Evaluation and Treatment of Cryptorchidism
Publication Date: August 1, 2014
Last Updated: March 14, 2022
Guideline Statements
Diagnosis
Providers should obtain gestational history at initial evaluation of boys with suspected cryptorchidism. (Strong, B)
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Primary care providers should palpate testes for quality and position at each recommended well-child visit. (Strong, B)
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Providers should refer infants with a history of cryptorchidism (detected at birth) who do not have spontaneous testicular descent by six months (corrected for gestational age) to an appropriate surgical specialist for timely evaluation. (Strong, B)
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Providers should refer boys with the possibility of newly diagnosed (acquired) cryptorchidism after six months (corrected for gestational age) to an appropriate surgical specialist. (Strong, B)
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Providers must immediately consult an appropriate specialist for all phenotypic male newborns with bilateral, nonpalpable testes for evaluation of a possible disorder of sex development. (Strong, A)
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Providers should not perform ultrasound or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral, as these studies rarely assist in decision making. (Strong, B)
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Providers should assess the possibility of a disorder of sex development (DSD) when there is increasing severity of hypospadias with cryptorchidism. (Moderate, C)
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In boys with bilateral, nonpalpable testes who do not have congenital adrenal hyperplasia, providers should measure müllerian inhibiting substance or anti-müllerian hormone and consider additional hormone testing to evaluate for anorchia. (Conditional, C)
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In boys with retractile testes, providers should assess the position of the testes at least annually to monitor for secondary ascent. (Strong, B)
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Treatment
Providers should not use hormonal therapy to induce testicular descent as evidence shows low response rates and lack of evidence for long-term efficacy. (Strong, B)
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In the absence of spontaneous testicular descent by six months (corrected for gestational age), specialists should perform surgery within the next year. (Strong, B)
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In prepubertal boys with palpable, cryptorchid testes, surgical specialists should perform scrotal or inguinal orchidopexy. (Strong, B)
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In prepubertal boys with nonpalpable testes, surgical specialists should perform examination under anesthesia to reassess for palpability of testes. If nonpalpable, surgical exploration and, if indicated, abdominal orchidopexy should be performed. (Strong, B)
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At the time of exploration for a nonpalpable testis in boys, surgical specialists should identify the status of the testicular vessels to help determine the next course of action. (Clinical Principle)
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In boys with a normal contralateral testis, surgical specialists may perform an orchiectomy (removal of the undescended testis) if a boy has a normal contralateral testis and either very short testicular vessels and vas deferens, dysmorphic or very hypoplastic testis, or postpubertal age. (Clinical Principle)
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Providers should counsel boys with a history of cryptorchidism and/or monorchidism and their parents regarding potential long-term risks and provide education on infertility and cancer risk. (Clinical Principle)
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Recommendation Grading
Overview
Title
Evaluation and Treatment of Cryptorchidism
Authoring Organization
American Urological Association
Publication Month/Year
August 1, 2014
Last Updated Month/Year
May 30, 2023
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
This guideline is intended to provide physicians and non-physician providers (primary care and specialists) with a consensus of principles and treatment plans for the management of cryptorchidism
Inclusion Criteria
Male, Adolescent, Child, Infant
Health Care Settings
Ambulatory, Hospital
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management, Treatment
Diseases/Conditions (MeSH)
D003456 - Cryptorchidism
Keywords
cryptorchidism, undescended testis, testis cancer
Supplemental Methodology Resources
Methodology
Number of Source Documents
244
Literature Search Start Date
January 1, 1980
Literature Search End Date
March 1, 2013