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org

Original Article

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: arumwesta@gmail.com

Abstract
Introduction: Cryptorchidism is the commonest birth anomaly in boys
but data on the entity is scarce in Kenya. Neither population nor facility based study documenting the condition is available.
Objective: To determine the age of presentation, presenting complaints and findings among patients with cryptorchidism in Consolata
hospital Nyeri, Kenya.
Methods: We carried out an eight-year retrospective study by analysing 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 complaint 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.

are non-existent. No study exists in Kenya to give the

Introduction

prevalence of this condition.

Cryptorchidism or undescended testes is the common-

This study determines the pattern of presentation and

est birth anomaly in boys (1-2). This condition, whose

management of cryptorchidism at the Consolata hospi-

mechanism of development is not well understood, oc-

tal in Nyeri, Kenya.

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).

Methods

We carried out an eight- year retrospective cross-section-

The timing of presentation carries prognostic and man-

al study in Consolata Hospital Nyeri- a catholic level 4

agement

hospital in Kenya. The hospitals surgical department

implications (1,2,6) with late presentation

being associated with

poor spermatogenesis, testicular

which offers both in-patient and out-patient surgical ser-

atrophy and increased risk of malignant transforma-

vices is run by a team lead by a resident general surgeon.

tion (1, 2, 6-8). All these are in tandem with the altered

It also has a visiting urologist and three visiting general

physiology in the undescended testis (5). As such early

surgeons.

surgery plays a critical role in re-establishing a normal

The hospital has an elective theatre operating on two

sperm count (1,2,5) and reducing, though not eliminat-

days of the week. All cases operated on are entered into

ing, the risk of testicular cancer (1,2,9). Data from Africa

an operations record book capturing the patients name,

indicate that these boys are operated on later than is rec-

number, age, gender, diagnosis, type of operation and

ommended (10-12).

the date of the operation.

In their comprehensive review of cryptorchidism in Afri-

We extracted data from this operations book for the peri-

ca, Braga and colleagues (10) decry the scarcity of African

od extending from 1st October 2003 to 30th September

reports on the condition. They quote a few West African

2011. The decision for the eight year period for the study

population and institutional studies and a Tanzanian in-

was informed by a previous institution based study in

stitution based study. Still, there remains paucity of data

Tanzania (11).

highlighting the post-operative outcomes and/or com-

dism were extracted. The patients age, in-patient num-

plications associated with this condition. Studies analys-

ber, laterality and intra-operative findings were entered

ing the distribution of this condition across the lifespan

into preformed forms. Using the in-patient numbers,

All cases with a diagnosis of cryptorchi-

The AnnAls of AfricAn surgery Volume 9 July 37

100 The ANNALS of AFRICAN SURGERY. July 2012 Volume 9 Issue 2

Original
Article
Original
Original
article
article

The ANNALS of AFRICAN SURGERY | www.sskenya.org

Original
article
The Presentation
The Presentation
Of Cryptorchidism
Of Cryptorchidism
At Consolata
At Consolata
Hospital Nyeri
Hospital Nyeri
Ilkul J.H,Wahinya
Ilkul J.H,Wahinya
W. M, MwendaW. AS
M, Mwenda AS
The Presentation Of Cryptorchidism At Consolata Hospital Nyeri
Ilkul J.H,Wahinya W. M, Mwenda AS

Presenting complaint
empty scrotum (absent
testis)
empty scrotum+inguinal
swelling
empty scrotum+inguinal
swelling+inguinal pain
scrotal swelling

40

Numbers of cases

30

20

10

0
Age in years

Figure 2: Presenting complaints

Figure 2: Distribution of crytorchidism by age

files were retrieved from the hospital records office and

The median age of presentation was 9.0 years (SD

The median
Theage
files weredetails
retrieved
files about
werefrom
retrieved
the hospital
from
therecords
hospital
records
and office and
median
of presentation
age of
was 9.0 years
was 9.0
(SD years (SD
presenting
complaint
and office
examination
16.09,
range 0.58-80
years)
( Figure
1). presentation
findings
added.
We
analysed
38
cases range
of cryptorchidism
among
654 total
details about
details
presenting
about presenting
complaint complaint
and examination
and examination
16.09,
range
16.09,
0.58-80
years)
0.58-80
( Figure
years)
1). ( Figure
1).
Each
form was
counter checked by a second researcher
findings added.
findings
added.

