Adult cryptorchidism: Unrevealing the cryptic facts

BACKGROUND: The incidence of cryptorchidism is 3.7% at birth and by 1 year of age, the incidence declines to about 1% and remains constant thereafter in life. The standard age at which cryptorchid testis is to be corrected is 18 months. In our routine practice, many patients present late in their life with significant risk of malignancy and infertility. AIMS: We tried to evaluate the causes of late presentation in our population. SETTINGS AND DESIGN: To diagnose the true causes late presentation for orchidopexy, a questionnaire-based study was conducted on all adult cryptorchids operated in our institute over a 15 year period. The questionnaire is attached as addendum. MATERIAL AND METHODS: Thirty-three adult cryptorchid patients operated in our institute over a 15-year period (1988-2002), included in this retrospective study. RESULTS: We found that only 9% (3/33) of the patients didn't present due to ignorance. The rest 91% (30/33) knew about their missing testis in childhood. Of these, 14 patients did not present due to shyness while the other 16 had consulted a rural practioners; surprisingly 8 of these 16 patients were not guided further. Five of the twelve patients with bilateral cryptorchidism had infertility. Of the four patients who presented with malignancy, one died during the course of treatment. CONCLUSION: The present study revealed that many treating rural practioners and paramedics were equally responsible for the late presentation of the patients. There is a need for thorough physical examination following birth by attending obstetrician, pediatrician and other practicing physicians. An advice for early corrective surgery will go a long way in reducing the complications due to late presentation.