Diagnosis and Management of the Undescended Testicle: A Modern Update on Cryptorchidism for the Primary Care Clinician

Cryptorchidism affects 3% of term and a higher percentage of per-term males. Undescended testicles present in a variety of ways and have impact on fertility potential and malignancy risk. The purpose of this review is to provide the primary care provider with an update on current guideline-based management of cryptorchidism and will serve as an all-in-one resource for optimized care. The initial evaluation of cryptorchidism centered on a nuanced physical exam. Newborn phenotypic boys with bilateral undescended testicles should be evaluated urgently for congenital adrenal hyperplasia and followed with hormone evaluation. There is no role for imaging in the routine workup of boys with an undescended testicle. Cryptorchidism is a common and treatable condition. Boys with unilateral undescended testicles should be referred to a pediatric urologist for intervention as early as 6 months to preserve fertility potential and reduce malignancy risk. Boys with descended testicles at birth require annual genital exams to monitor for secondary or acquired ascent.