male
paediatric
surgical
giving
We analysed
We38
analysed
casescases
of 38
cryptorchidism
casesthe
of proportion
cryptorchidism
amongof 654among
total 654 total
58/1000.
Operations
for
cryptorchidism
accounted
for
Each form Each
was counter
form was
checked
counterbychecked
a secondbyresearcher
a second researcher
male paediatric
male surgical
paediatriccases
surgical
givingcases
the proportion
giving the proportion
of
of
ware. Data were analysed using SPSS for windows ver1.6% of all operations, translating to 3.66% among the
for verification before entering data into statistical soft-

for verification
for verification
before entering
beforedata
entering
into statistical
data into softstatistical soft58/1000. Operations
58/1000. Operations
for cryptorchidism
for cryptorchidism
accounted accounted
for
for
sion 17.0 (Chicago, IL, USA). Descriptive statistics and

paediatric cases.

frequency analyses were used where applicable.

Of the cases analysed, 17 (31.48%) were bilateral, 18

ware. Data ware.

were Data
analysed
wereusing
analysed
SPSSusing
for windows
SPSS forverwindows veroperations,
translating translating
to 3.66% among
to 3.66%
theamong the
1.6% of all1.6%
of all operations,
sion 17.0Approval
(Chicago,
sion 17.0
IL,
(Chicago,
USA).
Descriptive
IL, USA).
Descriptive
statistics
statistics and
paediatricright
cases.
paediatric
instito carry
out
the study
was granted
by the and
sided andcases.
16(29.63%) left sided. Data
(33.33%)
frequencytutions
analyses
frequency
were
analyses
where
werecommittee.
used
applicable.
where applicable.
Of the cases
Of analysed,
the was
cases
17
analysed,
17 were
(31.48%)
(31.48%)
bilateral, 18
ethics
andused
research
laterality
missing
in 3 (5.56%)
ofbilateral,
the were 18
concerning

Approval For
toApproval
carry
outtothe
carry
was
thewe
granted
study
byterm
granted
the instiby the instisided right
and sided
16(29.63%)
and 16(29.63%)
left sided. left
Datasided. Data
(33.33%) right
(33.33%)
the purpose
of study
thisout
study,
used was
the
paedicases.
atric
toand
refer
to patients
aged thirteen
years and below.
complaints.
Figure
2 showsconcerning
the main presenting
tutions ethics
tutions
ethics
research
andcommittee.
research
committee.
laterality
was
laterality
missing
wasin missing
3 (5.56%)
in 3of(5.56%)
the
of the
concerning
informed
by Mlay
The
choice
this study,
ageof
group
Table
the main intraoperative findings.
For the purpose
For
theof of
purpose
this
this
we was
used
study,
theweterm
used
paedithe and
term paedicases.1 portrays
cases.
Sayi
(11).
In
terms 2ofshows
intervention,
orchidopexy
was complaints.
performed
atric to refer
atric
to to
patients
refer toaged
patients
thirteen
aged
years
thirteen
and below.
years and below.
Figure
Figure
the2 main
shows
presenting
the main
presentingincomplaints.
88.7 %( n=63) of the cases while 7 %( n=5) and 4.2 %(

The choice The

of this
choice
age of
group
this was
age group
informed
wasby
informed
Mlay and
by Mlay and
findings. findings.
Table 1 portrays
Table the
1 portrays
main intraoperative
the main intraoperative

Results
Sayi (11). Sayi (11).

n=3) had orchidectomy and orchidopexy with testicu-

There were 4574 operations carried out during the pe-

Results
Results
cases,
645 (62.14%) of them being boys.

riod of study. Of these 1038 (22.69%) were paediatric

In terms of In
terms of intervention,
intervention,
orchidopexy
orchidopexy
was performed
was performed
in
in

lar biopsy, respectively. The latter two interventions were

%(and 4.2 %(
88.7 %( n=63)
88.7 of
%(the
n=63)
casesofwhile
the cases
7 %( while
n=5) 7and
%( 4.2
n=5)

performed on patients above 30 years of age.

n=3) had n=3)

orchidectomy
had orchidectomy
and orchidopexy
and orchidopexy
with testicuwith testicu-

Discussion

There were
There
4574
were
operations
4574(38operations
carried
carried
during
out
the during
pethe lar
pe-biopsy, lar
respectively.
biopsy, respectively.
The latter two
Theinterventions
latter two interventions
were
were
A total
of 54
patients
being 13out
years
and below)
with
riod of study.
Of
of these
study.testes
1038
Of were
these
(22.69%)
1038 were
(22.69%)
paediatric
undescended
analysed.
Of these,
17were
cases paediatric
71riod
performed
performed
on patients
above
patients
30 years
above
30
age.years
Fifty
four patients
with 71 on
undescended
testesofwere
ana- of age.
missing.
D ata being
on ofthe
presenting
complaint,
cases, 645were
(62.14%)
cases,
645 of(62.14%)
them
them
boys.
being boys.

