# Undescended testis (cryptorchidism) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Cryptorchidism - StatPearls (NCBI Bookshelf NBK470270) - https://www.ncbi.nlm.nih.gov/books/NBK470270/ · Undescended testis - disease-level clinical article (undescended-testis-full.txt) · Undescended testis - disease-level clinical article (undescended-testis-clinical.txt) - Verified date: 2026-08 ## Verified against - Cryptorchidism - StatPearls (NCBI Bookshelf NBK470270) - https://www.ncbi.nlm.nih.gov/books/NBK470270/ - Undescended testis - disease-level clinical article (undescended-testis-full.txt) - Undescended testis - disease-level clinical article (undescended-testis-clinical.txt) ## Treatment metadata - Watchful waiting to 6 months, then surgical referral (no drug therapy) - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text UNDESCENDED TESTIS (CRYPTORCHIDISM) Sources: Cryptorchidism - StatPearls (NCBI Bookshelf NBK470270) - https://www.ncbi.nlm.nih.gov/books/NBK470270/ · Undescended testis - disease-level clinical article (undescended-testis-full.txt) · Undescended testis - disease-level clinical article (undescended-testis-clinical.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SIGNS - what you find (3) - The clearest sign is an empty scrotum with no testicle felt on that side - An inguinal hernia and reduced scrotal skin folds often accompany the finding [hernia] - Normal skin folds with a testicle present in the scrotum instead suggests a retractile testicle, which usually needs no treatment TESTS (6) - An experienced examiner can feel more than 70% of cryptorchid testes on exam alone, without needing imaging - Ultrasound is not very reliable for finding a non-palpable testis, at about 45% sensitive and 78% specific - Nearly half of boys with a non-palpable testis and a negative ultrasound turn out to have an intra-abdominal testis - No imaging test can reliably confirm a testis is truly absent - Karyotype testing can confirm or rule out a dysgenetic form of hypogonadism - In bilateral non-palpable testes, a male karyotype with high FSH and no detectable anti- Mullerian hormone or inhibin B points strongly to no testicular tissue at all IF NOT THIS - what else fits (4) - A retractile testicle is more common than a true undescended testis and doesn't need surgery - A retractile testis, unlike a truly undescended one, can be gently guided into a stable scrotal position without tension, at least temporarily - Bilateral impalpable testes should prompt a work-up for a disorder of sexual development, and circumcision should wait until that's done - Severe congenital adrenal hyperplasia in a genetically female infant can be mistaken for bilateral cryptorchidism Source StatPearls "Cryptorchidism" - disease-level clinical article Status traced to the source above 1. WATCHFUL WAITING TO 6 MONTHS, THEN SURGICAL REFERRAL (NO DRUG THERAPY)[1st line] Adult Source Undescended testis - disease-level clinical article (undescended-testis-full.txt) Why The whole management is a clock. If the testis has not come down by 6 months, the article treats spontaneous descent as unlikely, and turns to surgery: the AUA guidelines it cites advise operating on a congenitally undescended testis somewhere between 6 and 18 months of age. Nothing is prescribed; a date is set. Caution THE WINDOW - where the testis stays undescended, the advice is orchidopexy somewhere between 6 and 18 months of age, bringing it down into the scrotum, which lowers the risks and gives infertility less chance of following. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) EARLIER IS BETTER WITHIN THAT WINDOW - many specialists favour operating early, often at around 6 months, to give the testis the best growth and to protect fertility. The younger the child, moreover, the shorter the distance the testis has to travel; that distance grows as he does. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) BEFORE 6 MONTHS, WAIT - left alone, an undescended testis will most likely come down within the first 3 months of life (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270), and descent of its own accord remains possible through the first 6 months. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) NO HORMONE IS PRESCRIBED HERE, AND THAT IS THE ARTICLE'S POSITION - the AUA guidelines advise against using hormones to bring a testis down: too few respond, and nothing lasts. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) A meta-analysis of 7 randomised trials, the article adds, found hormonal treatment no better than placebo. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) hCG is reserved for a named exception (Prader-Willi syndrome) and is a specialist decision. DO NOT ORDER AN ULTRASOUND - scanning as a matter of routine gets you nowhere: at finding a testis that cannot be felt it runs at 45% sensitivity and 78% specificity. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) Worse: of the boys with an impalpable testis and a scan that showed nothing, 49% turn out in the end to have one inside the abdomen. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) A normal scan delays surgery and proves nothing. As things stand, no radiological test can establish beyond doubt that a testis is absent. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) EXAMINE, DO NOT IMAGE - an experienced pair of hands can feel over 70% of undescended testes, and those need no imaging at all. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) MOST BOYS DO NOT NEED THIS AT ALL - 3% of babies born at term have an undescended testis, and the figure falls to 1% between 6 months and 1 year of age. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) Among boys born prematurely it is 30%. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Undescended testis - disease-level clinical article (undescended-testis-clinical.txt) Why Two things go wrong in primary care: the referral is made too late, and a retractile testis is referred as an undescended one. Carries both, plus the consequences that make the deadline real. Caution RED FLAG - THE DEADLINE IS ROUTINELY MISSED: everyone working in paediatric and family practice needs to know that orchidopexy belongs at 18 months of age or sooner, because infertility and cancer are what is at stake. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) One study found that 70% of boys with undescended testes were operated on 6 months or more later than they should have been. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) WHY THE DELAY COSTS - left untreated, an undescended testis can bring long-term trouble: fertility reduced, most of all where both sides are affected; a raised risk of a germ cell tumour of the testis, though the overall risk stays under 1%; torsion; inguinal hernia; and psychological harm. Somewhere between 10% and 30% of men with one undescended testis may prove infertile, and with both affected the figure climbs from 35% to 65% or beyond. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) DO NOT REFER A RETRACTILE TESTIS - retractile testes outnumber undescended ones (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270), and the article says they need no operation. What marks one out, in the AUA's terms, is that you can bring it down by hand into a stable position at the bottom of the scrotum, without tension, and it stays there at least for a while. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) HOW TO TELL THEM APART - several manoeuvres help: sit the boy cross-legged; soap your fingers before examining; look again while he is in a warm bath. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) A cold room and cold hands produce a false empty scrotum. BILATERAL NON-PALPABLE TESTES IS A DIFFERENT PROBLEM - the article's workup takes in a karyotype, which will confirm or exclude a dysgenetic primary hypogonadism (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270), and it warns that further testing is sometimes essential, and is very likely to uncover an intersex condition. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) Refer urgently, and consider congenital adrenal hyperplasia in a newborn with bilateral impalpable gonads. KEEP LOOKING AFTER THE REFERRAL - the scrotum needs examining regularly, at review and by the parents at home, for anything abnormal or any sign the boy is uncomfortable. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) Ascent after an apparently normal newborn check does happen. SET THE FAMILY'S EXPECTATIONS - diagnosed properly and treated, the outlook is excellent. The risks of testicular cancer and of infertility do stay slightly above those of men generally. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) Tell the patient and the family what untreated cryptorchidism is and where it leads, and puts the case for operating early. What that education has to land is why acting in time matters, and what is risked by letting the surgery slide. (Cryptorchidism - StatPearls - NCBI Bookshelf, NBK470270) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)