Cryptorchidism
Basics
Description
- Incomplete or improper descent of one or both testicles; also called undescended testes (UDT) (1)
- Normally descent is in month 7 to 8 of gestation. The cryptorchid testis may be palpable or nonpalpable.
- Can be congenital or acquired
- Types of cryptorchidism
- Prescrotal: at or above scrotal inlet
- Abdominal: testis located inside the internal inguinal ring
- Canalicular: testis located between the internal and external inguinal rings
- Ectopic: located outside the normal path of testicular descent; may be ectopic to perineum, femoral canal, superficial inguinal pouch (most common), suprapubic area, or opposite hemiscrotum
- Retractile: fully descended testis that moves freely between the scrotum and the groin
- Iatrogenic: Previously descended testis becomes undescended due to scar tissue after inguinal surgery.
- Also may be referred to as palpable versus nonpalpable (1)
- System(s) affected: reproductive
- Synonym(s): UDT
Epidemiology
Incidence
Predominant age: newborn, more common in premature newborns
Prevalence
Etiology and Pathophysiology
- Not fully understood, may involve alterations in
- Mechanical factors (gubernaculum, length of vas deferens and testicular vessels, groin anatomy, epididymis, cremasteric muscles, and abdominal pressure), hormonal factors (gonadotropin, testosterone, dihydrotestosterone, and müllerian-inhibiting substance), and neural factors (ilioinguinal nerve and genitofemoral nerve)
- Insulin-like growth factor 3 (IGF-3) or androgen receptor gene (1)
- Environmental factors acting as endocrine disruptors
- Major regulators of testicular descent are the Leydig cell–derived hormones, testosterone, and IGF-3.
- Risk of ascent as high as 32% in retractile testis
Genetics
Increased risk of UDT in first-degree relatives suggests a genetic etiology.
Risk Factors
- Family history: highest risk if brother had UDT, followed by uncle and then father
- Low birth weight, prematurity, and small for gestational age (1)
- Retractile testes are at increased risk for ascent.
- Maternal smoking and diabetes during gestation
Commonly Associated Conditions
- Anatomic anomalies: inguinal hernia/hydrocele, abnormalities of vas deferens and epididymis, hypospadias, meningomyelocele
- Endocrine disorders: intersex abnormalities, hypogonadotropic hypogonadism, germinal cell aplasia
- Genetic disorders: Prune-belly syndrome, Prader-Willi syndrome, Kallmann syndrome, cystic fibrosis
- Wilms tumor
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Citation
Domino, Frank J., et al., editors. "Cryptorchidism." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688555/all/Cryptorchidism.
Cryptorchidism. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688555/all/Cryptorchidism. Accessed December 9, 2024.
Cryptorchidism. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688555/all/Cryptorchidism
Cryptorchidism [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 09]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688555/all/Cryptorchidism.
* Article titles in AMA citation format should be in sentence-case
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