Paediatrics

Cryptorchidism (Undescended Testis)

Cryptorchidism is failure of one or both testes to lie in the scrotum; persistent extrascrotal testes carry fertility, malignancy and torsion risks, so current NHS screening requires timely examination, referral and specialist orchidopexy planning.

In a nutshell

Cryptorchidism is a testis absent from the scrotum. Many testes descend in early infancy; current NHS England NIPE guidance advises review at 4 to 5 months and referral if still undescended or impalpable, so specialist assessment occurs no later than 6 months. Orchidopexy is usually performed around 1 year. Bilateral impalpable testes or hypospadias need urgent endocrine/DSD assessment; acute pain is possible torsion.

Classic presentation

A newborn boy has an empty hemiscrotum and a palpable inguinal testis; at 5 months it remains undescended and needs referral rather than ultrasound.

Key points

Differentiate a retractile testis, which can be brought down and stays, from true or ascending cryptorchidism.
Follow the current NIPE timing: review at 4 to 5 months and refer no later than 6 months if persistent.
Do not delay referral for routine ultrasound; impalpable testes are assessed by paediatric surgery/urology.
Orchidopexy is usually planned around 1 year, with technique determined by testis position.
Cancer risk remains above baseline after orchidopexy; teach testicular awareness from puberty.
Bilateral impalpable testes with hypospadias or atypical genitalia require urgent DSD/endocrine assessment.

First-line investigation

Warm clinical examination of both testes, with repeat NIPE/primary-care review and specialist surgical assessment if persistent.

Management

Examine and review

Examine both testes in the newborn period and distinguish a retractile testis from an undescended or ascending testis.^1,3
Review a persistent non-scrotal testis at 4 to 5 months and refer if still undescended or impalpable so specialist assessment occurs by 6 months.^1,2

Correct persistent disease

Offer specialist orchidopexy, usually around 1 year, with open or laparoscopic/staged technique according to testis position.^2,4,3
Do not routinely image an impalpable testis before referral; laparoscopy may locate it and guide treatment.^1,4

Escalate atypical cases

Bilateral impalpable testes, especially with hypospadias or atypical genitalia, need urgent paediatric endocrine, genetic and specialist assessment.¹

Protect the future

Follow retractile or ascending testes, explain persistent cancer risk after orchidopexy, and teach testicular awareness from puberty; acute pain or swelling needs emergency assessment.^1,3,4

Exam traps

A retractile testis is not the same as an undescended testis.
Routine ultrasound should not delay referral of an impalpable testis.
Orchidopexy reduces but does not abolish future testicular cancer risk.
Bilateral impalpable testes with hypospadias are not a routine outpatient cryptorchidism problem.
A painful groin or scrotum is a torsion emergency, not a routine review.

Illustrations

Inguinal undescended testis on ultrasoundAnnotated longitudinal ultrasound showing an undescended testis in the inguinal region between the pubic bone and empty scrotum; retain source attribution while image-quality remediation remains separate.Mikael Häggström, Wikimedia Commons · CC0

Key sources

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.