Cryptorchidism means one or both testes have not moved down into the scrotum, and it is the most common genital problem in newborn boys, especially if premature. Many descend in the first months, but a testis still undescended at 6 months needs surgery to protect fertility and allow cancer checks.
Key symptoms
- Empty or small scrotum noticed by parents or at a newborn check
- Usually painless
- Testis that can be felt in the groin
- Groin bulge from an associated hernia
What you find on exam
- Warm hands and a relaxed child, legs frog-legged or crossed
- Sweep from the groin toward the scrotum to find the testis
- Tell a retractile testis (comes down and stays) from an undescended one
- Check the penis and both sides; look for hypospadias
Tests
- Diagnosis is clinical; ultrasound is not routinely recommended
- Both testes not felt in a newborn: urgent karyotype and hormone tests
- Diagnostic laparoscopy for a testis that cannot be felt
- Hormone tests such as AMH to look for testicular tissue
Treatment basics
- Refer to pediatric urology if not descended by 6 months
- Orchiopexy, ideally between 6 and 18 months
- Orchiectomy for a tiny or nonviable testis
- Teach testicular self-exam after puberty
Red flags
- Both testes not felt with ambiguous genitalia or hypospadias
- Sudden groin or scrotal pain (torsion of an undescended testis)
- Painful groin swelling that cannot be reduced
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.