It has long been recognized that, on one hand, a testis may not descend normally because it is abnormal, whereas, on the other hand, a potentially normal testis that has not normally descended may be consequently damaged. Therefore the major problem in defining the detrimental consequences and appropriate treatment for cryptorchidism is the difficulty in determining whether testes that are already damaged or normal testes that may be at risk for damage are being dealt with. Timing of therapy may be crucial for the potentially normal testis, but it may make little difference for the dysgenetic testis. Current recommendations for the treatment of cryptorchidism are aimed, appropriately, toward the testis that has potential to be salvaged or improved. However, it is unclear whether currently recommended therapy when applied to all patients with undescended testes makes any difference concerning subsequent fertility or malignant degeneration.
The Problem
Testicular maldescent has many causes, although the specific cause in any individual patient is usually unknown. Therefore the rationale for treating cryptorchidism is generalized rather than being based on an etiologic diagnosis. This basis for treatment is the premise that cryptorchidism is associated with an increased incidence of infertility and testicular cancer.