Undescended Testicle Examination: What Is Checked, How to Prepare

In the evaluation of undescended testicle (cryptorchidism), all planning rests on the answer to two questions: is the testicle palpable, and if so, where? These two answers determine much of the path ahead — from which surgery will be needed to where it will be performed.

What families usually notice first is a difference between the two sides of the scrotum: one side looks full and hangs normally, while the other looks flat, small, and empty. When the testicle stays in the inguinal canal, a small bulge may be noticeable in that area. In bilateral cases the whole scrotum looks underdeveloped, and because there is no side to compare with, the difference is often noticed later.

• Appearance alone does not make the diagnosis in an infant. A testicle pulled upward by cold, or hidden behind diaper padding and fat tissue, can also give the impression of an empty scrotum; conversely, a testicle seen in the scrotum during a bath may sit higher later in the day. This is why comparing your child to photos online is misleading — only an examination in a warm room can make the distinction.

The testicle is pulled upward by the reflex of a thin muscle called the cremaster muscle in response to cold, fright, and touch. This reflex is weak in infancy and strengthens from around age two through school age; this is why the same child may be found 'undescended' at the clinic in the morning and 'in the scrotum' during a bath that evening.

If the testicle can be felt in the groin or above the scrotum, the physician evaluates several things together. The first is the lowest point to which the testicle can be brought down and whether it stays there; the second is its size and consistency, especially compared with the other testicle. A small, soft testicle is noted for follow-up, even though on its own it may not carry particular significance.

• Where the testicle can be brought down to, and whether it stays there
• Size and consistency; comparison with the other testicle
• Whether it lies on the normal path of descent or in an ectopic position
• Development of that half of the scrotum
• Any accompanying hernia, hydrocele, or penile anomaly

In a non-palpable testicle, the examination does not complete the diagnosis, but it does provide important clues. Marked enlargement of the other testicle may suggest it has taken over the function of a missing or non-functioning testicle; however, this alone is not decisive and does not remove the need for laparoscopy.

• At this point, families are usually told: ultrasound or MRI will not get you a step further. Definitive evaluation of a non-palpable testicle is carried out through a repeat examination while the child is under anesthesia and, if needed, diagnostic laparoscopy (a minimally invasive look inside the abdomen through a thin camera placed at the navel). These steps are planned in the same session, by the same team.

A few pieces of information gathered before the visit make the physician's job easier. You'll be asked about: gestational week and birth weight, whether the testicles were seen in the scrotum in infancy, results of any earlier examinations or ultrasounds, and any family history of undescended testicle.