Cryptorchidism diagnosis is made on physical exam when one or both testes are not present within the dependent portion of the scrotal sac.
Approximately 70% of cryptorchid testes are palpable within the upper portion of the scrotum or inguinal canal, whereas the other 30% are not palpable, suggesting either an intra-abdominal location, testicular nubbin, or anorchia.
Referral to a specialist should be made by 6 months corrected gestational age and surgical correction should be performed within the next year. Testes that remain undescended by 6 months are unlikely to descend spontaneously.
Boys with newly acquired (ascended) testicles should be referred to a surgical specialist.
Delayed or lack of treatment has been associated with a higher incidence of testicular cancer and reduced fertility from the affected testis.
Patients with bilateral cryptorchidism should be referred immediately for an evaluation with karyotype and biochemical workup for a difference of sex development (DSD).
Cryptorchidism, or undescended testis, is when one or both testes are not present within the dependent portion of the scrotal sac.
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
- secondary sex characteristics/pubertal signs in prepubertal/pubertal patients
- surgical scar in the inguinal region
- family history of cryptorchidism
- low birth weight (<2.5 kg) and/or small for gestational age
- environmental exposures
- maternal alcohol use
- gestational diabetes
- prior inguinal surgery
1st investigations to order
- clinical diagnosis
Investigations to consider
- 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)
undescended testicle(s): prepubertal, no hypospadias
undescended testicle(s): prepubertal, with hypospadias
undescended testicle: postpubertal
David J. Chalmers, MD
Maine Medical Center
DJC declares that he has no competing interests.
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.
DTW and NCB declare that they have no competing interests.
Martin Koyle, MD
Professor Pediatric Urology
Hospital for Sick Children
MK declares that he has no competing interests.
Paul J. Turek, MD
Professor of Urology
The University of California
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
VG declares that he has no competing interests.
Jørgen Thorup, MD, PhD
Professor and Head
Department of Pediatric Surgery
Rigshospitalet, University of Copenhagen
JT is an author of a reference cited in this topic.
- Differences of sex development (DSD)
- Female with congenital adrenal hyperplasia
- Guidelines on paediatric urology
- Diagnosis, management, and followup of cryptorchidism
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