Summary
Definition
History and exam
Key diagnostic factors
- malpositioned or absent testis
- palpable cryptorchid testis
- nonpalpable testis
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
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
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- ultrasound
- magnetic resonance imaging (MRI)
- hormonal evaluation with human chorionic gonadotropin (hCG) stimulation test
- hormonal evaluation with Mullerian inhibiting substance (MIS), inhibin B, and follicle-stimulating hormone (FSH)
- karyotyping
Treatment algorithm
retractile testicle(s)
undescended testicle(s): prepubertal, no hypospadias
undescended testicle(s): prepubertal, with hypospadias
undescended testicle(s): postpubertal
Contributors
Authors
Hsi-Yang Wu, MD
Professor of Surgery
Director of Pediatric Urology
Alpert Medical School
Brown University
Providence, RI
Disclosures
HYW has completed expert testimony for one case.
Acknowledgements
Dr Hsi-Yang Wu would like to gratefully acknowledge Dr David J. Chalmers, Dr Gabriel Belanger, Dr Duncan T. Wilcox, and Dr Nicol Corbin Bush, previous contributors to this topic.
Disclosures
DTW, DJC, 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American Urological Association. Evaluation and treatment of cryptorchidism (2025). 2014 [internet publication].Full text
European Association of Urology. Guidelines on paediatric urology. Mar 2026 [internet publication].Full text
American Family Physician. Cryptorchidism (undescended testicle). Oct 2023 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Differences of sex development (DSD)
- Female with congenital adrenal hyperplasia
More DifferentialsGuidelines
- Guidelines on paediatric urology
- Evaluation and treatment of cryptorchidism (2025)
More Guidelines
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