eMedicine Specialties > Urology > Common Problems of the Testicle

Cryptorchidism: Workup

Author: Joel M Sumfest, MD, Director of Pediatric Urology, Janet Weis Children's Hospital, Geisinger Medical Center; Vice Chairman, Department of Urology, Geisinger Medical Center
Coauthor(s): Thomas F Kolon, MD, Department of Urology, Division of Pediatric Urology, Assistant Professor of Urology, The Children's Hospital of Philadelphia; Daniel B Rukstalis, MD, Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group
Contributor Information and Disclosures

Updated: Jan 2, 2009

Workup

Laboratory Studies

  • For unilateral undescended testis without hypospadias, no laboratory studies are needed.
  • Bilateral nonpalpable testes associated with either hypospadias or ambiguous genitalia may represent a life-threatening situation. Consultation with a pediatric endocrinologist and/or geneticist is recommended. For unilateral or bilateral undescended testes with hypospadias or bilateral nonpalpable testes, tests include the following:
    • Testing to rule out intersexuality (mandatory)
    • 17-hydroxylase progesterone
    • Testosterone
    • Luteinizing hormone (LH)
    • Follicle-stimulating hormone (FSH)
    • Further laboratory studies depending on initial results
  • To determine anorchia in cases of bilateral nonpalpable gonads, perform the following:
    • LH testing
    • FSH testing
    • Testosterone level testing before and after stimulation with human chorionic gonadotropin (hCG): Elevated basal gonadotropin levels and a negative testosterone response to hCG stimulation suggests congenital bilateral anorchism. Numerous protocols exist for hCG stimulation tests, but the most practical is one injection of hCG (100 IU/kg or 2940 IU/body surface area), with a testosterone evaluation 72-96 hours postinjection.

Imaging Studies

  • Radiologic studies to localize the testis are currently of very little value. The overall accuracy of radiologic testing for undescended testis is only 44%.41 CT scanning and ultrasonography yield high false-negative rates in the evaluation of a nonpalpable testis and are not recommended. Magnetic resonance angiography (MRA) has been reported to have a nearly 100% sensitivity but requires sedation or anesthesia and is expensive and may not be cost-effective. To date, examination by a pediatric urologist has proven to be more valuable than ultrasonography, CT scanning, or MRA.
  • Ultrasonography of the upper urinary tract has been investigated because of the embryologic association of the ureteric bud and the Wolffian duct, but the yield of significant urinary pathology is no greater than the incidence of anomalies found in the general population.
  • Abdominal and pelvic ultrasonography combined with genitography should be used when intersexuality is suspected.

More on Cryptorchidism

Overview: Cryptorchidism
Workup: Cryptorchidism
Treatment: Cryptorchidism
Follow-up: Cryptorchidism
Multimedia: Cryptorchidism
References
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References

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Further Reading

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Keywords

cryptorchidism, undescended testis, undescended testes, maldescended testis, maldescended testes, orchiopexy, orchidopexy, orchiectomy, hidden testis, obscure testis, cryptorchid testis, abdominal testes, maldescended testis, retractile testis, vanishing testis, vanishing testis syndrome, hypogonadotropic hypogonadism, epididymal abnormality, abnormal epididymis, intersex, intersexuality, pseudohermaphroditism, hypospadias

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Contributor Information and Disclosures

Author

Joel M Sumfest, MD, Director of Pediatric Urology, Janet Weis Children's Hospital, Geisinger Medical Center; Vice Chairman, Department of Urology, Geisinger Medical Center
Joel M Sumfest, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas F Kolon, MD, Department of Urology, Division of Pediatric Urology, Assistant Professor of Urology, The Children's Hospital of Philadelphia
Thomas F Kolon, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Urological Association, Society for Fetal Urology, Society for Pediatric Urology, Society for the Study of Male Reproduction, Society of University Urologists, and Society of Urology Chairpersons and Program Directors
Disclosure: Nothing to disclose.

Daniel B Rukstalis, MD, Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group
Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science and American Urological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Martin I Resnick, MD †, Former Lester Persky Professor and Chair, Department of Urology, Former Professor, Department of Oncology, Case Western Reserve University School of Medicine
Martin I Resnick, MD † is a member of the following medical societies: American College of Surgeons, American Federation for Medical Research, American Institute of Ultrasound in Medicine, American Medical Association, American Society for Bone and Mineral Research, American Society for Reproductive Medicine, American Society of Andrology, American Surgical Association, American Urological Association, Association for Academic Surgery, Endocrine Society, National Kidney Foundation, Ohio Urological Society, and Pan American Medical Association
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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