Editing Undescended Testicle (section)

=== History and Physical Exam ===

==== History ====
* '''<span style="color:#ff0000">History of prior testicular position''' 
**'''Genital exam by an experienced healthcare provider with good documentation of testicular position should be conducted in all newborn males.'''
***History provided by the patient's family is least useful to the provider in determining the diagnosis of retractile vs. UDT.

==== Physical Exam ====
* '''<span style="color:#ff0000">Physical exam should focus on the''' 
**'''<span style="color:#ff0000">Inguinal canal'''
**'''<span style="color:#ff0000">Scrotum'''
**'''<span style="color:#ff0000">Ectopic sites (see below)'''
*'''<span style="color:#ff0000">Position: examine child in the supine and, if possible, upright cross-legged and standing positions'''
** '''Abduction of the thighs contributes to inhibition of the cremasteric reflex''', which is elevation of the testis that is elicited by scratching the inner thigh.
* '''<span style="color:#ff0000">Helpful maneuvers to facilitate exam:'''
*#'''<span style="color:#ff0000">Quiet room'''
*#'''<span style="color:#ff0000">Patient distraction'''
*#'''<span style="color:#ff0000">Warm room and hands'''
*#'''<span style="color:#ff0000">Use of lubrication/liquid soap on the examiner’s hands'''
*'''<span style="color:#ff0000">Distinguish between a normally located gonad, retractile testicle, palpable undescended/ectopic testicle, and non-palpable testicle.'''
** '''<span style="color:#ff0000">Assess testicular palpability</span>''', position, mobility, size, and possible associated findings such as hernia, hydrocele, penile size, scrotal asymmetry, and urethral meatus position.
***'''<span style="color:#ff0000">Palpable'''
**** '''<span style="color:#ff0000">Testicle may be:'''
***** '''<span style="color:#ff0000">Anywhere along the line of normal descent between the abdomen and scrotum ("true" undescended)'''
***** '''<span style="color:#ff0000">Ectopic, such as (7):'''
*****# '''<span style="color:#ff0000">Anterior to the rectus abdominus muscle (also called the superficial inguinal pouch)'''
*****#* '''<span style="color:#ff0000">Most common site of ectopic testicle'''
*****# '''<span style="color:#ff0000">Perirenal'''
*****# '''<span style="color:#ff0000">Prepubic'''
*****# '''<span style="color:#ff0000">Femoral'''
*****# '''<span style="color:#ff0000">Peripenile'''
*****# '''<span style="color:#ff0000">Perineal'''
*****# '''<span style="color:#ff0000">Contralateral scrotal position'''
**** '''Careful examination of these areas is needed to correctly classify a testis as palpable or non-palpable,''' a critical step that influences further diagnosis and treatment
**** '''Perirenal or other abdominal testes may be associated with multicystic dysplastic or absent ipsilateral kidneys and/or nonunion of the testis and epididymis'''
**** '''Determine the lowest position the testis may attain'''
***'''<span style="color:#ff0000">Non-palpable'''
****'''<span style="color:#ff0000">Possible clinical findings at surgery include (3):'''
****# '''<span style="color:#ff0000">Abdominal or transinguinal “peeping” location (25-50%)'''
****# '''<span style="color:#ff0000">Complete atrophy (vanishing testis, 15-40%)'''
****# '''<span style="color:#ff0000">Extra-abdominal location but nonpalpable testis because of body habitus, testicular size, and/or limited cooperation of the patient (10-30%)'''
*'''<span style="color:#ff0000">Evaluate contralateral testicle'''
**'''In patients with unilateral cryptorchidism, evaluation of the contralateral gonad is important in order to detect potential problems with the normally located testicle (such as atrophy, varicocele, abnormal volume, or consistency for age).'''
** '''Testicular hypertrophy, most often suspected when the axial length of the testicle is > 1.8‒2 cm),is associated with a higher likelihood of an absent or atrophic non-palpable gonad.'''
*'''<span style="color:#ff0000">Assess for associated abnormalities'''
**'''<span style="color:#ff0000">Inguinal hernia'''
**'''<span style="color:#ff0000">Hypospadias'''
**'''<span style="color:#ff0000">Ipsilateral scrotal hypoplasia'''
* '''<span style="color:#ff0000">CAUTION: A virilized newborn with bilateral non-palpable gonads should be considered to be 46XX with congenital adrenal hyperplasia (CAH) until proven otherwise.'''