Cryptorchidism

Last reviewed: 1 Jun 2022
Last updated: 03 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • malpositioned or absent testis
  • palpable cryptorchid testis
  • non-palpable testis
More key diagnostic factors

Other diagnostic factors

  • testicular asymmetry
  • scrotal hypoplasia or asymmetry
  • retractile testis
  • ascending cryptorchidism
  • hypospadias
  • micropenis
  • secondary sex characteristics/pubertal signs in prepubertal/pubertal patients
  • surgical scar in the inguinal region
Other diagnostic factors

Risk factors

  • family history of cryptorchidism
  • prematurity
  • low birth weight (<2.5 kg) and/or small for gestational age
  • environmental exposures
  • maternal alcohol use
  • gestational diabetes
  • prior inguinal surgery
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • ultrasound
  • magnetic resonance imaging (MRI)
  • hormonal evaluation with human chorionic gonadotrophin (hCG) stimulation test
  • hormonal evaluation with Mullerian inhibiting substance (MIS), inhibin B, and follicle-stimulating hormone (FSH)
  • karyotyping
More investigations to consider

Treatment algorithm

ACUTE

retractile testicle(s)

undescended testicle(s): prepubertal, no hypospadias

undescended testicle(s): prepubertal, with hypospadias

undescended testicle: postpubertal

Contributors

Authors

David J. Chalmers, MD
David J. Chalmers

Pediatric Urology

Maine Medical Center

Portland

ME

Disclosures

DJC declares that he has no competing interests.

Acknowledgements

Dr David J. Chalmers would like to gratefully acknowledge Dr Gabriel Belanger, Dr Duncan T. Wilcox, and Dr Nicol Corbin Bush, previous contributors to this topic.

Disclosures

DTW and NCB declare that they have no competing interests.

Peer reviewers

Martin Koyle, MD

Professor Pediatric Urology

Hospital for Sick Children

Toronto

Canada

Disclosures

MK declares that he has no competing interests.

Paul J. Turek, MD

Professor of Urology

Endowed Chair

Urologic Education

The University of California

San Francisco

CA

Disclosures

PJT declares that he has no competing interests.

Vincent Gnanapragasam, MBBS, BMedSci, PhD, FRCSEng, FRCSEd(Urol)

Lecturer in Uro-oncology and Consultant Urological Surgeon

Department of Urology

Addenbrooke's Hospital

Cambridge

UK

Disclosures

VG declares that he has no competing interests.

Jørgen Thorup, MD, PhD

Professor and Head

Department of Pediatric Surgery

Rigshospitalet, University of Copenhagen

Copenhagen

Denmark

Disclosures

JT is an author of a reference cited in this topic.

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