pediatrics
Cryptorchidism
Diagnosis of Cryptorchidism
Clinical evaluation Sometimes laparoscopy Rarely ultrasonography or MRI All boys should have a testicular examination at birth and annually thereafter to assess testicular location and growth. Undescended and ectopic testes must be distinguished from hypermobile (retractile) testes, which are present in the scrotum but easily retract into the inguinal canal via the cremasteric reflex. Diagnosis of cryptorchidism is by physical examination; a warm environment, warm examiner’s hands, and a relaxed patient are important to avoid stimulating testicular retraction. If needed, the child can be placed in a frog-leg position to better examine the testes. Lubricating the child's groin or the examiner's gloved hands with soap before the examination can help decrease friction and aid in the localization of the testis. In patients with a unilateral nonpalpable testis, a descended testis that is larger than expected suggests an atrophic undescended testis; confirmation requires surgical intervention typically via diagnostic laparoscopy to seek an intra-abdominal testis or confirm testicular agenesis. However, scrotal or inguinal exploration is sometimes done if a testicular remnant distal to the internal inguinal ring is suspected. For bilateral nonpalpable testes, patients in the immediate neonatal period should be evaluated for a possible disorder of sexual differentiation (consultation with a pediatric endocrinologist should be considered). If a disorder of sexual differentiation has been ruled out, laparoscopy is often necessary to identify testes located in the abdomen and then bilateral orchiopexy may be done. 