Complications
Risk of infertility is low with unilateral, but higher with bilateral undescended testes. Around 2% to 9% of patients with infertility also have a history of cryptorchidism. In patients with unilateral cryptorchidism, paternity rates are similar to the general population (about 90% vs. 94%).[87][115] However, in patients with unilateral cryptorchidism corrected late in life in whom testicular sperm extraction was performed, this demonstrated spermatozoa in only 1 of 25 cryptorchid testes.[116] Unlike rates in patients with unilateral cryptorchidism, paternity rates are significantly lower in patients with bilateral cryptorchidism (33% to 53%), with oligospermia demonstrated in 31% and azoospermia in 42%.[117] Sperm damage at adult age does not appear to be influenced by age at orchiopexy in congenital cryptorchidism, or by orchiopexy or spontaneous descent in acquired cryptorchidism.[118] Decreased Sertoli cell function, more pronounced in bilateral cryptorchidism, is a possible aetiology for decreased fertility.[119] Timely orchiopexy likely protects endocrine and spermatogenic testicular function.[120]
One cohort study of Swedish patients with undescended testes who underwent orchiopexy had a relative risk of testis cancer of 2.23 when they underwent orchiopexy prior to 13 years of age, and 5.40 after 13 years of age, compared with the general Swedish population.[75] Similarly, one meta-analysis of the literature demonstrated a 6-fold increased risk of testicular malignancy in those who underwent late orchiopexy (>10 years of age) or did not undergo surgical correction of cryptorchidism.[112] Systematic reviews of testicular cancer confirm that cryptorchidism is a significant risk factor.[114]
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