lysed in this study. This is a facility based study and the

Discussion
Discussion

intraoperative
findings
of
sample reflects on the hospital catchment area as well
A total of physical
54A patients
total examination
of 54
(38patients
beingand13
(38
years
being
and13below)
years
and
withbelow)
with
these 17 patients were not included in our final analyses.
as the private nature of the hospital. In Kenya, public

71 undescended
71 undescended
testes were testes
analysed.
were Of
analysed.
these, 17Ofcases
these, 17 cases
Fifty four patients
Fifty four
with
patients
71 undescended
with 71 undescended
testes were testes
ana- were anaFifty three (53) of the cases had their ages recorded.

hospitals tend to have higher numbers of patients due

were missing.
were Dmissing.
ata on D
the
ata presenting
on the presenting
complaint, complaint,
lysed in thislysed
study.
in this
This study.
is a facility
This isbased
a facility
studybased
and the
study and the
The
to financial considerations. We hypothesise that such a

physical examination
physical examination
and intra- and
operative
intra- findings
operative offindings sample
of
reflects
sample
on reflects
the hospital
on thecatchment
hospital catchment
area as wellarea as well
study in a level 4 public hospital in Kenya would yield

patients
not included
were not
in included
our finalinanalyses.
our final analyses.
these 17 patients
these 17were
as the private
as the
nature
private
of the
nature
hospital.
of the Inhospital.
Kenya, public
In Kenya, public
Fifty three Fifty
(53) three
of the(53)
cases
of had
the cases
their had
ages their
recorded.
ages recorded.
to have
tendhigher
to have
numbers
higher ofnumbers
patientsofdue
patients due
hospitals tend
hospitals
The
The
to financialtoconsiderations.
financial considerations.
We hypothesise
We hypothesise
that such athat such a

38 July 2012 Volume 9 The AnnAls of AfricAn surgery

study in a level
study 4inpublic
a levelhospital
4 publicin hospital
Kenya would
in Kenya
yieldwould yield

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July 2012
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101

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Table
1: Intra-Op
findings
Table
1: Intra-Op
findings
Finding
Finding
Location
of testis
indicated
Location
of testis
notnot
indicated
Testis
at
superficial
inguinal
Testis at superficial inguinal ringring
Testis
at the
deep
inguinal
Testis
at the
deep
inguinal
ringring
Testis
at mid-inguinal
region
Testis
at mid-inguinal
region
Associated
ipsilateral
inguinal
hernia
Associated ipsilateral inguinal hernia
Atrophic
testis
3
Atrophic testis 3
Cryptorchidism
prostatic
cancer
Cryptorchidism
andand
prostatic
cancer
Associated
hydrocele
Associated
hydrocele
Abdominal
testis
Abdominal testis
Testicular
agenesis
Testicular agenesis
Cryptorchidism,
inguinal
hernia
Cryptorchidism,
inguinal
hernia
andand
appendicitis
appendicitis
Total
Total

would take
take well
well laid
laid out
out structures
structures to
itit would
to ensure
ensure all
all chilchildren
are
screened
for
cryptorchidism
and
their
dren are screened for cryptorchidism and their records
records

Frequency
Frequency
4040
66
66
44
44
4.24.2
22
22
22
11

Percentage
Percentage
56.3
56.3
8.5
8.5
8.58.5
5.65.6
5.65.6

11
7171

1.41.4
100
100

2.82.8
2.82.8
2.82.8
1.41.4

available for
for perusal
perusal when
when they
they come
come back
available
back with
with similar
similar
complaints
in
adulthood
[9].
A
median
age
complaints in adulthood [9]. A median age of
of presenpresentation of
of 9.0
9.0 years
years affirms
affirms the
the
tation
elsewhere
that
the
age
at
which
elsewhere that the age at which
way beyond
beyond the
the
isisway
recommendations
recommendations

finding
finding
African
African

as
as documented
documented
patients
patients present
present
4
year
ceiling
that
appears
in
4 year ceiling that appears in several
several
(6, 10).
10). This
This underscores
(6,
underscores the
the need
need

