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 investigations
1st investigations to order
- clinical diagnosis
Investigations 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: postpubertal
Contributors
Authors
David J. Chalmers, MD
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.
Differentials
- Differences of sex development (DSD)
- Female with congenital adrenal hyperplasia
More DifferentialsGuidelines
- Guidelines on paediatric urology
- Diagnosis, management, and followup of cryptorchidism
More Guidelines
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