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Management
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Last reviewed: 23 May 2025
Last updated: 13 Jul 2022
Summary
Cryptorchidism diagnosis is made on physical examination when one or both testes are not present within the dependent portion of the scrotal sac.
Approximately 70% of cryptorchid testes are palpable within the upper portion of the scrotum or inguinal canal, whereas the other 30% are not palpable, suggesting either an intra-abdominal location, testicular nubbin, or anorchia.
Referral to a specialist should be made by 6 months corrected gestational age and surgical correction should be performed within the next year. Testes that remain undescended by 6 months are unlikely to descend spontaneously.
Boys with newly acquired (ascended) testicles should be referred to a surgical specialist.
Delayed or lack of treatment has been associated with a higher incidence of testicular cancer and reduced fertility from the affected testis.
Patients with bilateral cryptorchidism should be referred immediately for an evaluation with karyotype and biochemical workup for a difference of sex development (DSD).
Definition
Cryptorchidism, or undescended testis, is when one or both testes are not present within the dependent portion of the scrotal sac.
History and exam
Key diagnostic factors
- presence of risk factors
- malpositioned or absent testis
- palpable cryptorchid testis
- non-palpable testis
Full details
Other diagnostic factors
- testicular asymmetry
- scrotal hypoplasia or asymmetry
- retractile testis
- ascending cryptorchidism
- hypospadias
- micropenis
- secondary sex characteristics/pubertal signs in prepubertal/pubertal patients
- surgical scar in the inguinal region
Full details
Risk factors
- family history of cryptorchidism
- prematurity
- low birth weight (<2.5 kg) and/or small for gestational age
- environmental exposures
- maternal alcohol use
- gestational diabetes
- prior inguinal surgery
Full details
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Diagnostic investigations
1st investigations to order
- clinical diagnosis
Full details
Investigations to consider
- ultrasound
- magnetic resonance imaging (MRI)
- hormonal evaluation with human chorionic gonadotrophin (hCG) stimulation test
- hormonal evaluation with Mullerian inhibiting substance (MIS), inhibin B, and follicle-stimulating hormone (FSH)
- karyotyping
Full details
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Treatment algorithm
ACUTE
retractile testicle(s)
undescended testicle(s): prepubertal, no hypospadias
undescended testicle(s): prepubertal, with hypospadias
undescended testicle: postpubertal
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Contributors
Authors
David J. Chalmers, MD
Pediatric Urology
Maine Medical Center
Portland
ME
Disclosures
DJC declares that he has no competing interests.
Acknowledgements
Dr David J. Chalmers would like to gratefully acknowledge Dr Gabriel Belanger, Dr Duncan T. Wilcox, and Dr Nicol Corbin Bush, previous contributors to this topic.
Disclosures
DTW and NCB declare that they have no competing interests.
Peer reviewers
Martin Koyle, MD
Professor Pediatric Urology
Hospital for Sick Children
Toronto
Canada
Disclosures
MK declares that he has no competing interests.
Paul J. Turek, MD
Professor of Urology
Endowed Chair
Urologic Education
The University of California
San Francisco
CA
Disclosures
PJT declares that he has no competing interests.
Vincent Gnanapragasam, MBBS, BMedSci, PhD, FRCSEng, FRCSEd(Urol)
Lecturer in Uro-oncology and Consultant Urological Surgeon
Department of Urology
Addenbrooke's Hospital
Cambridge
UK
Disclosures
VG declares that he has no competing interests.
Jørgen Thorup, MD, PhD
Professor and Head
Department of Pediatric Surgery
Rigshospitalet, University of Copenhagen
Copenhagen
Denmark
Disclosures
JT is an author of a reference cited in this topic.
References
Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.
Key articles
Virtanen HE, Toppari J. Epidemiology and pathogenesis of cryptorchidism. Hum Reprod Update. 2008 Jan-Feb;14(1):49-58.Full textAbstract
Hutson JM, Clarke MC. Current management of the undescended testicle. Semin Pediatr Surg. 2007 Feb;16(1):64-70.Abstract
Kolon TF, Herndon CD, Baker LA, et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014 Aug;192(2):337-45.Full textAbstract
European Association of Urology. Guidelines on paediatric urology. 2022 [internet publication].Full text
Kollin C, Stukenborg JB, Nurmio M, et al. Boys with undescended testes: endocrine, volumetric and morphometric studies on testicular function before and after orchidopexy at nine months or three years of age. J Clin Endocrinol Metab. 2012 Dec;97(12):4588-95.Abstract
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):E251-60.Full textAbstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Differences of sex development (DSD)
- Female with congenital adrenal hyperplasia
More Differentials
Guidelines
- Guidelines on paediatric urology
- Diagnosis, management, and followup of cryptorchidism
More Guidelines
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