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Tests and diagnosis
By Mayo Clinic staffYour doctor can easily determine that a testicle hasn't descended into the scrotum. The goal of further examination is to locate the position of the testicle and monitor changes in its position. If the testicle is in the groin, your doctor may be able locate it by touch. If it can't be felt (nonpalpable), then he or she will likely refer you to a pediatric urologist for further tests. About 20 percent of undescended testicles are nonpalpable.
If your son has a nonpalpable testicle, the pediatric urologist may order one or more of the following procedures:
- Ultrasound. An ultrasound is a noninvasive device that uses sound waves to create images of internal structures of the body. An ultrasound may enable the pediatric urologist to locate a nonpalpable testicle, particularly if it's located within the groin.
- Magnetic resonance imaging (MRI) with a contrast agent. MRI is a technology that uses a magnetic field and radio waves to create images of soft tissues in the body. A contrast agent is a safe "dye" injected into the bloodstream that can improve the imaging capability of the procedure. This procedure may enable your pediatric urologist to locate a testicle in the groin or abdomen.
- Laparoscopy. This procedure is generally considered the best choice for locating a nonpalpable undescended testicle. Laparoscopy uses a tiny video device connected to a tube that a surgeon inserts through a small incision in your son's abdomen. Images appear and can be enlarged on a video screen. Surgical correction of the undescended testicle may be done during the same procedure.
- Open surgery. Direct exploration of the abdomen through a larger incision may be necessary in a small number of more complicated cases.
Other diagnostic issues
If your infant has two nonpalpable undescended testicles, your doctor may order tests to determine the sex of your child. The "absent" testicles may, for example, be because your child is genetically a female but has external male genitals. This condition of unclear biological sex is called ambiguous genitalia, or intersex. Tests to assess the possibility of ambiguous genitalia include:
- Measurements of various hormone levels in blood and urine
- Analysis of your baby's sex-related genes
- Ultrasound investigation for female sex organs (ovaries)
- Elder J. Disorders and anomalies of the scrotal contents. In: Kliegman R, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa.: Saunders, Elsevier; 2007. http://www.mdconsult.com/das/book/body/102535550-2/0/1608/1246.html?tocnode=54484554&fromURL=1246.html#4-u1.0-B978-1-4160-2450-7..50547-8_9817. Accessed Aug. 15, 2008.
- Hutson JM, et al. Current management of the undescended testicle. Seminars in Pediatric Surgery 2007;16(1):64-70.
- Barthold JS. Undescended testis: Current theories of etiology. Current Opinion in Urology. 2008;18(4):395-400.
- Kelsberg G, et al. Clinical inquiries. When should a child with an undescended testis be referred to a urologist? Journal of Family Practice. 2006;55(4):336-337.
- Cooper, CS. Undescended testicle (cryptorchidism). www.uptodate.com/home/index.html. Accessed July 25, 2008.
- Esposito C, et al. Management of boys with nonpalpable undescended testis. Nature Clinical Practice Urology. 2008;5(5):252-60.
- Liptak GS. Genital defects. The Merck Manuals Online Medical Library. http://www.merck.com/mmhe/sec23/ch265/ch265d.html. Accessed Aug. 19, 2008.
