Referral for Babies with Cryptorchidism

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 2, 3
Boys with newly diagnosed (acquired) cryptorchidism after 6 months of age should also be referred to an appropriate surgical specialist 4, 5
For phenotypic male newborns with bilateral nonpalpable testes, immediate consultation with an appropriate specialist is required to evaluate for possible disorders of sex development 2, 6

Primary care providers should palpate testes for quality and position at each recommended well-child visit 4, 3
Providers should not perform ultrasound or other imaging modalities prior to referral, as these studies rarely assist in decision making 2, 7
Obtaining gestational history is important at initial evaluation, as premature infants have higher rates of cryptorchidism (15-30% vs 1-3% in full-term) 3

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 2, 6
A newborn with bilateral nonpalpable gonads should not be circumcised until after workup is complete 2
When cryptorchidism is present with phallic anomalies (hypospadias or micropenis), evaluation for disorders of sex development or other syndromes should be considered 2, 8

Early surgical intervention (orchiopexy) reduces the risk of impaired fertility potential 1
Testes that remain undescended by 6 months are unlikely to descend spontaneously 9, 3
Continued damage may occur to testes that remain in a non-scrotal location 4

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 2, 6
Hormonal therapy (hCG) alone is not recommended as primary treatment for cryptorchidism, though it may have a role in specific situations 1