Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness

Area of Science:

• Pediatric Urology
• Diagnostic Imaging
• Genitourinary Anomalies

Background:

• Cryptorchidism, or undescended testis, is the most frequent genitourinary anomaly observed in male infants.
• Accurate localization of undescended testes is crucial for appropriate management and to prevent potential complications.

Purpose of the Study:

• To review the diagnostic performance of various imaging modalities for localizing undescended testes.
• To determine the role of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) in evaluating cryptorchidism.

Main Methods:

• A comprehensive literature review was conducted.
• The diagnostic accuracy (sensitivity and specificity) of ultrasound, CT, and MRI for undescended testes was analyzed.

Main Results:

• Ultrasound demonstrates limited utility for nonpalpable undescended testes, with reported sensitivity and specificity of 45% and 78%, respectively.
• MRI offers higher accuracy but is limited by cost, availability, and the need for sedation in pediatric patients.
• Diagnostic laparoscopy provides nearly 100% sensitivity and specificity for localization and enables simultaneous surgical correction.

Conclusions:

• Diagnostic imaging, including ultrasound, is generally not indicated for routine cryptorchidism evaluation.
• Imaging, particularly ultrasound, may be necessary in specific cases, such as evaluating children with ambiguous genitalia or hypospadias alongside undescended testes to identify müllerian structures.