Assessment of Prior Well Child Checks in Children With Concerns for Testicular Position: Opportunities for Early Referral From an Integrated Health System.

OBJECTIVE: To assess, through an integrated primary and specialty care pediatric health system, the association of well-child checks prior to referral with final urological diagnosis with the aim to identify opportunities for earlier referral of care. METHODS: We performed a retrospective review of children referred from primary care to urology for undescended testis (UDT) within our integrated primary-specialty care health system in 2019, comparing children who had undescended testicles to those with either normal or retractile testicles based on the final urology examination. Demographics, including age, comorbidities, and the status of prior well-child check (WCC) within primary care, were reviewed. Outcomes of age at referral and surgical intervention for UDT were compared across referral categories. RESULTS: Stratifying by final diagnosis of 88 children included in the analysis, children with UDT were referred much later (85months, interquartile ranges 31-113) than children without UDT on final diagnosis (33months, interquartile ranges 15-74, P = .002). Furthermore, children with UDTs had a greater proportion with prior abnormal WCCs (N = 21/41, 51%) than those without UDT (N = 8/47, 17%) (P < .001). CONCLUSION: Children with prior abnormal WCCs were more likely to have a final diagnosis of UDT, with prior abnormalities being documented approximately 12months prior to referral, indicating opportunities for improved referral patterns to urology.

Síndrome de Prune-Belly / Prune-Belly syndrome

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Management of undescended testes in children in Zaria, Nigeria.

OBJECTIVE: To study the presentation, management and outcome of undescended testes in children in a northern Nigerian population. DESIGN: Retrospective study. SETTING: Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. SUBJECTS: Thirty six children aged < or = 12 years with 43 undescended testes managed in 10 years. INTERVENTIONS: Orchidopexy, orchidectomy, herniotomy. RESULTS: The age at surgery was fourteen months to 12 years (median six years); four (11%) had correction before two years, 15 (42%) before five years and 21 (57%) at age > or = 5 years. Thirty two (74%) testes were palpable and eleven (26%) non-palpable. Evaluation was mainly clinical. Ultrasonography was performed for three non-palpable testes but was not helpful. Laparoscopy was not used in any patient. The condition was unilateral in 29 (81%) and bilateral in seven (19%). Forty five per cent of the testes were in the inguinal canal, 31% at the external ring, and 12% each at the internal ring and abdomen respectively. Ten (24%) testes were macroscopically atrophic (canalicular five, abdominal four, internal ring one). Orchidopexy was performed for 37 undescended testes and orchidectomy for four. Groin and scrotal haematoma developed following one orchidopexy. Following orchidopexy, four (10%) testes retracted necessitating repeat surgery. CONCLUSION: There is a need to educate parents, traditional birth attendants, midwives and doctors in our environment to ensure earlier presentation and treatment.

[Endocrine studies in cryptorchidism (author's transl)]. / Estudio endocrinológico del testículo criptorquídico.

The endocrinological study of the cryptorchid testicle was carried out using a HCG and LH-RH tests to stimulate the hypophysis. Stimulation with LH-RH demonstrated a low hypophysis reserve in some cases which made suspect the presence of a hypo-stimulated testicle. One is led to believe in the heterogeneous nature of the endocrinological response.