History and exam

Key diagnostic factors

common

malpositioned or absent testis

Affected testis may be palpable or nonpalpable, unilateral, or bilateral.

palpable cryptorchid testis

Unable to be manipulated into the scrotum or immediately returns to a higher position after being manipulated into the scrotum.

nonpalpable testis

Testis is unable to be located/palpated in the scrotum, inguinal canal, or femoral or perineal regions despite thorough physical exam.

Other diagnostic factors

common

testicular asymmetry

The unilateral undescended testis may be smaller than the contralateral descended testis at birth.[63] Testicular growth in puberty is likely also impaired in congenitally cryptorchid boys.[64]

scrotal hypoplasia or asymmetry

Scrotal skin may be well developed or poorly developed with decreased rugae and lighter color than the contralateral scrotum in cases of unilateral undescended testis, although this is not consistent.[65] Testicular hypertrophy may be a predictor of monorchism.[66]

retractile testis

Testis that is located in a suprascrotal position but can be manipulated down without pain into the scrotum and remains there after traction is released.

uncommon

ascending cryptorchidism

Cryptorchidism may also present as an ascending event in patients with previously documented normal testis position in the scrotum, later noted to have ascended into the high portion of the scrotum or the inguinal canal.

hypospadias

Presence of hypospadias should prompt referral for genetic testing and further urologic assessment.

micropenis

Penile length less than 2 standard deviations below normal for age.

secondary sex characteristics/pubertal signs in prepubertal/pubertal patients

These should be sought for a patient presenting with cryptorchidism at an older age.

surgical scar in the inguinal region

Cryptorchidism may be iatrogenic.

Risk factors

strong

family history of cryptorchidism

May be present in up to 23% of cases.[23][24] Underlying genetics may play a significant role.[35] The precise genetic loci that are responsible for cryptorchidism remain elusive, and the condition is likely to be a heterogeneous and multifactorial process.[36]

prematurity

The descent of the testis from the inguinal region into the scrotum generally occurs during 24 to 35 weeks of gestation.[37] Premature infants have a 9% to 45% incidence of cryptorchidism at birth and an odds ratio (OR) of 2.5 compared with controls.[4][38][39] Cryptorchidism at birth may resolve in many of these infants when adjusted for gestational age.

low birth weight (<2.5 kg) and/or small for gestational age

Case control studies have demonstrated a separate increased risk of cryptorchidism in infants small for gestational age and/or low birth weight even when controlling for prematurity, with OR ranging from 1.2 to 3.53 and a prevalence of 1.0 to 4.6%.[4][39][40] A study has shown that those infants who reach normal weight by 1 year of age have a higher chance of testicular descent than those who remain underweight.[41]

weak

environmental exposures

There is growing appreciation of the toxicity of environmental endocrine disruptors.[42] These may include organochlorines such as polychlorinated biphenyls (PCBs), environmental estrogens, phthalate esters, and bisphenol-A (BPA).[15][43][44][45][46] A 13% nationwide increase in cryptorchidism was observed following the Fukushima nuclear accident in Japan in 2011.[47] Analgesic consumption, smoking, and pesticides or agricultural exposure have also all been linked to increased risk of cryptorchidism, although a review of literature demonstrates that studies are often conflicting and difficult to interpret due to the complexity of chemical compound mixtures and the unclear pathophysiology of cryptorchidism.[5][8][12][16][17][18][19][20][21][48][49][50]

maternal alcohol use

Consumption of 5 or more alcoholic beverages per week during pregnancy was associated with an adjusted OR of 3.1 for cryptorchidism among newborn males.[18][22]

gestational diabetes

Abnormalities of maternal glucose metabolism during pregnancy were associated with an OR of 2.44 to 3.98 increased risk of cryptorchidism in Finnish newborn boys.[51]

prior inguinal surgery

Cryptorchidism may be iatrogenic in such cases.[52]

Use of this content is subject to our disclaimer