Optimizing Care for Undescended Testicles in Children and Adolescents—Diagnosis, Management, and Outcomes: A Narrative Review of Current Evidence

Cryptorchidism is the most prevalent congenital anomaly of the male genitourinary tract, with an incidence of approximately 1 to 9 percent in full-term male infants, decreasing with age due to spontaneous descent. It encompasses testes that fail to descend into the scrotum, which may be intra-abdominal, inguinal, or ectopic, and can be associated with syndromic, genetic, or environmental factors. The descent process occurs in two phases: intra-abdominal, driven by gubernacular development and androgen-independent mechanisms, and inguinoscrotal, regulated by hormonal and mechanical factors including androgens and the gubernaculum. Clinically, cryptorchidism manifests as absent or hypoplastic scrotal testes, often with inguinal fullness. Palpation and physical examination are primary diagnostic tools, with imaging such as ultrasound or MRI reserved for specific cases. Surgical exploration remains the definitive diagnostic modality, especially for nonpalpable testes. Early referral, ideally before 12 months of age, is essential for timely orchidopexy, which aims to position the testes within the scrotum to reduce risks of torsion, trauma, subfertility, and malignancy. Hormonal therapy shows limited efficacy and is generally not recommended as a primary treatment modality. Long-term outcomes indicate that early orchidopexy improves spermatogenic potential and fertility. Men with a history of cryptorchidism exhibit elevated risks of subfertility and testicular germ cell tumors, with the risk being higher if surgical correction is delayed or if testes remain intra-abdominal. The increased malignancy risk persists even after orchidopexy, underscoring the importance of vigilant surveillance. Management strategies emphasize a multidisciplinary approach, combining surgical intervention with ongoing monitoring, to optimize functional and oncological outcomes. Early diagnosis, appropriate surgical treatment, and patient education are critical components in minimizing long-term complications associated with cryptorchidism.