Will the undescended testis (UDT) in a newborn with jaundice spontaneously descend into the scrotum?

Will the Undescended Testis Spontaneously Descend?

The undescended testis may spontaneously descend during the first 6 months of life (corrected for gestational age), but after 6 months, spontaneous descent is highly unlikely and surgical referral is mandatory. 1, 2

Timeline for Spontaneous Descent

• Spontaneous descent can occur only in the first 6 months of life (corrected for gestational age), after which the probability becomes negligible 1, 2
• Testes normally descend between 25-30 weeks of gestational age, with the androgen-dependent inguinoscrotal phase occurring during this period 2
• After 6 months (corrected age), testes that remain undescended will NOT descend spontaneously and require surgical intervention 1, 2

Immediate Action Required

You must refer this infant to a pediatric urologist or surgical specialist by 6 months of corrected age if the testis remains undescended 1, 2. The rationale for this timing is:

• Low probability of spontaneous descent after 6 months 1
• Continued testicular damage occurs when testes remain in non-scrotal locations 1
• After 15-18 months of age, cryptorchid boys begin to lose germ cells in the testes, with approximately 40% of bilateral cryptorchid boys having no germ cells by 8-11 years 2

Critical Warning: Bilateral Nonpalpable Testes

If BOTH testes are nonpalpable, this is a medical emergency requiring immediate specialist consultation 1, 2. This could represent:

• Congenital adrenal hyperplasia in a 46 XX individual (genetic female) presenting as a phenotypic male 1, 2
• This is life-threatening and can cause shock, hyponatremia, and hyperkalemia if not diagnosed rapidly 1, 2
• Do NOT circumcise the infant until this workup is complete 1

Surgical Timing

Orchidopexy should be performed between 6-18 months of age, with 18 months being the absolute latest recommended time 2. This timing:

• Preserves fertility potential 2
• Results in a 2- to 6-fold reduction in testicular cancer risk compared to postpubertal orchidopexy 2
• Has success rates exceeding 96% with testicular atrophy occurring in less than 2% of cases 2

What NOT to Do

• Do NOT order ultrasound or other imaging studies prior to referral - these rarely assist in decision-making and should not delay specialist consultation 1, 2
• Do NOT wait beyond 6 months of corrected age to refer 1, 2
• Do NOT expect spontaneous descent after 6 months 1, 2

Regarding the Jaundice

The jaundice in this newborn is a separate issue requiring its own evaluation:

• All jaundiced infants should be monitored at least every 8-12 hours 1
• Obtain transcutaneous bilirubin (TcB) or total serum bilirubin (TSB) measurement if jaundice appears in the first 24 hours 1
• If jaundice persists beyond 3 weeks, measure total and direct/conjugated bilirubin to identify cholestasis and check newborn thyroid and galactosemia screening results 1
• The jaundice does not affect the management of the undescended testis 1

Follow-up Plan

• Examine the scrotum at every well-child check throughout childhood 1
• If the testis descends spontaneously before 6 months, continue monitoring as "acquired cryptorchidism" (re-ascent of a previously descended testis) can occur later, peaking around 8 years of age 1, 2
• Counsel parents about increased risks of infertility and testicular cancer associated with cryptorchidism 2