Undescended Testis
An undescended testis (cryptorchidism) is a testis not in the scrotum — a palpable one is treated by orchidopexy around 6–18 months to protect fertility and aid cancer surveillance, while bilateral non-palpable testes are a neonatal endocrine/DSD emergency, and imaging does not reliably locate a non-palpable testis.
The big picture
In cryptorchidism the testis has not completed its descent into the scrotum and lies anywhere along the path (intra-abdominal, inguinal) or is ectopic; it may be palpable or non-palpable. Many testes that are undescended at birth descend spontaneously in the first months, but those still undescended beyond that need treatment. Undescended testes carry risks: impaired fertility, a higher risk of testicular cancer (and a malpositioned testis is harder to examine/survey), torsion, and associated inguinal hernia.
Palpable undescended testis → orchidopexy around 6–18 months; non-palpable testis → examination under anaesthesia and laparoscopy (imaging is unreliable); bilateral non-palpable testes → urgent endocrine/DSD evaluation.
Symptom sorter
Examination first.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Treatment ladder
Relocate and fix a palpable undescended testis early; locate a non-palpable testis surgically (not by imaging); treat bilateral non-palpable testes as an endocrine emergency.
Complications
- Subfertility, testicular cancer (and harder surveillance), torsion, associated hernia
- Testicular atrophy, re-ascent, surgical complications
- Timely orchidopexy; careful surgical technique
- Redo orchidopexy or orchidectomy; lifelong cancer awareness
Follow-up
- Testicular position (re-ascent), growth/viability
- Fertility counselling; cancer-awareness/self-examination
- Complications of surgery
- Postoperative review; long-term cancer-awareness counselling
- Scrotal, palpable testis enabling examination and surveillance
- Re-ascent, testicular atrophy, missed DSD
- Limited role; not for locating non-palpable testes
- Subfertility, elevated testicular cancer risk (lifelong self-examination), need for orchidectomy in some
Memory hooks
Palpable → orchidopexy ~6–18 months.
Non-palpable → laparoscopy, not imaging.
Bilateral non-palpable = endocrine emergency.
Retractile testis is normal.
Lifelong testicular self-examination (cancer risk).
Board traps
Non-palpable testis → EUA + laparoscopy (imaging unreliable).
Bilateral non-palpable neonate → endocrine/DSD emergency.
Orchidopexy timing ~6–18 months for palpable undescended testes.
Clinical cases
A 9-month-old has a right testis palpable in the inguinal region that cannot be brought into the scrotum. The left testis is normally located.
What is the management?