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Cryptorchidism

Background

Overview

Definition
Cryptorchidism, also known as undescended testis, is a common congenital abnormality among males that is characterized by the failure of one or both testes to permanently descend.
1
Pathophysiology
Cryptorchidism is caused due to a disruption in any phase of testicular descent triggered by hereditary, hormonal, anatomical, environmental, or social factors.
1
Disease course
The disruption in any phase of testicular descent results in cryptorchidism, which causes an increased chance of inguinal hernia, torsion, and trauma that leads to psychological distress in parents. It may also lead to reduced fertility and testicular cancer in adult males.
1
Prognosis and risk of recurrence
Orchiectomy for ASA 3 and ASA 4 is associated with 0.49% and 3.31% of mortality risk.
2

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of cryptorchidism are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2025), the European Association of Urology (EAU/ESPU 2025), the American Academy of Family Physicians (AAFP 2023), the European Thyroid Association (ETA 2018), the Canadian Urological Association (CUA 2017), and the American Urological Association ...
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Screening and diagnosis

Indications for screening: as per AUA 2014 guidelines, palpate testes for quality and position at each recommended well-child visit.
B
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Diagnostic investigations

History and physical examination: as per AAFP 2023 guidelines, obtain serial examinations for the diagnosis of cryptorchidism because the testicle usually descends to the correct location by 6 months of age.
B

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  • Evaluation for disorders of sex development

  • Hormone testing

  • Diagnostic imaging

  • Evaluation for central hypothyroidism

Medical management

Hormonal therapy
As per EAU/ESPU 2025 guidelines:
Do not offer hormonal therapy in patients with unilateral undescended testes for testicular descent only.
D
Offer endocrine treatment in cases of bilateral undescended testes to preserve future fertility potential.
B

Surgical interventions

Orchidopexy, pre-pubertal: as per EAU/ESPU 2025 guidelines, perform surgical orchidofunicolysis and orchidopexy before the age of 12 months, and by 18 months at the latest.
A
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  • Orchidopexy (post-pubertal)

  • Surgical or laparoscopic exploration

  • Orchiectomy

Patient education

General counseling: as per EAU/ESPU 2025 guidelines, inform the patient/caregivers about:
the increased risk of malignancy with an undescended testis increasing with the age at orchidopexy
B
the increased risk of later malignancy with a failed or delayed orchidopexy; the earlier the treatment, the lower the risk of impaired fertility and testicular cancer
B
the reduced rates of fertility with unilateral undescended testis
B
the reduced rates of fertility and paternity with bilateral undescended testes.
B

Preventative measures

Prophylactic contralateral orchidopexy: as per CUA 2017 guidelines, decide on performing prophylactic orchidopexy based on informed discussion of options with the patient parents or legal guardian.
B

Follow-up and surveillance

Indications for specialist referral: as per AAFP 2023 guidelines, refer patients for surgical consultation by 6 months of age or at the time of diagnosis in older patients.
B

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  • Follow-up