Background
Undescended Testes (UDT) is the most common genital disorder identified at birth.
Diagnosis
Palpate testes for quality and position at every well-child visit.
Cryptorchidism (detected at birth) vs. newly diagnosed (acquired) cryptorchidism after 6 months (corrected for GA)
Don’t do U/S or any other imaging before referring (Per AUA). It rarely helps in decision making.
Complications: UDT increases the risk of testicular cancer, especially if orchiopexy is done after puberty.
Treatment / Management
Cryptorchidism detected at birth. Refer to urology at 6 months of age (corrected for GA) if it hasn’t spontaneously descended.
Newly diagnosed (acquired) cryptorchidism after six months (corrected for gestational age). Refer to urology immediately.
Consult an appropriate specialist for all phenotypic male newborns with bilateral, nonpalpable testes for evaluation of a possible DSD.
Assess the possibility of a DSD when there is increasing severity of hypospadias with cryptorchidism.
In boys with bilateral, nonpalpable testes who do not have CAH, measure Müllerian Inhibiting Substance (MIS or Anti- Müllerian Hormone [AMH]) level), and consider additional hormone testing, to evaluate for anorchia.
In boys with retractile testes, assess the position of the testes at least annually to monitor for secondary ascent.
Specialist to perform surgery within the next year.
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**GA = Gestational Age; CAH=congenital adrenal hyperplasia; DSD =disorder of sex development
Further Reading / Reference
American Urological Association (AUA) 2014 guidelines for managing Cryptorchidism.
http://www.auanet.org/guidelines/cryptorchidism-(published-2014)