How is undescended testis diagnosed?

An undescended testis is easily diagnosed by its absence from the scrotum. The doctor will use his finger to feel around, or palpate, for the testicle. In 70 percent of undescended testis cases, the doctor will be able to feel the testicle through the abdominal wall. In cases where the doctor cannot feel the testicle, it may be because the testicle is too deep inside the body, or it may be because the testicle never formed properly and is not present at all.

Evaluation of the position and health of the testes is a part of the newborn and annual male pediatric physical examination. Most often the diagnosis of an undescended testis initially made by a pediatrician or family practioner who discovers that the testis is above the normal scrotal position. Referral to a physician trained in pediatric urology or pediatric surgery is then made for the purpose of confirming the diagnosis and determining the best treatment. The two conditions that must be considered by the surgeon, are whether a testis residing in an elevated position is truly undescended versus a testis that is normal but retractile.

All males have a sleeve of muscular tissue called the cremaster muscle that surrounds the cord structures (vas and vessels) leading to the testis. With natural contraction of this muscle, the testis will temporarily move, retract, to a higher position. With relaxation of this muscle the testis will fall back into a normal scrotal position. This cremasteric reflex is much more active in young boys than in postpubertal males. To declare a testis as retractile the examiner should be able to locate the testis on physical exam and gently displace the testis to a scrotal position where the testis will at least rest for a few seconds before retracting up again. A true undescended testis either cannot be palpated at all; or, if it can be found, it cannot be displaced to a normal scrotal position during physical examination. This distinction is important since retractile testis are much more common and do not require operative treatment.  Generally, imaging such as ultrasound has not been found to helpful for the diagnosis of undescended testes unless both sides are undescended and neither can be palpated (bilateral nonpalpable undescended testes).

An undescended testicle (cryptochoridism) is a testicle that hasn’t correctly descended into its proper position in the scrotum prior to birth.  Typically just one testicle is affected, but it is possible for both to be undescended.
An undescended testicle is often detected shortly after birth and upon examination by the physician.  If the testicle is not in the scrotum, the physician will lightly press against the infant’s skin to try to locate it.  If the testicle is in the inguinal canal, the physician can try to move it gently into the scrotum. 
If the physician cannot feel the undescended testicle, they may order an ultrasound or MRI to locate it non-invasively.  A laparoscopy or open surgery can also be recommended, especially if the testicle is further in the abdomen and cannot be reached by hand, and involve a small incision in the baby’s abdomen to locate and help descend the testicle.
Your baby’s physician will determine how often he needs to be monitored for this condition.  If the problem hasn’t corrected itself by the time your son is 4 months old, surgery might be necessary.  Treating the undescended testicle while your son is still an infant can reduce the risk of complications later in life (including infertility and testicular cancer).

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.