2-week old with empty scrotum
Patient will present as → a one-year-old child who is brought to your office for his 12-month visit. You note that the boy's testicles are inappreciable on the exam. The medical record reports that the child's testicles had been examined at two previous visits. The mother is very concerned and asks if her son will need surgery.
↑ Risk in premature infants 30% vs. 5% in full-term infants
- If not descended by 6 months and before he is 12 months old surgery (orchiopexy) should be performed.
- Complications of undescended testes is testicular cancer (in both descended and undescended testes) or infertility (which occurs in up to 75% of male children with bilateral cryptorchidism and in 50% of male children with unilateral cryptorchidism.)
Thorough GU exam, including an attempt to "milk" inguinally located testes into the scrotum
- If one or both testes are palpable in the scrotum or inguinal canal, re-examine at next well-child exam
- If neither testes are palpable at birth, obtain ultrasound and karyotype promptly
Undescended testes can be monitored for spontaneous descent over the first 6 months of life
- If still non-palpable at 6 mo well-child exam, refer to urology/surgery for evaluation and possible orchiopexy
- For absent testes, strongly consider consultation with a specialist regarding labs for CAH
Orchiopexy is not necessary