Introduction

Learning objectives

Distinguish an undescended testicle from a retractile testicle.
Know the risks associated with cryptorchidism and the appropriate timing for referral.
Understand when to recommend orchiopexy without unnecessary delay.

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Video lesson

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Video pending upload (embedded YouTube)

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Summary

What is it?

Cryptorchidism is the absence of one or both testicles from their normal position in the scrotum due to a disorder of descent.

Physical examination

When the scrotum appears empty, we should try to determine whether the testicle is:

palpable in the inguinal canal;
retractile;
ectopic;
non-palpable.

Retractile testicle

A retractile testicle can move upward due to the cremasteric reflex, but it can be manually brought down into the scrotum and stay there temporarily.

It is not the same as a truly undescended testicle.

Why does cryptorchidism matter?

It is associated with an increased risk of:

impaired fertility;
testicular cancer;
torsion;
inguinal hernia.

Should we wait several years?

No.

A proportion of testicles descend spontaneously during the first months of life. After approximately 6 months, spontaneous descent becomes unlikely.

Surgical treatment with orchiopexy should be performed early, usually during the second half of the first year of life and without unnecessary delay beyond the first 12–18 months.

Is an ultrasound needed before referral?

In a child with a non-palpable testicle, routine ultrasound generally does not replace specialist examination or change the need for referral.

Key concept

Testicle not in the scrotum at 6 months → refer for evaluation.

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PDF

⬇ Download lesson summary

Downloadable PDF pending upload.

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Practical algorithm

Non-retractile foreskin in a young child, without scarring or complications → probably physiological → do not force.
Retracted foreskin that cannot be returned + edema → paraphimosis → emergency.
Testicle outside the scrotum after the first months of life → refer → do not wait years.
Painless, fluctuant scrotal swelling → consider communicating hydrocele.
Adolescent with varicocele → assess testicular development and volume.
Infant with fever without a source → consider urinary tract infection.
Recurrent febrile UTI → assess the need to investigate urinary anomalies/VUR.
Sudden testicular pain → urgently rule out testicular torsion.

In Pediatric Urology, the primary care physician does not need to resolve every condition: they need to distinguish the physiological from the pathological, and recognize when to observe, when to investigate, when to refer and, above all, when to act urgently.

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Clinical case

Content pending upload Progressive clinical case focused on decision-making.

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Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

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References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Cryptorchidism