This study was conducted in children of undescended testes at tertiary centre. Purpose of this study was to evaluate the reasons behind delayed orchidopexy at our tertiary centre. This study was conducted in 300 male children of undescended testes, which were operated at our centre.
Undescended testes is a common entity in children. Undescended testis is defined as failure of one or both testes to descend into the scrotum at birth. It is more common in preterm baby, low-birth weight, and twin infants. Undescended testes can be found as associated symptoms like in congenital, chromosomal, or inter gender disorders.[ 1 ] The incidence of undescended testes in premature children is 3 3% , in full-term children is 3-5% and at the age of one year it comes down to 0.8- 1 %.[ 2 ] Early treatment of undescended testes causes proper growth of testes reduces the chances of testicular malignancy. To get the higher most fertility potential in undescended testes, the recommended age of orchidopexy is soon after 6 month of age.[ 3 ]
Material and Method
This study was done in 300 male children of undescended testes at our tertiary centre. This retrospective study included the children who underwent orchidopexy by either laparoscopic or inguinal approach during December 2015 to December 2017. The purpose of study is to find out the reasons behind delayed orchidopexy in children of undescended testes, at our tertiary centre. We analyzed the number of children age wise that underwent for orchidopexy.
Out of 300 orchidopexy there were 160 right sided and 140 left sided orchidopexy. We observed that 15 patients (5%) operated before one year of age, 49 patients (16.33%) operated between 1 and 2 year of age, and 236 patients operated after the age of 2 years. Most of the patients operated between the age of 5 and 10 years.
Cryptorchidism is an entity in which absence of one or both testicles from the scrotum. Undescended testes are the most common congenital anomaly of the male genitalia.[ 4 ] There are various causes of undescended, like low birth weight of baby, small for gestational age, preterm delivery and mother took estrogen during the pregnancy.[ 5 ] Normal position of testes is in scrotum. Temperature of scrotum is comparatively low than abdomen. This low temperature initiates hormone mediated maturation of gonocyte to spermatogonia. Later on spermatogonia mature in spermatocytes. Thus untreated or delayed treated cases of undescended testes will lead to infertility and testicular malignancy.[ 6 ] Raghavendran et al showed most common cause delayed orchidopexy due to delayed presentation and careful of screening by physician.[ 7 ] Our study also revealed that delayed referral by physician is most common cause of late orchidopexy followed by lack of awareness of parents.
Our study emphasized the reason for delayed orchidopexy at our center are - ( 1 ) failure to diagnosed undescended testes at birth by pediatrician, ( 2 ) lack of parental awareness about the timing and outcomes of delayed orchidopexy, ( 3 ) delayed referral by pediatrician/physician, ( 4 ) associated serious medical condition precluding diagnosis of undescended testes. The conclusion is that the health care providers at periphery, parents and community, who were dealing with children, should be aware about the timing of orchidopexy and the complication resulting from delayed orchidopexy.
Table 1:Age wise distribution of number of orchidopexy
|Age||Number of orchidopexy||Percentage|
|6 month to ≤12 month||15||5|
|>12 month to ≤2 year||49||16.33|
|>2 year to ≤5 year||87||29|
|>5 year to ≤ 10 year||104||34.66|
Table 2:Reasons behind delayed orchidopexy
|Reasons||Number of patient||Percentage|
|Undiagnosed at birth||22||9.30|
|Lack of parental awareness||96||40.67|
|Associated Medical condition||19||8.05|
- The timing of elective surgery on the genitalia of male children with particular reference to undescended testes and hypospadias Courtiss EugeneH, Kelali s. Plastic and Reconstructive Surgery.1976-mar. CrossRef Google Scholar
- The Epidemiology of Congenital Cryptorchidism, Testicular Ascent and Orchiopexy BARTHOLD JULIASPENCER, GONZÁLEZ RICARDO. The Journal of Urology.2003-dec;:2396-2401. CrossRef Google Scholar
- Orchidopexy and its impact on fertility Murphy Feilim, Paran ThambipillaiSri, Puri Prem. Pediatric Surgery International.2007-mar;:625-632. CrossRef Google Scholar
- Cryptorchidism and Testicular Cancer: Separating Fact From Fiction Wood HadleyM, Elder JackS. The Journal of Urology.2009-feb;:452-461. CrossRef Google Scholar
- Epidemiology and pathogenesis of cryptorchidism Virtanen HE, Toppari J. Human Reproduction Update.2007-nov;:49-58. CrossRef Google Scholar
- Germ cell development in the postnatal testis: the key to prevent malignancy in cryptorchidism? Hutson JohnM, Li Ruili, Southwell BridgetR, Petersen BodilL, Thorup Jorgen, Cortes Dina. Frontiers in Endocrinology.2013. CrossRef Google Scholar
- Substitution urethroplasty for anterior urethral strictures: a critical appraisal of various techniques Dubey D, Kumar A, Bansal P, Srivastava A, Kapoor R, Mandhani A, Bhandari M. BJU International.2003-feb;:215-218. CrossRef Google Scholar