Undescended Testes: Contemporary Factors Accounting for Late Presentation

• Main Authors: O.H. Ekwunife, J.O. Ugwu, C. Onwurah, C.C. Okoli, L.K. Epundu
• Format: Article
• Language: English
• Published: SpringerOpen 2018-09-01
• Series: African Journal of Urology
• Online Access: http://www.sciencedirect.com/science/article/pii/S1110570418300596

Introduction: Early detection and treatment of undescended testes by orchiopexy by 6–12 months of age is important to minimize germ cell loss and improve the individuals’ fertility index. Decades since after the adverse relationship between the delayed treatment and infertility was established, we are still having young boys presenting very late with undescended testes. Objective: To understand the current reasons behind the increasing rate of late presentation of boys with undescended testes. Patients and methods: Clinical records of patients managed for undescended testis from January 2011 to December 2016 were reviewed. In addition, where the needed information was not recorded in the case files, telephone interviews and/or invitation for a clinical examination were employed when necessary to obtain complete data. Results: There were 39 patients with 50 undescended testes (16 left, 12 right and 11 bilateral). The age range at presentation to the hospital was from 1 day to 11 years. Undescended testes were noticed in 27 (69%) children at the age one year or less. Of this number, 19 (70%) sought medical attention at any hospital within one year of age of the child, 11(41%) were presented to our unit for treatment within the child’s first birthday, and 7 (26%) had surgical treatment within 2 years of age. Age at surgery ranges from 16 days to 11 years.The delay in presentation progressively declined as the parental academic level increases.Only 7 (18.0%) and 2 (5.1%) children were examined by a doctor after birth and at 6 weeks post natal visits, respectively. A majority of the empty scrotum was first noticed by the parents/grand mother in 25(64%) children as against 12 (31%) by health workers.Causes of late presentation include: parental ignorance of the abnormal position of the testes, 14 (35.9%); wrong information by clinicians at the hospital of first visit, 9 (23.1%) and erroneous belief that the testes will still descend, 8 (20.5%).At surgery, more testes in those aged 2 years and above were of low volume when compared with those aged less than 2 years. Conclusion: Majority of children with undescended testes are still being presented late for surgical correction, with its attendant adverse consequences on fertility. Non examination of the newborn by clinicians, inadequate parental health education and delayed or neglected referral are the major responsible factors. Keywords: Cryptochidism, Late presentation, Orchiopexy, Testicular atrophy, Scrotal examination