Predictors of delayed consultation in undescended testis patients at a Rwandan referral hospital

Abstract

INTRODUCTION: Delayed management of undescended testes (UDT) is associated with an
increased risk of malignancy and impaired fertility. To identify causes of delayed consultation of
patients with UDT at a Rwandan referral hospital
METHODS: This was a retrospective study of patients with delayed UDT presentations from 2012
to 2016. A delayed UDT presentation was defined as any patient presenting with UDT at >1 year
of age.
RESULTS: There were 44 cases of delayed UDT presentations. Most patients (n = 35, 79.5%) were
born at a hospital; the rest (n = 9, 20.5%) were born at home. The patient’s parent with higher
education in the family was considered. Most of the patients’ parents (n = 29, 65.9%) had a
primary education, 6 (13.6%) had a secondary education (high school graduate), 1 (2.3%) had
a university education, and 8 (18.2%) never went to school. The reported reasons for delays as
they appear in the patient chart were 16 (36.4%) patients due to ignorance, 12 (27.3%) due to
poor physical examination at birth, 7 (15.9%) due to poor guidance, 4 (9.0%) due to poverty and 5
(11.4%) due to long appointments. There were no overlapping reasons for delay reported. Patients
born at home were more likely to identify ignorance as a reason for the delay (p = 0.007). Of the
16 patients who reported a delay due to ignorance, 12 of their parents had primary education,
and 3 had no education. Most (n = 34, 77.3%) patients were fertile in adulthood, but 9 (20.4%)
presented with infertility and 1 (2.3%) presented with testicular torsion.
CONCLUSION: A number of reasons are responsible for delayed consultation in patients with
UDT, including ignorance, poor physical examination, poor guidance, and poverty. Most of the
causes are preventable. The urgent need for awareness of UDT and collaboration between
physicians is paramount for early consult and management.