for sensitization
sensitization on
on early
early screening,
screening, close
for
close follow
follow up
up and
and
early
intervention
for
cryptorchidism.
early intervention for cryptorchidism.
our study
study there
there were
were more
more unilateral
unilateral compared
InIn our
compared to
to
bilateral
undescended
testes
(34
vs
17).
bilateral undescended testes (34 vs 17). Among
Among the
the
unilateral cases
cases there
there were
were more
more right
unilateral
right (n=18)
(n=18) than
than left
left
sided
(n=16)
cases.
This
is
in
agreement
with
sided (n=16) cases. This is in agreement with several
several
past studies
studies (1,
(1, 2,
2, 4,
4, 9).
9). However,
However, our
past
our
eral
cases
being
more
than
left sided
sided
eral cases being more than left

findings
findings of
of bilatbilatcases
is
peculiar
cases is peculiar

that most
most past
past studies
studies appear
appear to
inin that
to have
have established
established aa
of
distribution
right>left>bilateral
pattern
right>left>bilateral pattern of distribution (2,
(2, 9,
9, 11).
11).
a larger
sample.It It
stilla
a larger
sample.
is is
still
patientsin ina
to to
thatthatof of
4040patients

a significantsample
samplecompared
compared
significant
astudy
studyatatMuhimbili
MuhimbiliMedical
Medical

Centrein inTanzania
Tanzania(11).
(11).Most
Mostother
otherstudies
studieshave
havebeen
been
Centre
populationbased
basedand
andthus
thushad
had larger
largersamples
samples sizes
sizes
population

(2,4,9).
Theprevalence
prevalenceofofcryptorchidism
cryptorchidismamong
among boys
boys
(2,4,9).
The
quotedelseelse5.8%,way
wayabove
abovemost
mostofofthethefigures
figuresquoted
waswas
5.8%,

wherein inourourliterature
literaturesearch
search(2,(2,4,4,12).
12).This
Thisborrows
borrows
where
fromthethefact
fact
thatthis
thisis isa ahospital
hospitalbased
basedstudy
studywith
with aa
from
that
predetermined
sample
population.
As
we
have
alluded
predetermined sample population. As we have alluded
earlier,ourourstudy
studypopulation
populationmay
maynot
notbebegeneralizgeneralizto to
earlier,
able
in
view
of
the
selective
clientele
that
attend
private/
able in view of the selective clientele that attend private/

mission
hospitals
Kenya.
mission
hospitals
in inKenya.
The
age
of
presentation
variedfrom
froma alow
lowofofsix
sixmonths
months
The age of presentation varied
a high
years.WeWe
attributethese
theseextremes
extremesofofage
age
to to
a high
of of
8080years.
attribute

Thisall
all isislikely
likely to
to be
be purely
purely coincidental
coincidental though.
This
though.
The
main
presenting
complaint
was
an
empty
The main presenting complaint was an empty scrotum
scrotum

(82.98%). Other
Other complaints
complaints included
included inguinal
(82.98%).
inguinal swelling
swelling
(10.64%)
and
inguinal
pain
(4.28%).
Mlay
and
Sayi
(10.64%) and inguinal pain (4.28%). Mlay and Sayi (11)
(11)
have found
found out
out that
that the
the main
main presenting
presenting complaint
have
complaint in
in
children
with
undescended
testes
is
an
empty
scrotum,
children with undescended testes is an empty scrotum,

finding that
that isis replicated
replicated in
in our
our study.
aa finding
study. They
They also
also obobserved
that
17.5%
of
their
study
subjects
had
inguinal
served that 17.5% of their study subjects had inguinal
hernia associated
associated with
with the
the undescended
undescended testis.
hernia
testis. In
In our
our

study, only
only 55 cases
cases (7%)
(7%) had
had associated
associated inguinal
study,
inguinal hernia.
hernia.
There isis aa possibility
possibility that
that the
the true
true picture
There
picture of
of associated
associated
inguinal hernia
hernia isis underreported
underreported in
in our
inguinal
our study
study either
either bebecause the
the surgeon
surgeon did
did not
not focus
focus to
to look
cause
look out
out for
for aa hernia
hernia
intra-operatively or
or they
they forgot
forgot to
to record
intra-operatively
record the
the same
same in
in the
the

retrospectivenature
natureofofthis
thisstudy
studysince
sinceeverybody
everybody
to to
thethe
retrospective
who
intra-operativediagnosis
diagnosisofofcryptorchidism
cryptorchidism
who
hadhadan an
intra-operative

operationnotes.
notes.
operation
Regrettably,
in our
our study,
study, those
those who
who had
Regrettably, in
had associated
associated ininguinal hernia
hernia did
did not
not have
have the
the exact
exact location
guinal
location of
of the
the testis
testis

