A four-month-old boy with bilateral undescended testes.

What manoeuvres should be included in the physical examination? Physical examination is the key diagnostic man­ oeuvre in boys with undescended testes and should be performed at all well­baby check­ups for male babies, starting at birth.1 The physical examination requires a cooperative baby and a diligent exam­ iner. The child is placed supine, in a frog­legged position, and the examiner uses a gentle palpation technique with warm hands. A bimanual technique is used, with the nondominant hand gently milking or sweeping down the testis along the inguinal canal and preventing its upward movement during the examination, and the other hand palpating the scrotum and groin to identify the testis. The undescended testis is usually located along the path of normal testicular descent, which is in the inguinal canal or just above the scrotum. Alter­ natively, the testis may be in an ectopic position in a superficial location near the groin, in the perineum below the scrotum, in the femoral tri­ angle or at the base of the penis. However, if the testis is located in the abdomen or is absent, it will be impalpable during the physical examination. At the conclusion of the examination, the physician should classify the undescended testis as palpable or impalpable and, if palpable, should define its location as suprascrotal, inguinal or ectopic.1 The examiner should also determine the location of the urethral meatus, to identify or rule out concomitant hypospadias. Boys with both proximal hypospadias and an undescended testis should be evaluated for an underlying dis­ order of sexual differentiation.1,2