Diagnostic Precision and Surgical Management of Canine Cryptorchidism: A Clinical Case Approach

Cryptorchidism remains one of the most clinically significant reproductive disorders encountered in small animal practice. While often asymptomatic, its implications, ranging from infertility to neoplasia, demand timely diagnosis and intervention. This case-driven discussion highlights the importance of structured clinical evaluation, imaging, and surgical decision-making in managing abdominal cryptorchidism. 

Understanding the Clinical Problem 

Cryptorchidism is defined as the failure of one or both testes to descend into the scrotum within the expected developmental window, typically by six months of age^1,2. Instead, the testes may remain in the abdominal cavity, inguinal canal, or ectopic locations. The condition is associated with developmental anomalies involving the gubernaculum and suspensory ligaments¹. 

Clinically, retained testes are often smaller and asymptomatic unless complicated by torsion, inflammation, or neoplasia. Despite the absence of overt pain, hormonal activity persists, contributing to behavioral abnormalities such as hypersexuality and aggression¹. 

Case Presentation: A Surgical Perspective 

A one-and-a-half-year-old male Golden Retriever weighing 26 kg presented with excessive sexual behavior and abnormal penile protrusion. Physical examination revealed a rudimentary scrotum with the absence of palpable testes. Vital parameters were within normal limits, indicating systemic stability for further diagnostics and intervention. 

Palpation, although routinely performed, failed to locate the testes, a limitation observed in nearly 52% of cases¹. This reinforces the need for adjunct diagnostic tools in cryptorchid cases. 

Role of Imaging in Diagnosis 

Radiographic imaging of the abdomen and pelvis did not reveal the retained testes, consistent with known limitations of X-rays in identifying soft tissue structures like undescended testes¹. 

Ultrasonography, however, proved decisive. Using a trans-abdominal probe (5–10 MHz), both testes were identified based on their echogenicity and structural characteristics. Ultrasound has been shown to have high sensitivity (96.6% for abdominal testes) and is considered superior to exploratory surgery for localization¹. 

Key ultrasonographic features included: 

• Hypoechoic to moderately echogenic oval structures 

• Distinct texture compared to surrounding organs 

• Absence of normal mediastinum in some cases 

This case reinforces ultrasound as a first-line diagnostic modality for non-palpable testes. 

Pre-Surgical Evaluation and Planning¹ 

A complete blood profile, including CBC, liver and renal function tests, and glucose levels, revealed no abnormalities. This step is crucial to rule out systemic contraindications before anesthesia and surgery. 

The dog was fasted for 12 hours prior to surgery. Premedication included: 

• Xylazine (1 mg/kg IM) 

• Atropine sulfate (0.02 mg/kg SC) 

Prophylactic medications included ceftriaxone (15 mg/kg IV) and meloxicam (0.2 mg/kg). General anesthesia was induced using diazepam and ketamine in a 1:1 ratio. 

Surgical Approach and Technique¹ 

A caudal midline laparotomy was performed, extending from the umbilicus to the cranial pubis. This approach provides optimal exposure for abdominal exploration and identification of retained testes. 

Both testes were successfully located and excised. The spermatic cord was ligated using absorbable catgut suture material. The abdomen was closed in three standard layers. 

Clinical Pearls for Surgeons 

• Always explore the caudal abdomen systematically to avoid missing ectopic testes 

• Confirm absence of both testes before closure in bilateral cases 

• Gentle tissue handling reduces postoperative complications 

Postoperative Care 

Postoperative management included¹: 

• Antibiotic therapy for five days 

• Daily wound dressing 

• Monitoring for complications such as edema, infection, or bleeding 

The recovery was uneventful, emphasizing that timely surgical intervention yields excellent outcomes. 

Why Early Intervention Matters 

Cryptorchid testes carry a significantly higher risk of neoplastic transformation, up to 13.6 times compared to normal testes. Common tumors include seminomas and Sertoli cell tumors, the latter often associated with feminization syndrome^1,3. 

Additionally, abdominal testes are more prone to torsion due to increased mobility¹. Early removal eliminates these risks and prevents long-term endocrine complications. 

Take-Home Clinical Insights 

• Always suspect cryptorchidism in dogs with absent scrotal testes 

• Do not rely solely on palpation, use ultrasonography for confirmation 

• Radiography has limited diagnostic value in these cases 

• Surgical removal (orchiectomy) remains the gold standard treatment 

• Early intervention prevents serious complications like torsion and neoplasia 

Conclusion 

This case exemplifies the importance of a systematic approach to cryptorchidism—combining clinical suspicion, imaging precision, and surgical expertise. Ultrasonography stands out as a critical diagnostic tool, while timely orchiectomy ensures both therapeutic and preventive benefits. For practicing veterinarians, integrating these steps into routine workflows can significantly improve patient outcomes and reduce long-term complications. 

Reference 

1. Shrestha A, Neupane N, Nepal G, Rimal S. Bilateral Abdominal Cryptorchidism: A Case Study in Dog and Review of Its Relevant Consequences. Mathews Journal of Veterinary Science. 2025 May 30;9(5):1-8. https://www.mathewsopenaccess.com/full-text/bilateral-abdominal-cryptorchidism-a-case-study-in-dog-and-review-of-its-relevant-consequences 

2. Leslie SW, Sajjad H, Villanueva CA. Cryptorchidism. [Updated 2024 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470270/ 
3. Park EJ, Lee SH, Jo YK, Hahn SE, Go DM, Lee SH, Lee BC, Jang G. Coincidence of Persistent Müllerian duct syndrome and testicular tumors in dogs. BMC veterinary research. 2017 Jun 2;13(1):156. https://link.springer.com/content/pdf/10.1186/s12917-017-1068-6.pdf