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 Table of Contents  
ORIGINAL ARTICLES
Year : 2021  |  Volume : 11  |  Issue : 1  |  Page : 21-22

Cryptorchidism in Dalhatu Araf Specialist Hospital, Lafia, Nigeria: Presentation, management, and outcome


1 Dalhatu Araf Specialist Hospital, Lafia, Nigeria; Department of Surgery, Benue State University, Makurdi, Nigeria
2 Dalhatu Araf Specialist Hospital, Lafia, Nigeria

Date of Submission06-Feb-2022
Date of Acceptance27-Mar-2022
Date of Web Publication22-Jun-2022

Correspondence Address:
Dr. Christian A Agbo
Department of Surgery, Benue State University, Makurdi
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jwas.jwas_36_22

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  Abstract 

Objective: To determine the presentation, management, and outcome of cryptorchidism in Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Materials and Methods: This is a retrospective study conducted at Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Information of patients who presented with cryptorchidism to the hospital from January 2015 to January 2020 was retrieved from the folders and analysed. Results: A total of 37 patients were studied during the study period. Only three (8.1%) presented and had correction before/at the age of two. A majority of patients (91.9%) presented after the age of two; 78% of the testes were palpable. The condition was unilateral in 30 patients (81.1%) and bilateral in seven patients (18.9%). Laparoscopy was used in one (2.7%) patient. A majority (51.4%) of the testes were in the inguinal canal, 29.7% at the external ring, 13.5% at the internal ring, and 5.4% within the abdomen. Orchidopexy was performed for 41 undescended testes and orchidectomy for three atrophic testes. There was a good outcome in 93.2% of the surgical corrections. Scrotal haematoma developed following two orchidopexies and one (2.2%) testis retracted. Conclusion: Cryptorchidism is a common anomaly in urology. The correction of cryptorchidism at the appropriate age is indicated to optimise testicular function, potentially reduce and/or facilitate the diagnosis of testicular malignancy, provide cosmetic benefits, and prevent complications such as a clinical hernia or torsion. Education of parents, traditional birth attendants, midwives, and doctors in our environment is required to ensure earlier presentation and treatment.

Keywords: Cryptorchidism, palpable, testis, undescended


How to cite this article:
Agbo CA, Godwin JT, Muhammad MY. Cryptorchidism in Dalhatu Araf Specialist Hospital, Lafia, Nigeria: Presentation, management, and outcome. J West Afr Coll Surg 2021;11:21-2

How to cite this URL:
Agbo CA, Godwin JT, Muhammad MY. Cryptorchidism in Dalhatu Araf Specialist Hospital, Lafia, Nigeria: Presentation, management, and outcome. J West Afr Coll Surg [serial online] 2021 [cited 2022 Jun 26];11:21-2. Available from: http://www.https:jwacs-jcoac.com/text.asp?2021/11/1/21/347882




  Introduction Top


Cryptorchidism (undescended testis) is the absence of one or both testes in normal scrotal position and, during initial clinical evaluation, may refer to palpable or nonpalpable testes, which are either cryptorchid or absent.[1] It is one of the most common congenital anomalies encountered in urology. It occurs in 1.0–4.6% of full-term and up to 1.1%–45.0% of preterm.[2]

The testis can be arrested along its path of descent from the abdomen to scrotum during the course of development. Late presentation and delayed treatment of this condition can lead to infertility, higher risk of testicular trauma, testicular malignancy, testicular torsion, and strangulation of associated inguinal hernia. Thus, there is a need for early diagnosis and treatment at the appropriate time. Although it has been studied extensively, there is no report from our environment. Therefore, a study was conducted to evaluate the presentation, management, and outcome of cryptorchidism in our environment.


  Materials and Methods Top


This was a retrospective study conducted between January 2015 and January 2020 at the Department of Surgery, Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Records of patients with undescended testes within the study periods were retrieved and analysed.

Statistical analysis was performed using statistical package for social sciences (version 22 SPSS Inc., Chicago, IL). A descriptive test statistic was used for the analysis.


  Results Top


Thirty-seven patients were studied during the study period. The age range of the patients was between one and 60 years. Only three patients (8.1%) had corrective surgery before the age of two [see [Table 1]]. A majority (78%) of testes were palpable and 22% were not palpable. The condition was unilateral in 30 (81.1%) and bilateral in seven (18.9%).
Table 1: Age at surgery

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The number and percentage based on the location of testes were shown in [Table 2]. A majority of testes (51.4%) were within the inguinal canal. Orchidopexy was done for 41 undescended testes and orchidectomy for three (due to atrophy). The success rate was 97.3%, whereas 2.7% had ascending testis.
Table 2: Location of testis at surgery

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Two (5.3%) patients developed haematoma and one (2.7%) patient had ascending testis. One patient (2.7%) presented at the age of 40 years with bilateral undescended testis and primary infertility.


