Referral for Babies with Cryptorchidism
Babies with cryptorchidism should be referred to a pediatric urologist or appropriate surgical specialist by 6 months of age (corrected for gestational age) if spontaneous testicular descent has not occurred. 1
Timing of Referral
- Infants with cryptorchidism detected at birth who do not have spontaneous testicular descent by 6 months (corrected for gestational age) should be referred to an appropriate surgical specialist for timely evaluation 1
- Boys with newly diagnosed (acquired) cryptorchidism after 6 months of age should also be referred to an appropriate surgical specialist 1
- For phenotypic male newborns with bilateral nonpalpable testes, immediate consultation with an appropriate specialist is required to evaluate for possible disorders of sex development 1
Appropriate Specialists for Referral
- Pediatric urologists are the most common specialists managing cryptorchidism 2, 3
- Pediatric surgeons are also appropriate specialists for managing undescended testes 3
- The choice between pediatric urology and pediatric surgery may depend on local availability and expertise 3
Pre-Referral Management
- Primary care providers should palpate testes for quality and position at each recommended well-child visit 1
- Providers should not perform ultrasound or other imaging modalities prior to referral, as these studies rarely assist in decision making 1
- Obtaining gestational history is important at initial evaluation, as premature infants have higher rates of cryptorchidism (15-30% vs 1-3% in full-term) 1, 4
Special Considerations
- For bilateral nonpalpable testes in a phenotypic male newborn, immediate specialist consultation is required to rule out disorders of sex development, particularly congenital adrenal hyperplasia 1
- A newborn with bilateral nonpalpable gonads should not be circumcised until after workup is complete 1
- When cryptorchidism is present with phallic anomalies (hypospadias or micropenis), evaluation for disorders of sex development or other syndromes should be considered 1, 5
Rationale for Early Referral
- Early surgical intervention (orchiopexy) reduces the risk of:
- Testes that remain undescended by 6 months are unlikely to descend spontaneously 1
- Continued damage may occur to testes that remain in a non-scrotal location 1, 7
Common Pitfalls in Referral
- Delayed referral patterns are common despite guidelines, with less than half of primary care providers referring by the recommended 6 months of age 2
- Many providers still incorrectly order ultrasound prior to referral, which is not recommended by guidelines 1, 3
- Failure to recognize the urgency of referral for bilateral nonpalpable testes can lead to delayed diagnosis of potentially life-threatening conditions like congenital adrenal hyperplasia 1
- Hormonal therapy (hCG) alone is not recommended as primary treatment for cryptorchidism, though it may have a role in specific situations 1, 8