Which physical findings are characteristic of cryptorchidism?

Updated: Dec 17, 2020
  • Author: Joel M Sumfest, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

In cryptorchidism, the most useful determination is whether the testes are palpable upon physical examination. Although this is seemingly self-explanatory, accurately determining the exact location of the testis is occasionally difficult. Body habitus, testicular position, and compliance of the child all are factors during the physical examination. Nonpalpable testes may be intra-abdominal or absent. Palpable testes may be undescended, ectopic, or retractile.

Approximately 80% of undescended testes are palpable and 20% are nonpalpable. [24] Most intra-abdominal testes are found within a few centimeters of the internal ring. Absent or vanishing testes are thought to be due to an intrauterine or perinatal vascular event, most likely during late gestation since most of these testicular nubbins are found below the internal inguinal ring. Only 20-40% of nonpalpable testes are absent upon surgical exploration.

Ectopic testes exit the external inguinal ring and are then misdirected along the normal course of the testis. Retractile testes may be palpated anywhere along the natural course of the testis, although most are inguinal. Although not truly undescended, these testes may be suprascrotal secondary to an active cremasteric reflex. This reflex is usually weak in infants and most active in boys aged 5 years. These testes can be manipulated into the scrotum, where they remain without tension. This condition is considered a variant of normal; however, the risk of ascent may approach 50%. [25, 26] Ascent probably represents an undescended testis that was almost in normal position. The distinction can be difficult, even to an experienced pediatric urologist. Therefore, children with retractile testes should be monitored regularly, at least until puberty.


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