Our approach to the initial evaluation of and referral for cryptorchidism in children

CAH: congenital adrenal hyperplasia; DSD: difference of sex development.

* Referral to pediatric urology may be warranted if the clinician is uncertain whether or not a testis is palpable or whether what is palpated is a testis.

¶ A retractile testis often can be brought into a dependent scrotal position and will remain there if it is held in the scrotum for ≥1 minute to overcome the cremasteric reflex. However, differentiation between a retractile and a truly undescended testis can be difficult and may require consultation with a pediatric urologist.

Δ Testis that has stopped short along its normal path of descent into the scrotum. Undescended testes may remain in the abdomen, in the inguinal canal, or just outside the external ring (suprascrotal).

◊ Normal testis that has been pulled into a suprascrotal position by the cremasteric reflex.

§ Testis that descended normally through the external ring but was diverted to an aberrant position (eg, superficial inguinal pouch, suprapubic region, femoral canal, perineum, contralateral scrotal compartment). Ectopic testes in the superficial inguinal pouch may be indistinguishable from true undescended testes on examination.

¥ Refer to UpToDate content on evaluation of DSD in children for details.