Delayed Diagnosis of Undescended Testis: Still a Reality

Abstract

Ram Mohan Shukla, Pooja Tiwari*, Ritesh Dixit, Maneesh Joleya, Vinod Raj, B. K. Lahot, Manoj Joshi, Shashi Shankar Sharma and Ashok Kumar Laddha

Background: Undescended Testis (UDT) is best defined as a testis that cannot be manipulated to the bottom of the scrotum without undue tension on the spermatic cord. UDT is a very common surgical problem treated by pediatric surgeons. But even today, majority of children are referred for definitive treatment at an older age. The probable reasons for late referral are lack of awareness among the general physicians, pediatricians regarding the correct age of surgery, ignorance among parents that it’s a correctable anomaly, delayed diagnosis of the condition, lack of expertise in the rural areas, financial reasons and other factors.

Materials and methods: The cross-sectional study, at a randomly selected public health institute of central India, included all patients with UDT attending pediatric surgery Outpatient Department (OPD) over a period of seven years. Patients with retractile testis and those with UDT but age less than 6 months were excluded from the study. Following parameters were observed, findings noted and statistically analyzed-name, registration number, age of presentation, cause of delay, type of presentation, diagnosis, associated anomalies, if any and operative procedure done. Sample size was calculated with Cochran’s formula and statistical analysis done using Fischer Exact test.

Results: A total of 141 patients were included in the study. The median age at which patients presented was 7.9 years. Associated anomalies were present in 12.3%. In our series, commonest cause of delay in treatment for undescended testis was found to be delayed referral by physicians in 72 patients (51.06%) followed by 31patients (21.99%) whose parents were aware but afraid to get operated at an early age, in 25 patients (17.73%) parents were unaware of the anomaly itself. Only 13 patients (9.22%) came at appropriate age for surgery.

Conclusion: Meticulous examination of external genitalia at birth by the attending nurse and pediatrician before sending the baby home is must for early diagnosis and management in developing countries like ours. Thorough education and training of the medical professionals is needed to prevent delay in management of this correctable anomaly in modern day to day practice.