In evaluating an undescended testicle in an infant or child with a history suggesting prematurity, which physical examination step is essential?

In evaluating an undescended testicle in an infant or child with a history suggesting prematurity, which physical examination step is essential?

• A. Examine the scrotum and check for inguinal hernia or testicular torsion.
• B. Order scrotal ultrasound as the first test.
• C. Measure testicular length with external calipers only.
• D. Perform colonoscopy to assess associated anomalies.

Answer: (A)

The most important step is a careful examination of the scrotum and the groin to locate the testis and assess for related problems. Palpating the scrotum and inguinal region lets you determine whether the testis is truly nonpalpable, located in the inguinal canal, or descended, which directly guides management. This is crucial because an undescended testis can be associated with an inguinal hernia, and torsion of an undescended testis is a surgical emergency that needs urgent detection on exam. Imaging or other tests don’t replace this initial physical assessment; ultrasound may be used later if the testis is nonpalpable, but it is not the essential first step, and colonoscopy has no role in evaluating cryptorchidism.

The most important step is a careful examination of the scrotum and the groin to locate the testis and assess for related problems. Palpating the scrotum and inguinal region lets you determine whether the testis is truly nonpalpable, located in the inguinal canal, or descended, which directly guides management. This is crucial because an undescended testis can be associated with an inguinal hernia, and torsion of an undescended testis is a surgical emergency that needs urgent detection on exam. Imaging or other tests don’t replace this initial physical assessment; ultrasound may be used later if the testis is nonpalpable, but it is not the essential first step, and colonoscopy has no role in evaluating cryptorchidism.