This document presents a case report of cryptorchidism in a 46-year-old male patient who underwent an orchidectomy. Cryptorchidism refers to undescended testes and affects 2-4% of male births. Undescended testes have a 3-48 times higher risk of testicular cancer. The patient had a right undescended testicle since birth and was admitted for a pseudotumoral formation in the right inguinal area. Histopathological examination found total atrophy of the germinal cells in the right testicle, confirming orchidectomy was necessary. Management of cryptorchidism in adults includes observation, orchiopexy to lower the testes, or orchiectomy

1. Cryptorchidism in adults
- case report -
Scientific coordinators: Prof. Doctor Scripcariu Viorel, MD, PHD
Dr. Simionescu Oana, surgical resident
The III-rd Surgical Department, Sf. Spiridon Hospital
Sandrina M. Dăscălescu, Anca Merlă, Raluca Poeată
University of Medicine and Pharmacy Gr.T.Popa Iasi

2. Cryptorchidism
• absence of one or both testes from the scrotum
• the most frequent congenital birth defect in male
children (2–4% in full-term male births)

3. • In cryptorchid testicles, the incidence of testicular cancer is
considered to be 3 to 48 times greater than in the general
population.
• In the past 5 years in the IIIrd Surgical Clinic at “Sf.
Spiridon” Hospital were admitted only 4 patients with
ectopic testis, all past the age of puberty. They all
underwent specific surgical treatment.

4. Risk factors
• Low birth weight, premature birth and small size for gestational age
-associated with substantial increase in the incidence of cryptorchidism,
which may reach 20–25% in infants with birth weight less than 2.5 kg
• Family history of undescended testicle or other problems of genital
development
• Conditions of the fetus that can restrict growth, such as Down syndrome
or an abdominal wall defect
• Alcohol use by the mother during pregnancy
• Cigarette smoking by the mother or exposure to secondhand smoke
• Obesity or/ and diabetes in the mother

5. Genetic causes
• mutations in the INSL3 and its
receptor RXFP2 genes
• mutations in the androgen receptor gene
• microdeletions of the Y chromosome long arm (Yq)
• polymorphisms in the ESR1 gene
• inactivating mutations of LH receptor gene
• chromosomal alterations

6. Syndromes frequently associated
• Velocardiofacial syndrome (deletion 22q11.2)
• Beckwith-Wiedemann syndrome
• Smith-Lemli-Opitz syndrome
• De Lange syndrome
• Prader-Willi syndrome
• Klinefelter syndrome
• Noonan syndrome
• FG syndrome

7. • Endocrine Disruptors - exogenous
substances with an ability to disrupt normal
endocrine homeostasis and reproduction
- xenoestrogens (industrial chemicals)
- synthetic and natural hormones
- phyto- and mycoestrogens
- persistent organohalogen pollutants
- phthalates
- different herbicides and fungicides and other
industrial chemicals

8. Complications
• In order for testicles to develop and function
normally, they need to be slightly cooler than
normal body temperature, scrotum providing this
cooler environment.
• Higher temperatures can lead to complications
such as:
- testicular cancer
- fertility problems - low sperm counts,
poor sperm quality and decreased fertility

9. • Other complications related to the abnormal
location:
- testicular torsion
- trauma
- inguinal hernia
- gastroschisis

10. Treatment - surgical
• Orchiopexy - adequate mobilization of the testis
and spermatic vessels, ligation of the associated
hernia sac, and adequate fixation of the testis in a
dependent portion of the scrotum.
• Orchidectomy - castration

11. Case report
Patient M.E., male, age 46, admitted in February2012
in the 3rd Surgical Clinic of “Sf Spiridon” Hospital.

12. • Personal history
- cryptorchidism in the right testicle
- disc protrusion L4-L5, L5-S1
- active hemangioma D12
- obesity, stage II
• Behavior towards the environment
- 20 years of smoking, aprox 10 cigars/ day
- moderate alcohol consumption

13. Clinical and paraclinical investigations
Clinical features: a pseudotumoral formation localized in the
right inguinal area, with a diameter of 3 cm, well defined,
sensible to palpation and without cough impulse.
• Biochemical: High blood level of glucose
• X-ray : microcalcification mass in the right pelvic ground

14. Surgical procedure - orchidectomy

15. - A 4–6 cm incision runs obliquely midway between
the pubic tubercle and the anterior superior iliac
spine.
- The external oblique fascia is incised along its
fibers and the spermatic cord is identified and
isolated.
- From there, the testicle is pulled into the field
through the inguinal canal.
- The spermatic cord is clamped off in two places
and cut between the clamps.

17. Histopathological exam
• Macroscopic: right orchidectomy of 9/6/2 cm,
testicle of 4,5/2/2 cm and spermatic cord of 5 cm
- testicular surface - smooth, glossy, perly - white
- on the section - compact appearance

18. • Microscopy: testicle with total atrophy of the
germinal cells, hyalinized seminiferous tubules and
interstitial edema

19. Post-operatory follow-up
• electrolytic and hemodynamic stabile
• normal transit and diuresis
• no sign of any infection
• The patient was discharged 5 day after admission

20. Discussions
• There are 3 basic management choices for
cryptorchidism in postpubertal patients:
- close observation
- orchiopexy
- orchiectomy

21. Discussions
• An association between testicular maldescent and
testis cancer has been known for more than a
century.
• The combined risk for all cryptorchid males,
irrespective of the location of the testes,
has been calculated at 20 to 46 times greater than
for patients with normally located testes.

22. Conclusions
• The choice of therapy should take into
consideration the risks associated with an
undescended testicle, which include testicular
torsion and cancer.
• If orchiectomy is considered, issues involved in loss
of the testicle must also be addressed, including
fertility and cosmetic changes.

23. Thank You!