surgery
cases,a scenario
a scenarioininwhich
whichsuch
sucha astudy
study would
would
surgery
cases,
have
beenlimited.
limited.This
Thispeculiarity
peculiarityisisnonetheless
nonethelessuseful
useful
have
been

operatively was
was not
not indicated.
indicated. Other
Other locations
operatively
locations included
included
the deep
deep inguinal
inguinal ring
ring (8.5%),
(8.5%), superficial
superficial inguinal
the
inguinal ring
ring

captured.WeWe
alsoacknowledge
acknowledgethat
thatour
ourstudy
study setsetwaswas
captured.
also
does
havea separate
a separaterecord
recordbook
bookfor
forpaediatric
paediatric
tingting
does
notnothave

it has
brought
spectrum ofofage
ageacross
acrosswhich
which
as as
it has
brought
outoutthethespectrum
cryptorchidismcancanpresent,
present, anan aspect
aspectthat
that has
has not
not
cryptorchidism
appearedin in literature
literature elsewhere.
elsewhere. Literature
Literature has
has
appeared
documented
a specialcategory
categoryofofundescended
undescendedtestis
testisviz;
viz;
documented
a special

acquired cryptorchidism
cryptorchidismororthethe (ascending)
(ascending) nomad
nomad
acquired
testis(9,13).
(9,13).WeWehypothesise
hypothesisethat
that the
thecases
casesofofadults
adults
testis
presentingwith
withundescended
undescendedtestis
testiscould
could
as as
oldoldas as
8080presenting
intosuch
suchcategories.
categories.ToTocategorise
categorisethem
theminto
into such,
such,
fallfall
into

102 The ANNALS of AFRICAN SURGERY. July 2012 Volume 9 Issue 2

indicated either.
either. They
They form
form the
the bulk
bulk (56.3%)
indicated
(56.3%) of
of our
our cascaswhere the
the exact
exact location
location of
of the
the testis
eseswhere
testis as
as assessed
assessed intraintra-

(8.5%)and
and midmid- inguinal
inguinal canal
canal (5.6%).
(5.6%). A
(8.5%)
A peculiar
peculiar findfindingisisthat
that of
of aa case
case of
of testicular
testicular agenesis
agenesis and
ing
and absent
absent sperspermatic cord
cord in
in aa 16
16 year
year old.
old.
matic

Majority of
of the
the cases
cases underwent
underwent orchidopexy
orchidopexy with
Majority
with only
only
undergoing
orchidectomy.
It
is
a
similar
finding
7%
else7% undergoing orchidectomy. It is a similar finding else-

where (13).
(13). Of
Of note
note is
is the
the distribution
distribution of
where
of the
the type
type of
of opoperation
with
age;
orchidectomy
being
performed
among
eration with age; orchidectomy being performed among

age 30
30 years
years and
and above.
above.
patientsage
patients

TheAnnAls
AnnAls ofof AfricAn
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The Presentation Of Cryptorchidism At Consolata Hospital Nyeri

Ilkul J.H,Wahinya W. M, Mwenda AS
The options available for the management of cryptorchidism are out of the scope of this paper. We were also
unable to bring out issues related to complications of

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cryptorchidism such as infertility and testicular malignancy due to the retrospective nature of the study and

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lack of clear documentation of follow-up of the patients

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study though draws strength from its being the first to try

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in Kenya as well as in its lack of limitation to the paediatric age group. It brings out the spectrum of age across
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We recommend a larger prospective study to further

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analyse the different modes of treatment and their respective outcomes, complications associated with cryptorchidism as well as complications and failure rates as-

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sociated with surgical intervention. A population based

study also would help to determine the prevalence of

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Hack WWM, Sijstermans K, van Dijk J et al. Prevalence of ac-

In conclusion, cryptorchidism is a common condition

quired undescended testis in 6-year, 9-year and 13-year-old

not only among young boys but across the entire life-

Dutch schoolboys. Arch Dis Child. 2007; 92(1): 17-20

time, being associated with co-morbidities such as inguinal hernia and hydrocele. Orchidopexy remains the
modality of treatment for cryptorchidism in our facility,
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Acknowledgements

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We thank Paul Maina and Joshua Kabea for their invaluable help in extracting the patients files from the hos-

Med J. 1986; 63: 251-257

13. Mouriquand P. The Nomad testis. Arch Dis Child. 2007; 92:3

pital records store. We also acknowledge the staff at the

hospital theatre for their co-operation during the duration of data collection.

40 July 2012 Volume 9 The AnnAls of AfricAn surgery

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