# Undescended Testicle — GCMD Library living collection

Everything in the library about undescended testicle — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 44 cited statements

## Episodes
### Surgical Management
- [Laparoscopic Orchidopexy](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257) — video · 5:48 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257.md)

### Evidence & Research
- [Age at Orchiopexy JPS Review](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147) — video · [machine version](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147.md)

### In-Depth Reviews
- [Cryptorchidism Rapid Fire Session: Update Course 2015](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907) — video · 6:03 · [machine version](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=0) Cryptorchidism Overview and Management Controversies (Ep 1)
- [4:52](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=292) Clinical Decision Points in Cryptorchidism Management (Ep 1)
- [5:37](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=337) Transition to Next Topic (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=0) Introduction and paper overview (Ep 2)
- [1:10](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=70) Current practice patterns versus AUA guidelines (Ep 2)
- [2:19](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=139) Lancet study on timing and testicular location (Ep 2)
- [3:30](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=210) Summary and future research directions (Ep 2)
- [0:03](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=3) Diagnostic laparoscopy findings for non-palpable undescended testicle (Ep 3)
- [2:00](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=120) Mobilization of testicle, vas deferens, and testicular vessels (Ep 3)
- [4:00](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=240) Creation of dartos pouch and transabdominal passage (Ep 3)
- [5:20](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=320) Outcomes at 2 weeks and 2 years (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Cryptorchidism is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth." (epidemiological) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=0)
- "There are two types of cryptorchidism: congenital (found at birth) and acquired (testicles previously descended but can no longer be brought down without discomfort)." (clinical) [Ep 1 · 1:00](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=60)
- "Treatment of cryptorchidism reduces risks including impaired fertility, testicular malignancy, risk of torsion, and treats associated inguinal hernia." (clinical) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=120)
- "The actual mechanism of action of hormonal therapy agents for cryptorchidism is unknown." (clinical) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=180)
- "Published studies on hormonal therapy included multiple treatment strategies with different doses and intervals, none showing good response rates or demonstrable long-term benefits." (clinical) [Ep 1 · 3:20](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=200)
- "Hormonal therapy should not be used to induce testicular descent due to low response rates and lack of evidence for long-term efficacy." (guideline) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=240)
- "70% of undescended testicles are palpable, though they may not be palpable during examination while the child is awake but are usually palpable under anesthesia." (clinical) [Ep 1 · 4:20](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=260)
- "Ultrasound has a sensitivity of only 45% and specificity of only 78% in determining testicle location and size." (clinical) [Ep 1 · 4:50](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=290)
- "Ultrasound cannot identify intra-abdominal testicles." (clinical) [Ep 1 · 5:10](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=310)
- "Other imaging modalities are expensive, require anesthesia, or irradiate tissues, and no radiologic test is 100% accurate to determine whether a testicle is absent." (clinical) [Ep 1 · 5:20](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=320)
- "Surgical exploration (diagnostic laparoscopy or open exploration) must be performed on all non-palpable unilateral and many bilateral cryptorchid patients." (guideline) [Ep 1 · 5:50](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=350)
- "Imaging should not be performed for cryptorchidism as it is not helpful and can actually delay treatment." (guideline) [Ep 1 · 6:20](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=380)
- "There is no advantage for laparoscopic versus open exploration for intra-abdominal testicles." (clinical) [Ep 1 · 6:40](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=400)
- "For salvageable intra-abdominal testicles, three surgical options exist: primary orchiopexy, one-stage Fowler-Stevens, or two-stage Fowler-Stevens." (clinical) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=420)
- "The decision tree for intra-abdominal testicles prioritizes sparing testicular vessels if possible." (clinical) [Ep 1 · 7:30](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=450)
- "There is no apparent advantage of one-stage versus two-stage Fowler-Stevens procedure when testicular vessels cannot be spared." (clinical) [Ep 1 · 6:03](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=363)
- "Orchiectomy may be prudent in the presence of a normal contralateral descended testicle." (opinion) [Ep 1 · 6:03](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=363)
- "Most of the time the testes can be brought down without needing to divide the testicular vessels." (opinion) [Ep 1 · 4:58](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=298)
- "For prepubertal patients (e.g., 10 years old), orchiopexy should be attempted; for pubertal patients (e.g., 14 years old), orchiectomy is preferred; 12 years old is a difficult decision point." (opinion) [Ep 1 · 5:15](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=315)
- "The teaching is that if the patient is prepubertal, orchiopexy can be attempted, but if going through puberty, orchiectomy should be performed." (guideline) [Ep 1 · 5:17](https://library.globalcastmd.com/watch/cryptorchidism-rapid-fire-session-update-course-2015-907?t=317)
