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Neonatal Diagnoses: When to refer?

Jean Hollowell

Inguinal – Scrotal Swelling Should refer to pediatric urologist:

 Scrotal swelling with concern for neonatal torsion

NOT necessary for:

 scrotal swelling that is congenital/ infant hydrocele

Inguinal – Scrotal Swelling Scrotal swelling with concern for neonatal torsion –

 discoloration (bluish, erythematous)  Scrotal wall thickening  Possibly tenderness  Cannot palp normal testis

Should be seen by us as surgery to pex the contra lateral testis needs to be addressed

Inguinal – Scrotal Swelling Congenital/ infant hydrocele:

 Scrotal skin normal color and no edema of scrotal wall  No tenderness  Testis palpable and normal to palpation  Scrotal swelling transilluminates and can see shadow of testis

Undescended Testis Should refer to pediatric urologist:

ď&#x201A;&#x2014; Bilateral non palp testes: Both testes NOT palpable (not just undescended, but neither can be palpated)

ď&#x201A;&#x2014; One testis not palpable PLUS hypospadias (even if contralateral testis is palpable/descended)

These should be considered cases of disorder of sexual differentiation until proven otherwise

Undescended Testis(s) Recommend refer at 3-4 months old:

ď&#x201A;&#x2014; One testis is non palpable, but the other testis is descended and normal and the penis is normal

ď&#x201A;&#x2014; One testis is undescended but palpable ď&#x201A;&#x2014; Both testes are undescended but both are

Never helpful to obtain US in cases of undescended testes whether palpable or non palpable

Hypospadias When both testes are descended and normal to palpation and only GU abnormality is hypospadias

 Will plan for surgery at 4- 6 months old (usually 6 months)  Can wait until 3 months old to refer to us

Considerations to refer sooner:

 Severe hypospadias  Parents anxious

 Concerned about parent following up

Neonatal Diagnoses: When To Refer? - Dr. Jean Hollowell

Published on Apr 8, 2014

This lecture was presented at Albany Medical Center's annual course in Pediatric Urology, Nephrology, & Radiology. Missed this year's confe...