History

Determining if the testis was palpable in the scrotum at any time is important. The patient's antenatal 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 the 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, it is vital to 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. The examiner should 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 undescended right testis.

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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 differences (disorders) of sex 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.

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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.

Differential Diagnoses

Braga LH, Lorenzo AJ. Cryptorchidism: A practical review for all community healthcare providers. Can Urol Assoc J. 2017 Jan-Feb. 11 (1-2Suppl1):S26-S32. [QxMD MEDLINE Link]. [Full Text].
Bishop BM, Anderson KM. Cryptorchidism Review for the Primary Care Provider. S D Med. 2023 May. 76 (5):222-228. [QxMD MEDLINE Link].
Barthold JS, Redman JF. Association of epididymal anomalies with patent processus vaginalis in hernia, hydrocele and cryptorchidism. J Urol. 1996 Dec. 156 (6):2054-6. [QxMD MEDLINE Link].
Sharma S, Sen A. Complete testicular epididymal dissociation in the abdominal cryptorchid testis. J Pediatr Urol. 2013 Dec. 9 (6 Pt B):1023-7. [QxMD MEDLINE Link].
Loebenstein M, Thorup J, Cortes D, Clasen-Linde E, Hutson JM, Li R. Cryptorchidism, gonocyte development, and the risks of germ cell malignancy and infertility: A systematic review. J Pediatr Surg. 2020 Jul. 55 (7):1201-1210. [QxMD MEDLINE Link].
Hutson JM, Southwell BR, Li R, Lie G, Ismail K, Harisis G, et al. The regulation of testicular descent and the effects of cryptorchidism. Endocr Rev. 2013 Oct. 34 (5):725-52. [QxMD MEDLINE Link].
Dicke AK, Albrethsen J, Hoare BL, Wyrwoll MJ, Busch AS, Fietz D, et al. Bi-allelic variants in INSL3 and RXFP2 cause bilateral cryptorchidism and male infertility. Hum Reprod. 2023 Jul 5. 38 (7):1412-1423. [QxMD MEDLINE Link].
Nguyen MT, Showalter PR, Timmons CF, Nef S, Parada LF, Baker LA. Effects of orchiopexy on congenitally cryptorchid insulin-3 knockout mice. J Urol. 2002 Oct. 168 (4 Pt 2):1779-83; discussion 1783. [QxMD MEDLINE Link].
Ferlin A, Simonato M, Bartoloni L, Rizzo G, Bettella A, Dottorini T, et al. The INSL3-LGR8/GREAT ligand-receptor pair in human cryptorchidism. J Clin Endocrinol Metab. 2003 Sep. 88 (9):4273-9. [QxMD MEDLINE Link].
Ayers K, Kumar R, Robevska G, Bruell S, Bell K, Malik MA, et al. Familial bilateral cryptorchidism is caused by recessive variants in RXFP2. J Med Genet. 2019 Nov. 56 (11):727-733. [QxMD MEDLINE Link]. [Full Text].
Tian Q, Zhao X, Zhang C, Yu K, Fang E, Zhou X, et al. Compared outcomes of high-level cryptorchidism managed by Fowler-Stephens orchiopexy versus the Shehata technique: A systematic review and meta-analysis. J Pediatr Urol. 2023 Jun. 19 (3):313-319. [QxMD MEDLINE Link].
Wood HM, Elder JS. Cryptorchidism and testicular cancer: separating fact from fiction. J Urol. 2009 Feb. 181 (2):452-61. [QxMD MEDLINE Link].
Piltoft JS, Larsen SB, Dalton SO, Johansen C, Baker JL, Cederkvist L, et al. Early life risk factors for testicular cancer: a case-cohort study based on the Copenhagen School Health Records Register. Acta Oncol. 2017 Feb. 56 (2):220-224. [QxMD MEDLINE Link].
Florou M, Tsilidis KK, Siomou E, Koletsa T, Syrnioti A, Spyridakis I, et al. Orchidopexy for congenital cryptorchidism in childhood and adolescence and testicular cancer in adults: an updated systematic review and meta-analysis of observational studies. Eur J Pediatr. 2023 Jun. 182 (6):2499-2507. [QxMD MEDLINE Link].
Weintraub A, Eldar-Geva T. Anti-Mullerian Hormone (AMH) Determinations in the Pediatric and Adolescent Endocrine Practice. Pediatr Endocrinol Rev. 2017 Jun. 14 (4):364-370. [QxMD MEDLINE Link].
Tasian GE, Copp HL, Baskin LS. Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness. J Pediatr Surg. 2011 Dec. 46 (12):2406-13. [QxMD MEDLINE Link].
Banieghbal B, Davies M. Laparoscopic evaluation of testicular mobility as a guide to management of intra-abdominal testes. World J Urol. 2003 May. 20 (6):343-5. [QxMD MEDLINE Link].
