• Dr. Simon Moore MD CCFP

4 NOTs for NUTS: New undescended testicle tips. PLUS 3 DON'Ts.

SNAP SAMP - Answers below:

  • At what age do you refer a boy with an undescended testicle?

  • What is the appropriate imaging for a boy with undescended testicle?

  • What is the correct position in which a pediatric patient should be examined for testicular concerns?

  • List FIVE locations where a palpable ectopic testicle may be found.

Recently published in Canadian Family Physician (so probably a good thing to know for your exam if it’s in there) is an update on when to refer boys with testicular issues. Here are the main points:

REFER IF your patient meets 1 of the 4 NOTs - the testicle is

  • Not descended: Palpable but undescended - refer at 6 months*

  • Not positioned properly: Palpable but in the wrong place - Ectopic**

  • Not there anymore: Palpable but not in the scrotum - Ascended testis (previously documented as descended but no longer)

  • Not there: You can’t palpate the testicle at all


  • Get an ultrasound.

  • Imaging is a poor indicator of position.

  • Skip the testicular exam.

  • With every male well baby visit, make sure that the testicles are present. I’ve picked up on an undescended testicle that I would have missed if I assumed that somebody else checked.

  • Panic if you aren’t sure.

  • Many clinicians have difficulty with this physical exam maneuver. Try with the patient in frog-leg position. Ask a colleague or refer if you aren’t sure.

*Corrected gestational age

** If palpable, you may find these in the superficial inguinal pouch; less likely, they’ll be somewhere else like the perineum, wrong side of the scrotum, prepubic above the penis, or femoral region.

This article is based on the helpful Clinical Review written by pediatric urologists from Ottawa and Saskatoon, and published in the most recent Canadian Family Physician journal.

See the full article here:

Practical approach to evaluating testicular status in infants and children

Source: Can Fam Physician 2017;63:432-5

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The only Canada-Wide CCFP exam course - created by two Family Doctors who wished this existed when we were residents, and are on a mission to help CCFP exam candidates. Disclosures: The Review Course founders have no conflicting commercial interests. As is the case with any private events hosted on a university campus or hospital, this event is not affiliated with nor endorsed by the host venues. Our materials are peer-reviewed and prepared by Canadian physicians; we do not guarantee that our preparation materials are representative of any Canadian examination and we do not provide questions from any other examination nor are they intended as medical advice. The College of Family Physicians of Canada does not affiliate with nor endorse any exam preparation course.