Late diagnosis of cryptorchidism: a failure of medical screening?

Abstract

A retropective review of hospital and available community records of 47 children undergoing orchidopexy in a district hospital was undertaken to determine adequacy of screening for cryptorchidism and factors associated with late referral. Twenty eight of these boys were previously examined on 108 occasions. Diagnosis was missed on 32 occasions and the record of 38 clinical examinations did not include position of testes. In the case of 16 boys (four under school age and 12 of school age) appropriate action was not taken once the diagnosis was made. Diagnosis was reliably made in school aged children but in children under the age of 1 year cryptorchidism was frequently missed by the examining doctor. It is suggested that criteria for diagnosis and referral should be agreed in any surveillance programme. Junior doctors in hospital responsible for routine clinical examination of children during admission and clinical medical officers or general practitioners during routine clinical examination of boys should be clearly instructed to examine and record the position of the testes.

Orchidopexy trends in the paediatric population of Victoria, 1999-2006

“…The study concluded that screening was poor by clinicians for children younger than 5, however, was more effective at school-age entry. This was supported by further observations of Sarmah [14].…”

“…The mean age of operation for acquired UDT was 10.5 years. Some authors [13,14] propose that the diagnosis of acquired UDT can be made accurately at school-age entry; however, Hirasing and Boontje [18] suggested that it is harder to accurately examine a child at school-age because of the cremasteric reflex.…”

Effectiveness of child health surveillance in lowering age of referral and surgery for undescended testis

“…2,3,9,10 However, American paediatric urologists presently recommend orchidopexy by 1 year of age 11 because there are possible risks for malignancy and spermatogenesis (reduced fertility index) 12,13 in the untreated UDT. 5,7,8 In our region there may have been different standards for the ideal age of surgery for UDT between the various hospitals, individual surgeons and in different years. 12 Another reason for recommending early surgery is evidence that the overwhelming number of children with UDT at birth will either have spontaneous testicular descent by 3 months from the child's expected date of delivery or descent will not occur.…”

“…4 In the Kent region (1989) only 4% were referred when less than 1 year old, 10% between 1 and 3 years and 85% after the age of 4 years. 5 In our study, the pattern of referrals was analysed only for children less than 6 years of age at surgery, because the local CHS programme was not fully established until the late 1980s, and in addition it was difficult to retrieve the screening records of the older children.…”

Screening of testicular descent in older boys is worthwhile: an observational study

“…11 Over a quarter of the boys in this study came to the attention of a surgeon after their abnormal testicular descent was detected incidentally when attending a doctor for another reason. All doctors should be aware of their potentially valuable role in detection of this common condition in all boys; 16 particularly now, in the absence of routine screening throughout childhood.…”