A parent brings a 1-week-old neonate into the clinic. The mother is concerned that the infant's testicles do not seem 'even.' The PNP notes that the cremasteric reflex is absent and the right testicle cannot be palpated in the scrotum. The PNP should:

A parent brings a 1-week-old neonate into the clinic. The mother is concerned that the infant's testicles do not seem 'even.' The PNP notes that the cremasteric reflex is absent and the right testicle cannot be palpated in the scrotum. The PNP should:

• A. Not allow the neonate to be discharged from the hospital
• B. Order a sonogram
• C. Consult with the physician
• D. Refer the neonate to the urology clinic

Answer: (D)

Nonpalpable testis in a neonate signals possible cryptorchidism and requires specialist evaluation for proper management. In newborns, a testis that cannot be palpated in the scrotum may be located in the inguinal canal or abdomen, and spontaneous descent can occur, but timely assessment is important to preserve fertility potential and reduce long-term cancer risk. The best next step is to refer the infant to pediatric urology for comprehensive evaluation and planning for possible orchiopexy or further diagnostic steps, such as laparoscopy if the testis cannot be located clinically. Ultrasound imaging is not reliably helpful in locating nonpalpable testes and does not change immediate management, so it is not the preferred initial test. Simply discharging the patient with no plan or delaying specialist input could miss an opportunity for timely intervention. A general physician consultation alone doesn’t provide the definitive surgical evaluation and planning that pediatric urology can offer. Refer to the urology clinic ensures a definitive assessment and appropriate treatment pathway.

Nonpalpable testis in a neonate signals possible cryptorchidism and requires specialist evaluation for proper management. In newborns, a testis that cannot be palpated in the scrotum may be located in the inguinal canal or abdomen, and spontaneous descent can occur, but timely assessment is important to preserve fertility potential and reduce long-term cancer risk. The best next step is to refer the infant to pediatric urology for comprehensive evaluation and planning for possible orchiopexy or further diagnostic steps, such as laparoscopy if the testis cannot be located clinically.

Ultrasound imaging is not reliably helpful in locating nonpalpable testes and does not change immediate management, so it is not the preferred initial test. Simply discharging the patient with no plan or delaying specialist input could miss an opportunity for timely intervention. A general physician consultation alone doesn’t provide the definitive surgical evaluation and planning that pediatric urology can offer. Refer to the urology clinic ensures a definitive assessment and appropriate treatment pathway.