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The ascending testis: is late orchidopexy due to failure of screening or late ascent?
M Lamah1, E S McCaughey, F O Finlay
1Wessex Regional Centre for Paediatric Surgery, Southampton General Hospital, UK.
Insights
Infant boys with undescended testes (UDT) often have testes documented as descended or retractile during screening, leading to delayed orchidopexy surgery. This suggests potential issues with child health surveillance or late testicular ascent.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Pediatrics
Background:
- Undescended testes (UDT) require timely surgical intervention, ideally before 18 months.
- The mean age at orchidopexy in the study institution was significantly delayed at 5.5 years.
Purpose of the Study:
- To investigate reasons for delayed orchidopexy in boys over 3 years old.
- To analyze screening history, examinations, and management of boys with UDT.
Main Methods:
- Retrospective review of community, general practitioner, and hospital records.
- Analysis of 36 children with available pre-referral information.
Main Results:
- In 36 children, UDT were previously documented as descended (24) or retractile (10).
- One child experienced delayed referral, and another had operative delay.
- Significant discrepancies noted between initial documentation and need for orchidopexy.
Conclusions:
- Potential failure of Child Health Surveillance screening programs for UDT.
- Possibility of late testicular ascent in previously descended or retractile testes.
- Need for prospective studies to confirm the cause of delayed surgical management.
Abstract:
It is widely recommended that infant boys with undescended testes (UDT) should be referred for surgical opinion before the age of 18 months. To attempt to identify the reasons why the mean age at orchidopexy in our institution was as high as 5.5 years, a retrospective review of the screening history, examinations, and management of boys over the age of 3 years at the time of orchidopexy was undertaken by reference to community, general practitioner, and hospital records. In 36 children where hospital and community records giving information prior to referral were available, the UDT had previously been documented on at least one occasion as descended in 24 children or retractile in 10. In 1 child there was delayed referral, and in another, there was operative delay. It is concluded that there is either frequent failure of the Child Health Surveillance screening programme, or that late ascent of a testis previously sited in the scrotum is a common occurrence. We recommend further prospective studies to clarify this latter phenomenon.
