Cryptorchidism Evaluation

What is Cryptorchidism Evaluation?

Cryptorchidism means one or both testes have not descended into the scrotum. The testes normally move down from the abdomen before birth. In some boys, one or both testes stay in the abdomen or groin area instead of reaching the scrotum.

This is one of the most common birth differences in boys. It affects about 3 in 100 full-term newborns. Premature babies have higher rates, with up to 30 in 100 affected. Most cases resolve on their own in the first few months of life. When the testes don't descend by 6 months of age, medical evaluation and treatment are needed.

Undescended testes can affect fertility and increase the risk of testicular cancer later in life. Early detection and treatment help protect long-term health. Blood tests can help doctors understand if testicular tissue is present and functioning. This information guides decisions about surgery and other treatments.

Anti-Mullerian Hormone (AMH), Female

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Symptoms

One or both testes cannot be felt in the scrotum during physical exam
Empty or underdeveloped appearance of the scrotum on one or both sides
Testicle located in the groin, abdomen, or other area outside the scrotum
Asymmetric scrotum with one side appearing smaller or flatter
Sometimes the testicle can be felt moving up and down between scrotum and groin

Most boys with cryptorchidism have no pain or other symptoms. The condition is usually discovered during routine newborn exams or well-child visits. Some parents notice the difference in the scrotum's appearance when changing diapers or bathing their child.

Causes and risk factors

Cryptorchidism happens when the normal descent of the testes is interrupted during development. The exact cause is often unknown. Hormones guide the testes down from the abdomen through the inguinal canal into the scrotum. Problems with these hormones or the structures they act on can prevent normal descent. Genetic factors may play a role in some cases.

Risk factors include premature birth, low birth weight, family history of cryptorchidism, and certain genetic conditions. Maternal diabetes, exposure to some chemicals during pregnancy, and twin or multiple pregnancies also increase risk. Boys born with certain hormonal or developmental conditions are more likely to have undescended testes. In many cases, no specific risk factor can be identified.

How it's diagnosed

Diagnosis begins with a physical exam. The doctor checks if one or both testes can be felt in the scrotum or elsewhere. Sometimes imaging tests like ultrasound help locate the testes. Blood tests measure hormones that indicate whether testicular tissue is present and working.

Anti-Mullerian Hormone, or AMH, is particularly useful in prepubertal boys. Detectable AMH in the blood indicates functioning testicular tissue is present. This helps doctors tell the difference between cryptorchidism and anorchia, which means the testes are completely absent. Rite Aid offers AMH testing as an add-on to help evaluate this condition. The results guide decisions about surgery and other treatments.

Treatment options

Watchful waiting for the first 6 months of life, as many cases resolve naturally
Hormone therapy with injections to stimulate testicular descent in select cases
Orchiopexy surgery to move the testicle into the scrotum, typically between 6 and 18 months of age
Removal of non-functioning testicular tissue if found during surgery
Regular follow-up to monitor testicular growth and development
Self-examination education during teenage years to watch for testicular cancer
Fertility counseling in adolescence or adulthood if needed

Frequently asked questions

Treatment is typically recommended between 6 and 18 months of age if the testes haven't descended on their own. Early treatment during this window helps protect fertility and reduce cancer risk. Waiting beyond 18 months may increase the risk of long-term complications. Your pediatric urologist will determine the best timing based on your child's specific situation.

Yes, many cases resolve naturally in the first 6 months of life. About half of boys born with undescended testes will see them descend by 3 months of age. If the testes haven't descended by 6 months, they are unlikely to do so without treatment. Regular monitoring with your pediatrician is important during this period.

AMH is a hormone made by testicular tissue in young boys. Detectable AMH in a blood test means functioning testicular tissue is present somewhere in the body. This helps doctors know if the testes exist but are just hidden, or if they never formed. The test results guide decisions about whether surgery or other evaluation is needed.

Most boys treated early for cryptorchidism can have children as adults. Early surgery before 18 months gives the best chance for normal fertility. Boys with one undescended testicle usually have normal fertility if the other testicle is healthy. Those with both testes undescended may have lower fertility but can often still father children with proper treatment.

Yes, undescended testes have a higher risk of testicular cancer later in life. The risk is 4 to 8 times higher than in boys with normally descended testes. Early surgery may reduce but not eliminate this increased risk. Regular self-examination and medical follow-up throughout life are important for early cancer detection.

Cryptorchidism means the testes never properly descended and cannot be moved into the scrotum. Retractile testes can be gently moved into the scrotum during exam but pull back up due to an active muscle reflex. Retractile testes are normal and usually don't require treatment. A careful physical exam can tell the difference between these two conditions.

Surgery is the most common and effective treatment when testes don't descend by 6 months. Hormone therapy works in only about 20% of cases and is less commonly used. If testicular tissue is absent, surgery may still be needed to remove any remaining tissue. Your pediatric urologist will recommend the best approach based on exam findings and test results.

Orchiopexy is a procedure to move the undescended testicle into the scrotum. The surgeon makes a small cut in the groin or abdomen to find the testicle. The testicle is then carefully moved down and secured in the scrotum. The surgery usually takes 1 to 2 hours and most children go home the same day.

Yes, about 10% of cryptorchidism cases involve both testes. Bilateral cryptorchidism requires more extensive evaluation to rule out hormonal or genetic conditions. Blood tests including AMH are particularly important in these cases. Treatment typically involves surgery on both sides, which may be done in one operation or staged procedures.

Follow-up visits are typically scheduled at 3 months, 6 months, and 1 year after surgery. Your doctor will check that the testicle stays in the scrotum and is growing normally. Annual visits during childhood help monitor development and teach self-examination as your child gets older. Continued monitoring into adulthood is recommended due to the slightly increased cancer risk.