Examination after birth frequently reveals abnormalities in the inguinal,

scrotal, or genital regions.

Some of these abnormalities require urgent attention; others require

non-urgent referral, or parental reassurance.

Problem
Hydrocoele

Description
Clinical findings
Persistence of
Swelling in the
the processus scrotum
vaginalis
Can be unilateral
results in
or bilateral
peritoneal
fluid in the
Skin may have
scrotum
bluish
around the
discolouration if
testis or
large
spermatic
cord
Can fluctuate in
size (if
communicating)

Has a distinct
upper margin

Transilluminates

Non-tender

Rare in females

Careful
examination to ensure
that testis is present
and that there is
no inguinal hernia

Inguinal swelling
(can extend to the
scrotum in males or
labia in females)

Management
Reassurance

Surgical review if
still present at 18
months or diagnostic
uncertainty at any age

Inguinal
hernia

Swelling in
inguinal
region (can
extend to
scrotum in
males, or to
labia in
females)
secondary to
persistence of
a wide

Difficult to define
the upper
margin of the
swelling
(unlike hydrocoel
es)

If reducible and
infant in NICU nonurgent surgical referral
for surgical repair prior
to discharge

If reducible and
infant at home
discuss with
surgical registrar
(will usually be

processus
vaginalis,
with
herniation of
bowel (or, in
females, the
ovary)

Usually reducible

Will be firm and

tender if
incarcerated

May
transilluminate

repaired within
1-2 weeks)
If
incarcerated,urgent s
urgical referral

More
common in
premature
infants
More
common in
infants with
raised intraabdominal
pressure
Undescended May affect

The scrotum
testes
2% of males. may be smooth and
(cryptorchidi
underdeveloped or
sm)
Testes should may look normal
be in the
Assess penile
scrotum by
size and any
birth/term. In
abnormalities
these infants
(note:undescen
a testis can
ded testes
be said to be
andhypospadias
undescended
indicates
by 3 months
anintersex
disorder till
In preterm
proven
infants this
otherwise)
can be
confidently
Examine infant
diagnosed by
for
other
abnormalities
6 months
post delivery (association with other
syndromes, e.g. SmithLemli-Opitz, OtoPalato-Digital, Prune
Belly Syndrome)
Testicular
In neonates,
Tender, red firm
torsion
typically

If possible
intersex disorder, refer
to theambiguous
genitalia guideline

For males with

undescended
testes, refer to
paediatric
surgical clinic

If remain
undescended,
orchidopexy usually
performed within the
first year. If associated
with ahernia refer as
perhernia guidelines

Urgent
referral to paediatric

perinatal in
and enlarged testis
surgery
origin
Will not
Is also

Imaging
transilluminate (ultrasound with
associated
withundescen
Doppler) may be useful
Usually unilateral
ded testes
but should not delay
(but can be
surgical referral
bilateral)
Differential
includes testicular
tumour
May

May see a blue

Urgent
mimic testicul dot (ecchymosis) on
referral as per torsion
ar torsion.
the scrotum
with no ultrasound
Testicular
appendages
are only
palpable
when torsion
has occurred
Counterclock
Median raphe of
Non-urgent
wise (usually) the penis spirals to the referral to paediatric
rotation of
meatus
surgery
the penile
shaft, with

May be
meatus
associated
pointing
withhypospadias
obliquely
Penile shaft is
Penis is buried

Non-urgent
hidden under under the suprapubic referral to paediatric
the pre-penile fat pad
surgery
skin

Ensure penile
length is normal
See hypospadias guideline
See ambiguous genitalia guideline
A range of other conditions may cause scrotal swelling
including:

Ectopic or strangulated gonads

Varicocoele (not in neonates)

Torsion of the
testicular
appendages

Penile
torsion

Buried
penis

Hypospadias
Microphallus
Other causes
of groin/
scrotal
swelling

Intra-abdominal (e.g. adrenal) haemorrhage

Pneumoperitoneum

Calcifications following healed meconium peritonitis

Testicular tumour
Epididymitis (in association with UTI)

http://www.adhb.govt.nz/newborn/Guidelines/Anomalies/InguinalScrotalGenitalProbl
ems.htm