Cryptorchidism Workup

Updated: Oct 10, 2022
  • Author: Joel M Sumfest, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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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 a single injection of hCG (100 IU/kg or 2940 IU/body surface area) followed by a testosterone evaluation 72-96 hours postinjection.


Imaging Studies

American Urolological Association guidelines recommend against imaging studies in boys with cryptorchidism prior to surgical referral. [1] Radiologic studies to localize the testis are of very little value. The overall accuracy of radiologic testing for undescended testis is only 44%. [46]

Computed tomography (CT) scanning and ultrasonography yield high false-negative rates in the evaluation of a nonpalpable testis and are not recommended. [47] 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.

Abdominal and pelvic ultrasonography combined with genitography should be used when intersexuality is suspected. 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. [48]

For discussion and images, see Cryptorchidism Imaging