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Pediatric Cryptorchidism Surgery Clinical Presentation

  • Author: Marcos Perez-Brayfield, MD; Chief Editor: Marc Cendron, MD  more...
Updated: Jul 27, 2015


Determining if the testis was palpable in the scrotum at any time is important. The patient's prenatal history should include the following:

  • Gestational age at birth
  • Any need for assisted reproduction
  • Maternal hormonal treatment
  • Mother's number of gestations

Any previous history of inguinal surgery should be noted, as should a family history of cryptorchidism and other associated conditions.

Cryptorchidism is associated with inguinal hernia and/or patent processus vaginalis, hypospadias, cerebral palsy, mental retardation, Down syndrome, Wilms tumor, prune belly syndrome, and Prader-Willi syndrome.


Physical Examination

Physical examination is most important tool in the diagnostic evaluation of cryptorchidism. The patient must be examined in a warm, relaxed environment. Closely observing the scrotum before manipulation is important. The frog-leg or catcher position may be used to facilitate palpation of the testis.

Determining if the testis is palpable is essential. If the testis is palpable, ascertain whether it can be retracted. The retractile testis should stay in the dependent portion of the scrotum after manipulation.

The best method of evaluating for an undescended testis is to start palpating at level of the inguinal canal and perform a milking motion down toward the scrotum. Look for hemiscrotal asymmetry and for contralateral testicular hypertrophy; both are partial indicators of an absent testis.

Hypoplastic right hemiscrotum in a patient with an Hypoplastic right hemiscrotum in a patient with an undescended right testis.

Examination of potential ectopic sites (eg, penile, femoral, and perineal areas) is important if the testicle cannot be felt in the inguinal area. Patients with hypospadias and cryptorchidism have a higher incidence of disorders of sexual development (DSDs), and a workup should be considered. If any doubt remains after the initial examination, reevaluation of the patient is mandatory before surgical management is recommended.

Ectopic testis. Ectopic testis.

No staging system is reported; the physical finding of a palpable testis versus a nonpalpable testis is the most reliable and easy way of grouping cryptorchidism cases.

Contributor Information and Disclosures

Marcos Perez-Brayfield, MD Consulting Staff, HIMA-San Pablo; Assistant Professor, University of Puerto Rico School of Medicine

Marcos Perez-Brayfield, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Urological Association

Disclosure: Nothing to disclose.


Andrew J Kirsch, MD, FAAP, FACS Clinical Professor of Urology, Chief of Pediatric Urology, Emory University School of Medicine, Children's Healthcare of Atlanta; Partner, Georgia Urology, PA

Andrew J Kirsch, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, Society for Fetal Urology

Disclosure: Received consulting fee from Salix for speaking and teaching; Received royalty from Cook for device.

Adam G Baseman, MD Pediatric Urologist, North Texas Pediatric Urology Associates, Urology Clinics of North Texas

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Harry P Koo, MD Chairman of Urology Division, Director of Pediatric Urology, Professor of Surgery, Virginia Commonwealth University School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond

Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Urological Association

Disclosure: Nothing to disclose.

Chief Editor

Marc Cendron, MD Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, New Hampshire Medical Society, Society for Pediatric Urology, Society for Fetal Urology, Johns Hopkins Medical and Surgical Association, European Society for Paediatric Urology

Disclosure: Nothing to disclose.

Additional Contributors

Bartley G Cilento, Jr, MD Instructor, Department of Surgery, Division of Urology, Children's Hospital of Boston and Harvard Medical School

Bartley G Cilento, Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, Massachusetts Medical Society

Disclosure: Nothing to disclose.

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Hypoplastic right hemiscrotum in a patient with an undescended right testis.
Ectopic testis.
Diagnostic laparoscopy of a crossed ectopic testis.
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