Cryptorchidism

Question 1

Diagnosis

Answer 1

• Providers should obtain gestational history at initial evaluation of boys with suspected cryptorchidism.
• Primary care providers should palpate testes for quality and position at each recommended well-child visit.
• Providers should refer infants with a history of cryptorchidism (detected at birth) who do not have spontaneous testicular descent by six months (corrected for gestational age) to an appropriate surgical specialist for timely evaluation.
• Providers should refer boys with the possibility of newly diagnosed (acquired) cryptorchidism after six months (corrected for gestational age) to an appropriate surgical specialist.
• Providers must immediately consult an appropriate specialist for all phenotypic male newborns with bilateral, non-palpable testes for evaluation of a possible disorder of sex development (DSD).
• Providers should not perform ultrasound (US) or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral as these studies rarely assist in decision making.
• Providers should assess the possibility of a disorder of sex development (DSD) when there is increasing severity of hypospadias with cryptorchidism.
• In boys with bilateral, non-palpable testes who do not have congenital adrenal hyperplasia (CAH), providers should measure Müllerian Inhibiting Substance (MIS or Anti- Müllerian Hormone [AMH]) and consider additional hormone testing to evaluate for anorchia.
• In boys with retractile testes, providers should assess the position of the testes at least annually to assess for secondary ascent.

Question 2

Treatment

Answer 2

• Providers should obtain gestational history at initial evaluation of boys with suspected cryptorchidism.
• Primary care providers should palpate testes for quality and position at each recommended well-child visit.
• Providers should refer infants with a history of cryptorchidism (detected at birth) who do not have spontaneous testicular descent by six months (corrected for gestational age) to an appropriate surgical specialist for timely evaluation.
• Providers should refer boys with the possibility of newly diagnosed (acquired) cryptorchidism after six months (corrected for gestational age) to an appropriate surgical specialist.
• Providers must immediately consult an appropriate specialist for all phenotypic male newborns with bilateral, non-palpable testes for evaluation of a possible disorder of sex development (DSD).
• Providers should not perform ultrasound (US) or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral as these studies rarely assist in decision making.
• Providers should assess the possibility of a disorder of sex development (DSD) when there is increasing severity of hypospadias with cryptorchidism.
• In boys with bilateral, non-palpable testes who do not have congenital adrenal hyperplasia (CAH), providers should measure Müllerian Inhibiting Substance (MIS or Anti- Müllerian Hormone [AMH]) and consider additional hormone testing to evaluate for anorchia.
• In boys with retractile testes, providers should assess the position of the testes at least annually to assess for secondary ascent.

Question 3

Treatment algorithm

Answer 3