Check boys for undescended testes up to adolescence
?Palpation of the scrotum to exclude undescended testes (UDT) has become a routine part of health examination for boys. Many GPs take the view that if both testes are present then everything is all right and further checks are not required.
A recent study from the Netherlands elegantly reminds us that acquired UDT, or ascending testes, is not uncommon, and emphasises the need to check for testis presence in the scrotum whenever boys up to adolescence are routinely examined.
The study examined 3,433 boys aged six, nine and 13 years in a healthcare system similar to that in the UK. A key objective was to quantify the number of individuals with acquired UDT.
The authors comment that there are two peaks for diagnosis of UDT: the first in boys under one year old and the second after the age of five. This second peak relates to boys with acquired UDT.
According to the study, 52 boys were diagnosed with acquired UDT and the prevalence of UDT ranged from 1.1 to 2.2 per cent, depending on age. If the data is accepted then acquired UDT is a condition we should all be looking for. In particular, boys with retractile testes or high scrotal testes should be targeted for more intensive follow-up.
Most GPs would be inclined to refer for surgical advice as to the need for orchidopexy. This paper points out that the problem spontaneously resolves during adolescence in most boys with normal testicular volume and function, meaning that surgery is unnecessary.
I will certainly be more assiduous in my checks, and perhaps a little less ready to criticise colleagues who have reported normal testicular position in a child I subsequently diagnose with UDT.
Hack WWM, Sijstermans K, van Dijk J, et al. Prevalence of acquired undescended testis in 6-year, 9-year and 13-year-old Dutch schoolboys. Arch Dis Child 2007;92:17-20 doi: 10.1136/adc.2005.076208Reviewer
Dr Peter Saul
GP, Wrexham and hospital practitioner in paediatrics (asthma and allergy)