Cryptorchidism in the Adolescent Males: A Five-Year Review in Two Referral Health Facilities in the Niger-Delta Region, Nigeria

Abstract

Background: Cryptorchidism is one of the most common developmental anomalies in children. It is an anomaly of testicular descent often detected in the infant age group. Most patients with cryptorchidism have this pathology rectified by surgery before puberty. In sub-Saharan Africa and other developing nations, it is not uncommon for patients with undescended testes to present in adolescence and adulthood. The management of the undescended testis in the adolescent patient is challenging due to multiple factors such as difficulty in locating the impalpable testis, the increased risk of testicular malignancies, and impaired fertility. The purpose of this study was to review the undescended testes in the adolescents over a five-year period in two referral centers in the Niger-Delta region of Nigeria.
Material and Method: This was a retrospective study, conducted from January 1, 2015, to December 31, 2019. The data were retrieved from the patients' hospital records. All the patients aged 11-19 years who were managed and followed up in the urology clinic for undescended testis were included in this study. Consent was also obtained from patients whose clinical photographs were used in this work. Data pertaining to the basic characteristics of the patients, clinical characteristics, intra-operative findings, and postoperative complications were documented. A proforma was used to collect the data. Data analysis was done using simple statistics and statistical programming for social sciences (SPSS, Chicago, IL, USA) version 21.
Results: A total of forty-eight (48) patients with undescended testes were operated upon in this period. Ten patients in the age range of 11-19 years were included in this study. The mean age at the time of surgery was 13.2 years. The majority of the patients were in the 11-12 years age group. The empty scrotal sac was the main presenting complaint. The majority of the patients were delivered either at home or in the Primary Health Centre (n=8, 80%) to mothers with poor educational background. Poor financial standing (n=5, 50%) and inappropriate advice (n=4, 40%) were the main causes of delay in presentation. Right undescended testis was predominant (n=7, 70%) with the testis located in the external inguinal ring in most patients (n=6, 60%). Orchidopexy was carried out in nine (90%) patients while orchiectomy was performed in one patient who had atrophic testis. One patient had a postoperative wound infection.
Conclusion: Early presentation and management are paramount to a successful outcome in individuals with undescended testis. There is a need to educate parents, traditional birth attendants, and health workers in sub-Sahara Africa on the benefits of early detection and prompt referral in order to prevent late presentation and its attendant complications.