Undescended testisBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l926 (Published 25 March 2019) Cite this as: BMJ 2019;364:l926
- Alexander Cho, paediatric urology fellow1,
- Johanna Thomas, consultant urologist2,
- Ranil Perera, general practitioner3,
- Abraham Cherian, consultant paediatric urologist1
- 1Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- 2Royal Berkshire Hospital, Reading, UK
- 3Conway PMS, London, UK
- Correspondence to: A Cherian
What you need to know
Examine testicular position in boys at newborn and 8 weeks old to identify undescended testis
Review at 3 months of age to check for spontaneous descent of testes; if still undescended refer to a surgeon
Urgently refer children with bilateral impalpable testes, penile abnormalities, or ambiguous genitalia to a tertiary paediatric centre
There is no role for pre-referral radiological imaging in children with undescended testes
Orchidopexy (surgical correction to reposition the testis) is ideally done between 6 and 18 months of age
Undescended testis or cryptorchidism is a common congenital anomaly affecting about 2-8% of boys in population studies in Europe.1 In the UK, about 6% of boys have an undescended testis at birth.2
Timely referral and surgical correction may improve fertility and reduce the malignancy rate associated with undescended testes.3 This article advises the non-specialist on evaluation of newborns and infants for undescended testis and current recommended practice in management.
How do patients present?
Testicular position is usually assessed in boys at newborn and 8 week checks. Parents may present with concerns about their child’s genitalia. Few patients present at a later age if the diagnosis was missed earlier or with the development of an ascending testis.4 Box 1 describes a classification based on site of undescended testis on examination.
Classification of undescended testis
True undescended testis—The testis lies along the expected path of descent but has never been present in the scrotum
Ectopic testis—The testis is palpated in a location outside the normal path of descent, such as the perineum or femoral area
Ascending testis—A previously descended testis that no longer lies within the scrotum. This has a peak incidence around 10 years of age and affects 1-2%.4 It may also occur as a complication of inguinal hernia surgery in children5
Risk factors include earlier gestational age …