  Discussion Top


Cryptorchidism is a common congenital anomaly in males. The time at presentation and intervention is a key to avoid the risk of subfertility and malignancy. Unfortunately, a majority of patients in developing countries present late. This study showed that only 8.1% had corrective surgery before of 2 years. The reasons for this abysmal low value include late presentation, ignorance, lack of recognition of the pathology by the attending primary care provider, and poverty. This finding is similar with reports from other regions of the country and developing countries. Ameh and Mbibu[3] reported that only 11% of patients with cryptorchidism had surgery before 2 years. In the south-eastern part of Nigeria, Ekpemo and Onyearugha[4] gave a value of 17% as those that had corrective surgery before 2 years. The European Association of Urology guideline recommended that for males with persistent undescended testis, orchidopexy should be done to bring the testis to the scrotum during the period of 6–18 months of age to ameliorate the risk of subfertility.[5]

More than half (51.4%) of the undescended testes were located in the inguinal region in our study. There were similar reports of inguinal being the commonest location of undescended testis. Avakoudjo et al.[6] found the testes in the inguinal region in 96.4% of cases, and Jeong et al.[7] reported 85% of patients. However, this is contrary to the finding reported by Shitta et al.[8] They observed that the commonest location of the testes at surgery was suprascrotal (64.4%) followed by canalicular (34.2%). This may be attributed to the effect of anaesthesia as the muscles were relaxed.

The outcome of corrective surgery for cryptorchidism is usually good.[9] In our study, most of the patients had good outcome after the surgery. Only two (5.3%) patients developed haematoma and one (2.7%) patient had ascending testis.

Training and retraining of primary care provider are required to improve on the age at surgery and to refer persistent case to a specialist early. Traditional birth attendants should also be taught the palpation of the scrotum at birth since many deliveries take place in the traditional home setting,


  Conclusion Top


Cryptorchidism is a common urological condition. Unfortunately, a majority of our patients presented late. Orchidopexy at 6–18 months is recommended to optimise testicular parameters and allow for regular examination. The training of primary care providers to identify and refer undescended testis to specialist at the appropriate time is required to change the ugly scenario of late presentation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Solpure S, Manjunath D, Harwal S, Radhakrishna V Presentation and management of undescended testes: A prospective study. Int Surg J 2018;5:1251-4.  Back to cited text no. 1
    
2.
Sijstermans K, Hack WW, Meijer RW, van der Voort-Doedens LM The frequency of undescended testis from birth to adulthood: A review. Int J Androl 2008;31:1-11.  Back to cited text no. 2
    
3.
Ameh EA, Mbibu HN Management of undescended testes in children in Zaria, Nigeria. East Afr Med J 2000;77:485-7.  Back to cited text no. 3
    
4.
Ekpemo SC, Onyearugha C Management of undescended testis in children in Aba, Nigeria. Int J Clin Urol 2019;3:15-7.  Back to cited text no. 4
    
5.
EAU Guidelines. Edn. presented at the EAU Annual Congress Milan. EAU Guidelines Office, Arnhem, The Netherlands. 2021; ISBN 978-94-92671-13-4. Available from: http://uroweb.org/guideline/paediatric-urology/.  Back to cited text no. 5
    
6.
Avakoudjo J, Hodonou F, Sewa E, Tandje Y, Sossa J, Yevi M, et al. Undescended testis in adult: Epidemiology and therapeutic aspects. About 23 cases in HKM University Teaching Hospital of Cotonou. Open J Urol 2018;8:206-13.  Back to cited text no. 6
    
7.
Jeong SC, Lee S, Ku JY, Lee SD Clinical characteristics and treatment of cryptorchidism in adults: A single center experience. World J Mens Health 2014;32:110-5.  Back to cited text no. 7
    
8.
Shitta A, Peter S, Dung E, Shilong D, Ale A, Isichei M, et al. Presentation of undescended testis to a paediatric referal centre in Jos. Open J Pediatr 2020;10:438-46.  Back to cited text no. 8
    
9.
Adesanya O, Ademuyiwa A, Elebute O, Ojewola R, Bode C The undescended testes in children: A prospective epidemiological study. East Cent Afr J Surg 2013;18:45-9.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2]



 

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