The Presentation Of Cryptorchidism At Consolata Hospital Nyeri
Authors: Ilkul J.H, M.B.Ch.B, MMed; Wahinya W. M,M.B.Ch.B; Mwenda AS,M.B.Ch.B. Affiliation: Department of Surgery,
Consolata Hospital Nyeri, Kenya. Correspondence: Aruyaru Stanley Mwenda. Email: firstname.lastname@example.org
Introduction: Cryptorchidism is the commonest birth anomaly in boys but data on the entity is scarce in Kenya. Neither population nor facil-ity based study documenting the condition is available.
Objective: To determine the age of presentation, presenting com-plaints and findings among patients with cryptorchidism in Consolata
hospital Nyeri, Kenya.
Methods: We carried out an eight-year retrospective study by analys-ing all the cases of cryptorchidism operated on in our theatre using the available patients’ records.
Results: A total of 54 patients with 71 undescended testes were analysed. The median age of presentation was 9.0 years (ranging from 0.58 to 80 years). Of the cases analysed, 31.48% were bilateral, 33.33% right sided and 29.63% left sided. The main presenting com-plaint was empty scrotum in 82.98% of the cases. Intra-operatively, 8.5% of the testes were at the deep inguinal ring, 8.5% at superficial inguinal ring and 5.6% at mid-inguinal regional. The location of the testes in 56.3% of the cases was not indicated. Orchidopexy was performed in 88.7% of the cases.
Conclusion: Cryptorchidism is common a n d across all age groups with most of patients presenting to hospital late. Early diagnosis and orchidopexy is recommended.
Cryptorchidism or undescended testes is the common-est birth anomaly in boys (1-2). This condition, whose mechanism of development is not well understood, oc-curs at a prevalence of 0.8-8% (2-5). Unilateral cases tend to be up to four times as common as the bilateral ones (1). The timing of presentation carries prognostic and man-agement implications (1,2,6) with late presentation being associated with poor spermatogenesis, testicular atrophy and increased risk of malignant transforma-tion (1, 2, 6-8). All these are in tandem with the altered physiology in the undescended testis (5). As such early surgery plays a critical role in re-establishing a normal sperm count (1,2,5) and reducing, though not eliminat-ing, the risk of testicular cancer (1,2,9). Data from Africa indicate that these boys are operated on later than is rec-ommended (10-12). In their comprehensive review of cryptorchidism in Afri-ca, Braga and colleagues (10) decry the scarcity of African reports on the condition. They quote a few West African population and institutional studies and a Tanzanian in-stitution based study. Still, there remains paucity of data highlighting the post-operative outcomes and/or com-plications associated with this condition. Studies analys-ing the distribution of this condition across the lifespan are non-existent. No study exists in Kenya to give the prevalence of this condition.
This study determines the pattern of presentation and management of cryptorchidism at the Consolata hospi-tal in Nyeri, Kenya.
We carried out an eight- year retrospective cross-section-al study in Consolata Hospital Nyeri- a catholic level 4 hospital in Kenya. The hospital’s surgical department which offers both in-patient and out-patient surgical ser-vices is run by a team lead by a resident general surgeon. It also has a visiting urologist and three visiting general surgeons.
The hospital has an elective theatre operating on two days of the week. All cases operated on are entered into an operations record book capturing the patient’s name, number, age, gender, diagnosis, type of operation and the date of the operation.
We extracted data from this operations book for the peri-od extending from 1st October 2003 to 30th September 2011. The decision for the eight year period for the study was informed by a previous institution based study in Tanzania (11). All cases with a diagnosis of cryptorchi-dism were extracted. The patients’ age, in-patient num-ber, laterality and intra-operative findings were entered into preformed forms. Using the in-patient numbers, files were retrieved from the hospital records office and details about presenting complaint and examination findings added.
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Each form was counter checked by a second researcher for verification before entering data into statistical soft-ware. Data were analysed using SPSS for windows ver-sion 17.0 (Chicago, IL, USA). Descriptive statistics and frequency analyses were used where applicable. Approval to carry out the study was granted by the insti-tutions ethics and research committee. For the purpose of this study, we used the term ‘paedi-atric’ to refer to patients aged thirteen years and below. The choice of this age group was informed by Mlay and Sayi (11).
There were 4574 operations carried out during the pe-riod of study. Of these 1038 (22.69%) were paediatric cases, 645 (62.14%) of them being boys. A total of 54 patients (38 being 13 years and below) with 71 undescended testes were analysed. Of these, 17 cases were missing. Data on the presenting complaint, physical examination and intra- operative findings of these 17 patients were not included in our final analyses. Fifty three (53) of the cases had their ages recorded. The median age of presentation was 9.0 years (SD 16.09, range 0.58-80 years) ( Figure 1). We analysed 38 cases of cryptorchidism among 654 total male paediatric surgical cases giving the proportion of 58/1000. Operations for cryptorchidism accounted for 1.6% of all operations, translating to 3.66% among the paediatric cases. Of the cases analysed, 17 (31.48%) were bilateral, 18 (33.33%) right sided and 16(29.63%) left sided. Data concerning laterality was missing in 3 (5.56%) of the cases.
Figure 2 shows the main presenting complaints.In terms of intervention, orchidopexy was performed in 88.7 %( n=63) of the cases while 7 %( n=5) and 4.2 %( n=3) had orchidectomy and orchidopexy with testicu-lar biopsy, respectively. The latter two interventions were performed on patients above 30 years of age.
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Fifty four patients with 71 undescended testes were ana-lysed in this study. This is a facility based study and the sample reflects on the hospital catchment area as well as the private nature of the hospital. In Kenya, public hospitals tend to have h