Cryptorchidism · Observe vs Orchidopexy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Age + palpability + type
   Age? Testis palpable? Retractile?
   • <6 months, undescended → <6 months → observe
   • ≥6 months still undescended, palpable → Palpable → inguinal orchidopexy
   • ≥6 months, non-palpable → Non-palpable → laparoscopic localization
   • Retractile testis (manually descendable, stays in the scrotum) → Retractile → follow up
2. [End] <6 months → observe
   <6 months → watchful waiting (some descend spontaneously); operate if still undescended after 6 months (corrected); hormone therapy is not routinely recommended.
3. [End] Palpable → inguinal orchidopexy
   ≥6 months, palpable undescended → inguinal orchidopexy, ideally completed within 6–18 months to reduce infertility and malignancy risk.
4. [End] Non-palpable → laparoscopic localization
   ≥6 months, non-palpable → diagnostic laparoscopic localization; an intra-abdominal testis is fixed (staged Fowler-Stephens if needed); manage the stump for an atrophic/absent testis; a postpubertal unilateral intra-abdominal testis may be removed.
5. [End] Retractile → follow up
   Retractile testis → observe and follow up (usually normal), annual review; some ascend to acquired undescended testis and need surgery.

Source guidelines & references

• Cryptorchidism management (AUA; EAU/ESPU pediatric urology guidelines)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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