American Academy of Pediatrics Section on Urology

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Released January 4, 2022

Do not perform diagnostic imaging to establish the diagnosis of cryptorchidism.

Referring providers should not perform or order ultrasound (US) 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 (AUA) 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 to 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 gold standard for both diagnostic and therapeutic purposes for non-palpable testes.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The AAP Section on Urology (AAP SOU) Executive committee worked together to develop five items in the practice of Pediatric Urology of tests or procedures that should not be done routinely. Approximately 11 members of this committee participated in the process. They submitted items from their practices and experiences of tests or procedures they found were commonly over-utilized. The committee then agreed on a final list of 5 based on incidence and importance of the condition. Educational committee fellows then reviewed the appropriate guidelines and literature to provide references and support for each item. The AAP SOU Education committee reviewed the 5 listed items and provided further feedback then approved the list, descriptions, and references. The AAP Executive Committee granted final approval of the list.

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Kolon T, Herndon C, Baker L, et al. Evaluation and Treatment of Cryptorchidism. 2014 Guideline [online]. American Urological Association. Available at: cryptorchidism-guideline [Accessed 11 Nov. 2019].

Tasian GE, Copp HL. Diagnostic Performance of Ultrasound in Nonpalpable Cryptorchidism: A Systematic Review and Meta-analysis. Pediatrics. 2011 Jan:127(1):119-128.

Kanaroglou N, To T, Zhu J, et al. Inappropriate Use of Ultrasound in Management of Pediatric Cryptorchidism. Pediatrics. 2015 Sept:136(3): 479-486.