[Guideline] Kolon TF, Herndon CDA, Baker LA, Baskin LS, Baxter CG, Cheng EY, et al. Evaluation and treatment of cryptorchidism. American Urological Association. Available at https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline. 2018; Accessed: September 7, 2023.
[Guideline] Braga LH, Lorenzo AJ, Romao RLP. Canadian Urological Association-Pediatric Urologists of Canada (CUA-PUC) guideline for the diagnosis, management, and followup of cryptorchidism. Can Urol Assoc J. 2017 Jul. 11 (7):E251-E260. [QxMD MEDLINE Link]. [Full Text].
Thorsson AV, Christiansen P, Ritzén M. Efficacy and safety of hormonal treatment of cryptorchidism: current state of the art. Acta Paediatr. 2007 May. 96 (5):628-30. [QxMD MEDLINE Link].
Penson D, Krishnaswami S, Jules A, McPheeters ML. Effectiveness of hormonal and surgical therapies for cryptorchidism: a systematic review. Pediatrics. 2013 Jun. 131 (6):e1897-907. [QxMD MEDLINE Link].
Chua ME, Mendoza JS, Gaston MJ, Luna SL Jr, Morales ML Jr. Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review. J Pediatr Surg. 2014 Nov. 49 (11):1659-67. [QxMD MEDLINE Link].
Cuda SP, Srinivasan AK, Kalisvaart J, Kirsch AJ. Evolution of single practice trends in the surgical approach to the undescended testicle. J Urol. 2011 Jun. 185 (6 Suppl):2451-4. [QxMD MEDLINE Link].
Ben Dhaou M, Zouari M, Zitouni H, Jallouli M, Mhiri R. [Comparison of the inguinal and scrotal approaches for the treatment of cryptorchidism in children]. Prog Urol. 2015 Sep. 25 (10):598-602. [QxMD MEDLINE Link].
Nazem M, Hosseinpour M, Alghazali A. Trans-scrotal Incision Approach versus Traditional Trans-scrotal Incision Orchiopexy in Children with Cryptorchidism: A Randomized Trial Study. Adv Biomed Res. 2019. 8:34. [QxMD MEDLINE Link]. [Full Text].
Huang WH, Xu LY, Chen SS, Chen ZQ, Cui X, Zhou CM. The effect of scrotal versus inguinal orchiopexy on the testicular function of children with clinically palpable, inguinal undescended testis: a randomized controlled trial. Asian J Androl. 2023 May 26. [QxMD MEDLINE Link]. [Full Text].
Daboos MA, Mahmoud MA, Gouda S, Salama A, Akl M, Mahfouz M, et al. Safety and Efficacy of Laparoscopic Management of Intracanalicular Testes in Pediatrics. J Laparoendosc Adv Surg Tech A. 2021 Nov. 31 (11):1351-1355. [QxMD MEDLINE Link].
Al Hindi S, Khalaf Z. The outcome of laparoscopic assisted orchidopexy in very young children: A single hospital experience. J Pediatr Urol. 2021 Aug. 17 (4):536.e1-536.e7. [QxMD MEDLINE Link].
Anand S, Krishnan N, Pogorelić Z. Utility of Laparoscopic Approach of Orchiopexy for Palpable Cryptorchidism: A Systematic Review and Meta-Analysis. Children (Basel). 2021 Aug 3. 8 (8):[QxMD MEDLINE Link]. [Full Text].
Kehoe JE, Christman MS. To 'Pex or Not to 'Pex: What to Do for the Contralateral Testis When a Nubbin Is Discovered. Curr Urol Rep. 2017 Feb. 18 (2):9. [QxMD MEDLINE Link].
Sfoungaris D, Mouravas V, Petropoulos A, Filippopoulos A. Prentiss orchiopexy applied in younger age group. J Pediatr Urol. 2012 Oct. 8 (5):488-92. [QxMD MEDLINE Link].
Mostafa MS, Shalaby MS, Woodward M. Outcome of redo orchidopexy after previous laparoscopic orchidopexy. Pediatr Surg Int. 2023 Feb 10. 39 (1):109. [QxMD MEDLINE Link].
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Media Gallery

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

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Author

Marcos Perez-Brayfield, MD Consulting Staff, HIMA-San Pablo; Associate 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.

Coauthor(s)

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: Nothing to disclose.

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, Societies 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.

Sections Pediatric Cryptorchidism Surgery
Overview
Presentation
DDx
Workup
Treatment
Guidelines
Medication
Media Gallery
References

Pediatric Cryptorchidism Surgery Clinical Presentation

History

Physical Examination

References

Tables

Contributor Information and Disclosures

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