Adult Patients Presenting with Undescended Testis in Awareness-Poor Region

Abstract

Objectives: The majority of patients with undescended testis present during childhood with minimal complications owing to straightforward treatment with excellent postoperative outcome. This paper reports the mode of presentation, challenges and outcome of management of adult patients with undescended testis. Methods: This prospective study included consecutive cases of adult patients managed with undescended testis from January 2004 to December 2008 in Evbuomore, Nigeria. Results: Eighteen adults with a mean age of 38.3 years (range 19-61) were managed during the period. Ten (55.5%) had bilateral, 5 (27.8%) right and 3 (16.7%) left lesions. Awareness was poor as they presented due to infertility in 8 (44.4%), associated hernia 5 (27.8%), wife/self discovery 4 (22.2%) and accidental discovery by a health worker 1 (5.6%), with 9 men (50%) presenting between 30 and 40 years of age. On inguinal exploration, only 3 (10.7%) patients had viable but significantly reduced testicular volume, 17 (60.7%) were atrophic/fibrotic while in 8 (28.6%) the vas deferens ended blindly in the inguinal canal with no viable testicular tissue. Apart from three patients who had children before presentation, infertility persisted even after treatment despite adequate hormone profiles and satisfactory sexual performance. Counseling of spouses was a major challenge, with 8 couples adopting children and three marriages ending in separation. Conclusion: Management of adults with undescended testis was challenging due to irreversible complications, psychological effects and poor outcome of treatment which shows the importance of awareness programs that will result in childhood presentation.

Key Words:

Undescended testis, cryptorchidism, infertility, adults, presentation, outcome