• Rationale and Comments

    Referring providers should not perform or order ultrasound or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral, as these studies rarely assist in decision-making. This is a standard in the American Urological Association Guideline statements with Grade B strength of evidence, based on strong observational studies. More than 70% of cryptorchid testes are palpable on examination by an experienced provider. Ultrasound has a sensitivity of 45% and specificity of 78% for localization of a nonpalpable undescended testis. CT imaging is usually avoided due to the risks of ionizing radiation. MRI has greater sensitivity and specificity compared with ultrasound, but is deferred by higher costs and the possible need for anesthesia. As there is no test that is sufficiently accurate, safe, and accessible to confirm testicular absence, a surgical exploration such as diagnostic laparoscopy or open exploration is the first-line choice for both diagnostic and therapeutic purposes for nonpalpable testes.

    Sponsoring Organizations

    • American Academy of Pediatrics - Section on Urology


    • Systematic review and meta-analysis


    • Pediatric
    • Urologic


    • Kolon TF, Herndon CD, Baker LA, et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014;192(2):337-345.
    • Tasian GE, Copp HL. Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis. Pediatrics. 2011;127(1):119-128.
    • Kanaroglou N, To T, Zhu J, et al. Inappropriate use of ultrasound in management of pediatric cryptorchidism. Pediatrics. 2015;136(3):479-486.