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12 Cards in this Set
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NIPE examination of the testes |
Primary aim of the Examination of the testes is to screen for Cryptorchidism which involves one or both testes not descending into the scrotum (PHE, 2018) Cryptorchidism is associated with testicular cancer, reduced fertility in adulthood and urogenital problems Such as hypospadias and testicular torsion, so is important to identify early and get early treatment if necessary to reduce morbidity and mortality (PHE, 2018; Lumsden,2010) Bilateral undescended testes may be associated with ambiguous genitalia or an underlying enrodcrine disorder such as congenital adrenal hyperplasia Early diagnosis and intervention will improve fertility, reduce the risk of torsion and may aid earlier identification of testicular cancer (PHE 2018) |
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What is the incidence of Cryptorchidism? |
2-6% of term neonates suffer with Cryptorchidism (PHE, 2018) In neonates less than 2500g the prevalence is increased to 20% (Lumsden, 2010) |
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Risk factors for Cryptorchidism |
A first degree relative history of crytochroidism (baby’s father or sibling) Low birth weight Small for gestational age or preterm birth |
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Development of the male testes |
The testes begin development in the abdominal cavity and start descent into the scrotum from 28weeks finally descending completely by term 37-40 weeks (Carr and Foster, 2014) |
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Information to gain from parents prior to examination |
Is there any family history Has baby passed urine. Can determine if baby suffering from anuria or oliguria which can be an indication of an abnormality with his genitalia and would prompt referral to a paediatrician due to risk of damage to the kidneys (Gordon, 2015) Risk factors from the full history are considered particularly ultrasound results. Cardiac abnormalities, numbers of umbilical vessels, olihydraminos or polyhydraminos and musculoskeletal abnormalities increase the risk of renal and genital abnormalities. |
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Process of examination |
The examination includes visual assessment of the genitalia and palpation of the testes (Boston and Durwood, 2017) |
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Inspection |
Inspect the shape, symmetry, size and colour of baby’s testes as well as the size of the penis and positioning of the urethral opening. Size of penis no less than 2.5cm (Gordon, 2015) Urethral opening should be central positioning in turn ruling out hypospadias and epispadias Should be no darkening or swelling of the scrotum, swelling being an indicator of a hydrocele or inguinal hernia and darkening of the scrotum indicating testicular torsion or adrenal hyperplasia (Baston and Durwood, 2017) All of which would require immediate referral to a paediatrician especially regarding testicular torsion which can result in ischaemia of the testicle. Observe for presence of Rugae which often develop around 36 weeks if no rugae can indicate prematurity or no testes within the scrotum (Lumsden, 2010) |
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Problems of the male genitalia |
Inguinal hernia- seen as bulging within the groin area. Incomplete closure of the inguinal canal allows protrusion of intestines towards or into the scrotum. Epispadias- urethral Meatus on upper aspect extremely rare but may be as extreme as bladder exstrophy Hypospadias- abnormal location of urethral meatus under penis with incomplete urethra Micro penis- short/ think penis beware of ambiguous genitalia Hydrocele- fluid filled scrotum Oedema- hormones or trauma Testicular torsion- twisted testes reddened/ darkened can lead to ischaemia and necrosis Bruising- may be caused by breech presentation or delivery |
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Ambiguous genitalia |
Will require involvement of the paediatrician, endocrinologist, geneticist and urologist. They will consider the genetic sex or Gonoidal sex (presence or a sense of testes) and screen for adrenal hyperplasia. Adrenal hyperplasia is a inherited autosomal recessive disorder characterised by a deficiency of one of the enzymes needed to make specific hormones, affects the adrenal glands located at the top of each kidney. If detected early children can have healthy growth and development |
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Palpation |
Hands should be warm (Lissauer and Fanaroff, 2011) Should palpate the inguinal canal down to baby’s scrotum (Carr and Foster, 2014) |
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Referral pathway |
If unilateral Cryptorchidism baby’s should be teased in 6-8 weeks (PHE, 2018) as according to Lumsden (2010) 98% of testes will descend spontaneously by six weeks of age If not descended by 6-8 weeks baby will be reviewed by GP again at 4-5 months of age and if still no descent would be reviewed by a surgeon no later than 6 months of age (PHE, 2018) and receive surgery by two years of age (Carr and Foster, 2014) If bilateral cryptorchidism baby would require a Senior paediatrician review within 24 hours to dismiss any intersex or metabolic conditions. If no descent by 6-8 weeks baby should be seen by a senior paediatrician within 2 weeks of the examination (PHE, 2018) If negative screening refer to healthy child programme, repeat examination in 6-8 weeks Provide information to parents |
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Information for parents |
What will happen in pathway of testes remains undescended What to look out for with undescended testes I.e unsymmetrical shaped testes, as testes occasionally can be retractable (Lumsden, 2010) Observe urine output if concerns contact healthcare professionals Will be repeated in 6-8 weeks Contact healthcare professionals with concerns If any problems with urethra or forskin parents should be advised not to have their baby circumcised because the surgeon will normally need to use the forsekin in the repair of the defect (lumsden, 2010) |
