Child health
AKT · Child health/Neonatal & surgicallow yield
Cryptorchidism
Undescended testis
Overview
Failure of one or both testes to descend into the scrotum. Most descend by 3 months; those still undescended at 6 months need referral. Important for fertility and (lifelong) testicular-cancer risk.
Recognise
- Empty scrotum; testis palpable in the inguinal canal or impalpable
- Unilateral > bilateral
- Distinguish from retractile testis (brings down, stays)
Red flags
- Bilateral impalpable testes with hypospadias → urgent endocrine/genetic work-up (DSD)
Differentials & how to tell them apart
Retractile testiscan be milked into scrotum and stays — no treatment
Ascending testispreviously descended, now high
Anorchiaabsent testis
Investigations
Clinical examination (warm hands). Bilateral impalpable → karyotype, hormonal evaluation; laparoscopy locates intra-abdominal testes.
Management
Orchidopexy (by ~12–18 months if not descended)
- 1Review at 6–8 weeks and 4–5 months. Refer if still undescended at 6 months.Gate: Bilateral impalpable testes (± hypospadias) → urgent referral to exclude a disorder of sex development
- 2Orchidopexy by 12–18 months to preserve fertility and allow examination.
Orchidopexy — surgical fixation, ideally by 12–18 months
Key points
Undescended testis carries a higher (and still elevated after orchidopexy) testicular cancer risk — orchidopexy aids examination, not just fertility.
Monitor & prognosis
Position post-op; later self-examination advice.
Good; residual fertility/cancer considerations.
Source: NICE CKS; paediatric urology