- "Laparoscopy is essential for the accurate diagnosis and optimal management of a non palpable undescended testicle." (clinical) [Ep 3 · 0:03](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=3)
- "When non-palpable undescended testicle is diagnosed, one of 3 possibilities will be confirmed on laparoscopy: an abdominal testicle, a blind ending vas (confirming absence of testicle), or vas deferens and testicular vessels exiting the deep ring (warranting inguinal exploration)." (clinical) [Ep 3 · 0:30](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=30)
- "When an abdominal testicle is found, options include single-stage laparoscopic orchiopexy without vessel ligation, one or two-stage Fowler-Stevens procedure with vessel ligation, and the Shehata traction orchiopexy." (clinical) [Ep 3 · 1:30](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=90)
- "The procedure is performed using a single 5 millimeter trocar at the umbilicus for the camera and two lateral stab incisions on the right and left sides at or just below the level of the umbilicus for 3 millimeter instruments." (clinical) [Ep 3 · 2:15](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=135)
- "The mobilization of the testicle starts with stretching the gubernaculum and clearly visualizing the vas deferens, then the gubernaculum is divided as far away as possible from the vas to untether the testicle." (clinical) [Ep 3 · 2:35](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=155)
- "The vas should be kept in view at all times during gubernaculum division, and the surgeon should keep in mind the possibility of a long looping vas." (clinical) [Ep 3 · 2:55](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=175)
- "The vas is mobilized using blunt and sharp dissection with fine shears in a lateral to medial direction approaching the wall of the bladder." (clinical) [Ep 3 · 3:10](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=190)
- "The testicular vessels are mobilized by dividing the retroperitoneal attachments, which is where most of the length will be gained." (clinical) [Ep 3 · 3:30](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=210)
- "If the mobilized testicle is able to reach the contralateral ring, it is likely to reach the scrotum without further mobilization." (clinical) [Ep 3 · 3:45](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=225)
- "The point of entry for the needle-sheath trocar should be between the epigastric vessels and bladder edge, just over the pubic tubercle." (clinical) [Ep 3 · 4:10](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=250)
- "A full bladder actually aids in safe entry into the abdomen during trocar placement." (clinical) [Ep 3 · 4:25](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=265)
- "Following entry into the abdomen, a 10 millimeter trocar is introduced through the sheath to dilate the tunnel." (clinical) [Ep 3 · 4:35](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=275)
- "The testicle is grasped by the gubernaculum and brought through the trocar, taking care to keep it oriented correctly with the vas medial and vessels lateral." (clinical) [Ep 3 · 4:45](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=285)
- "The testicle is fixed in the dartos pouch using a slow absorbable suture." (clinical) [Ep 3 · 5:00](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=300)
- "It is not necessary to close the deep ring, as the incidence of inguinal hernia after laparoscopic orchiopexy is extremely low." (clinical) [Ep 3 · 5:08](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=308)
- "At 2 weeks postoperatively, tethering can be seen in the scrotum." (clinical) [Ep 3 · 5:25](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=325)
- "At 2 years postoperatively, the tethering is mostly resolved, and a testicle of normal caliber is easily visible and palpable in the right scrotum." (clinical) [Ep 3 · 5:32](https://library.globalcastmd.com/watch/laparoscopic-orchidopexy-2257?t=332)
- "The American Urological Association released guidelines that orchiopexy should be done around one year of age but not later than 18 months." — Augustino Piero (guideline) [Ep 2 · 1:10](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=70)
- "The paper reviewed two major databases in the United States and found that 70% of children get orchiopexy six months beyond the suggested ideal time." — Augustino Piero (epidemiological) [Ep 2 · 1:10](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=70)
- "The median time for orchiopexy is between four and five years of age." — Todd Ponsky (host_summary) [Ep 2 · 1:53](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=113)
- "What matters is not the timing of surgery, it depends whether the patient has unilateral cryptorchidism or bilateral cryptorchidism or if their testis is palpable or impalpable." — Pam Choi (clinical) [Ep 2 · 2:19](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=139)
- "In a Lancet study, 142 adults who had orchiopexy between ages 7 and 13 years were examined for semen analysis." — Pam Choi (clinical) [Ep 2 · 2:19](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=139)
- "Semen analysis was normal or acceptable in patients who had unilateral cryptorchidism." — Pam Choi (clinical) [Ep 2 · 2:19](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=139)
- "Patients who had bilateral palpable testes in the superficial pouch had semen which was normal or acceptable." — Pam Choi (clinical) [Ep 2 · 2:19](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=139)
- "Patients who had bilateral impalpable testes (either in the abdomen or canalicular) were all azoospermic." — Pam Choi (clinical) [Ep 2 · 2:19](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=139)
- "The AUA recommends making the diagnosis of undescended testicle at six months of age with repair by 18 months." — Todd Ponsky (host_summary) [Ep 2 · 3:30](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=210)
- "Patients with palpable testicles who had orchiopexy at a later age had completely normal semen." — Todd Ponsky (host_summary) [Ep 2 · 3:30](https://library.globalcastmd.com/watch/age-at-orchiopexy-jps-review-1147?t=210)

## Changelog
- Sep 25: 3 items added automatically

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