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Author: Jonathan Jarow Last modified: March 19, 2002


  • One of the most common congenital anomalies in man.
  • Incidence at birth is 3.4%.
  • Many of these testes will descend within the first year of life.
  • Incidence at 1 year of life is approximately 1%.


  • Kallmann syndrome.
  • Anencephaly or pituitary aplasia.
  • Steroidogenic enzyme deficiency.
  • 5-alpha reductase deficiency.
  • Androgen resistance.
  • Prune belly syndrome.


  • Non-palpable testis.
  • Testis palpable in inguinal canal that cannot be brought down into the scrotum.
  • Testis palpable at an ectopic position; superficial inguinal pouch, suprapubic, contralateral scrotum, femoral or perineal.


  • True undescended testis.
  • Retractile testis.
  • Testicular agenesis.
  • Neonatal testicular torsion.


  • Endocrine studies, basal FSH, may be performed to differentiate anorchia from bilateral cryptorchidism.
  • Radiologic imaging, ultrasonography, CT and angiography, are only 44% accurate in determing the presence and location of non-palpable testes.
  • Ultrasonography may be utilized to monitor undescended testes for testicular cancer.
  • Laparoscopy may be used to determine the presence and location of non-palpable testes (ie. blind ending vessels infer that the testis is absent).
  • GnRH (1.2 mcg/day intranasal times 4 weeks) is utilized in cryptorchid children with low LH levels to reverse a pituitary defect such as Kallmann syndrome.
  • Hormonal therapy is only effective at inducing complete testicular descent is certain cryptorchid patients with endocrine abnormalities and patients with retractile testes.
  • hCG (100 IU/kg IM 3X weekly for 3 weeks)should be given to those patients with palpable undescended testes to differentiate between true cryptorchidism and retractile testes.
  • hCG (100 IU/kg IM 3X weekly for 3 weeks) may given prior to surgery to beef up the testicular vasculature.
  • Standard inguinal orchidopexy is performed for the vast majority of true undescended testes and ectopic testes.
  • Fowler-Stephens orchidopexy is utilized for high intra-abdominal testes and is based upon dividng the gonadal vessels and sparing the deferential vessels.
  • Microvascular autotransplantation is an option for the high intra-abdominal undescended testis.
  • Laparoscopic orchidopexy has been utilized as either a two stage approach whereby the gonadal vessels are ligated and an open Fowler-Stephens is subsequently performed or as a single stage procedure.
  • Orchiectomy is recommended for adults with untreated unilateral cryptorchidism because of the risk of neoplasia. However, the risks of surgery exceed the risk of neoplasia after age 32 years.
  • Retractile testes descend normally during puberty and have normal fertility potential.
  • There is a significant increased risk of testicular neoplasia of undescended testes regardless of treatment that requires lifetime monitoring.
  • There appears to be a deleterious effect of cryptorchidism, even unilateral, upon fertility regardless of age of treatment. However, follow up data on boys treated at approximately age 1 year has not
  • Syndromes associated with cryptorchidism include Klinefelter, Noonan, Prader-Willi and cystic fibrosis.
  1. Jordan GH ;  Laparoscopic management of the undescended testicle ;  Urol Clin North Am 2001 Feb;28(1):23-9, vii-viii

  2. Wolf CK, Maizels M, Furness PD 3rd. ;  The undescended testicle. ;  Compr Ther 2001 Spring;27(1):11-7

  3. Callaghan P. ;  Undescended testis. ;  Pediatr Rev 2000 Nov;21(11):395

  4. Jennings RW. ;  Prune belly syndrome. ;  Semin Pediatr Surg 2000 Aug;9(3):115-20

  5. Dieckmann KP, Skakkebaek NE. ;  Carcinoma in situ of the testis: review of biological and clinical features ;  Int J Cancer 1999 Dec 10;83(6):815-22

  6. Nguyen HT, Coakley F, Hricak H ;  Cryptorchidism: strategies in detection ;  Eur Radiol 1999;9(2):336-43

  7. Toppari J, Skakkebaek NE ;  Sexual differentiation and environmental endocrine disrupters ;  Baillieres Clin Endocrinol Metab 1998 Apr;12(1):143-56

  8. Gill B, Kogan S ;  Cryptorchidism. Current concepts ;  Pediatr Clin North Am 1997 Oct;44(5):1211-27

  9. Jarow JP, Berkovitz GD, Migeon CJ, Gearhart JP, Walsh PC ;  Elevation of serum gonadotropins establishes the diagnosis of anorchism in prepubertal boys with bilateral cryptorchidism ;  J Urol 1986 Jul;136(1 Pt 2):277-9

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