline, EMBASE, Cochrane, etc.).
- Applied the GRADE approach for quality assessment and multidisciplinary expert panel evaluation.
Main Results:
- Developed 28 evidence-based statements for cryptorchidism management.
- Experts reached consensus on 26 statements; two were rated as uncertain.
Conclusions:
- Clinical diagnosis is preferred for cryptorchidism.
- Surgical orchiopexy is recommended between 6-12 months of age, without routine biopsy.
- For non-palpable testes or signs of hypovirilization (e.g., hypospadias), assess chromosomal sex and hormonal status.
- Laparoscopy is the preferred method for diagnosing and managing intra-abdominal testes.
Question:
To develop clinical guidelines for the management of cryptorchidism in pre-pubertal boys, from early diagnosis through therapy to long-term follow-up and prognosis.
Method:
Systematic review of articles from the medical literature, referenced since 1966, using validated search strategies through the following databases: Medline, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, EMBASE, DARE, ACP Journal Club, National Guidelines Clearinghouse, Guidelines International Network. Relevant articles published after 1988 were taken as the basis for the statements. Each statement was graded on the basis of the study design and on its methodological quality (GRADE approach). A multidisciplinary panel of local experts discussed and evaluated each statement on the strength of this evidence.
Results:
28 statements based on the best available evidence were drafted. The experts agreed with all but two statements, which were rated uncertain.
Conclusions:
Cryptorchidism is best diagnosed clinically, and treated by surgical orchiopexy at age 6-12 months, without a routine biopsy. If no testis is palpable, or if other signs of hypovirilisation such as hypospadias are present, the chromosomal sex and hormonal status must be assessed. Laparoscopy is the best way of diagnosing and managing intra-abdominal testes.
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