Management of undescended testes: a comparative study in England and Africa

Abstract

Objective The aim of our study was to determine the timing of referrals and the outcome of undescended testes (UDT) over a 4-year period in a tertiary centre in England, and to compare this with a similar centre in Nigeria. Background data Cryptorchidism is a recognized cause of infertility and a key risk factor for testicular malignancy. Current recommendations are that orchidopexy be performed between 12 and 18 months of age; however, there is no consensus on this.
Materials and methods Data were obtained for orchidopexies performed between 2003 and 2007 from a tertiary referral centre in England. A standardized proforma was used to collect data into an Excel database, which was analysed and compared with data from a similar centre in Nigeria.
Results Eighty-eight patients from a tertiary referral centre in England underwent surgery for UDT. Fifty-six (63.6%) patients were referred and 38 (43.2%) patients were operated on within 2 years of age. Doctors and health visitors accounted for 69 (78.5%) referrals to the tertiary centre. Data from Nigeria demonstrated that of the 61 cases, 13 (21%) patients presented and 11 (18%) patients were operated on by 24 months. Referral beyond 60 months of age in the English series was due to ascending testis, whereas in the Nigerian study, the delayed presentation was due to delayed referral from lack of knowledge of the condition.
Conclusion In England and Nigeria, there is a lack of definitive guidelines relating to the appropriate age of referral of patients with UDT. A structured care pathway is needed to enable early detection and definitive management.