Pediatric Cryptorchidism Surgery Clinical Presentation
- Author: Marcos Perez-Brayfield, MD; Chief Editor: Marc Cendron, MD more...
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 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.
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.
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.
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