Management of undescended testes in children in Zaria, Nigeria

The hidden burden of Pediatric urology in Sub-Saharan Africa: an analysis of hospital admission data from three East African Health Centres

Specialist facilities for children are still unavailable in some Sub-Saharan African contexts. It is the case of pediatric urology, whose recent advances are still largely unshared. Prenatal diagnosis of urinary abnormalities (CAKUT) is largely unknown. Early recognition and referral of Undescended testis (UDT), Hypospadia, bladder exstrophy epispadias complex, ambiguous genitalia, stone disease, and tumours are uncommon in rural areas. Missed diagnosis is not uncommon and delayed management is associated with poor outcomes. We present a cross-sectional, descriptive study about the epidemiology of Pediatric urological admissions to three sub-Saharan East African Hospitals. All the urological cases between 0-18 years referred to three distinct East African Hospitals over 124 weeks were considered. Prevalence of different groups of diseases, age, and mode of presentation were reported. We found 351 cases (M/F 127/24) out of 2543 surgical referrals (13%). Seventy percent of cases were Hypospadias and UDT. Fifty percent of UDT were beyond 6, and most Hypospadias were between 4 and 7 yrs. CAKUT had a very low prevalence (4.84%), and about 50% of Wilms Tumours came too late to be resectable. In many African contexts, urology is still a tiny portion of the pediatric surgical workload compared to the 25% of European and American reports. There are also differences in the epidemiology of genitourinary conditions. A hidden burden of diseases may be presumed, remaining undiagnosed due to the shortage of specialist facilities.

Cryptorchidism in Dalhatu Araf Specialist Hospital, Lafia, Nigeria: Presentation, management, and outcome

Objective:

To determine the presentation, management, and outcome of cryptorchidism in Dalhatu Araf Specialist Hospital, Lafia, Nigeria.

Materials and Methods:

This is a retrospective study conducted at Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Information of patients who presented with cryptorchidism to the hospital from January 2015 to January 2020 was retrieved from the folders and analysed.

Results:

A total of 37 patients were studied during the study period. Only three (8.1%) presented and had correction before/at the age of two. A majority of patients (91.9%) presented after the age of two; 78% of the testes were palpable. The condition was unilateral in 30 patients (81.1%) and bilateral in seven patients (18.9%). Laparoscopy was used in one (2.7%) patient. A majority (51.4%) of the testes were in the inguinal canal, 29.7% at the external ring, 13.5% at the internal ring, and 5.4% within the abdomen. Orchidopexy was performed for 41 undescended testes and orchidectomy for three atrophic testes. There was a good outcome in 93.2% of the surgical corrections. Scrotal haematoma developed following two orchidopexies and one (2.2%) testis retracted.

Conclusion:

Cryptorchidism is a common anomaly in urology. The correction of cryptorchidism at the appropriate age is indicated to optimise testicular function, potentially reduce and/or facilitate the diagnosis of testicular malignancy, provide cosmetic benefits, and prevent complications such as a clinical hernia or torsion. Education of parents, traditional birth attendants, midwives, and doctors in our environment is required to ensure earlier presentation and treatment.

Early Experience with Laparoscopic Management of Nonpalpable Undescended Testes

Background:

Nonpalpable undescended testes (NPT) constitute 20%–30% of undescended testes, and its management has been a challenge both in diagnosis and treatment. Worldwide, laparoscopy is the current gold standard of management. In Nigeria, the management of NPT has largely been by open surgery with consequent high morbidity. In Nigeria, the trend is changing from a largely open management with its attendant high morbidity, to laparoscopic management which is the current worldwide gold standard of care.

Aim:

This study aims to classify the laparoscopic features of NPT and determine the outcome of managed cases in our center.

Methodology:

Prospective data were collected from consecutive patients who had laparoscopy for NPT at the Paediatric Surgical Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from June 2014 to July 2016.

Results:

A total of 15 patients with 23 testes were treated. There were eight patients with bilateral NPT; four had left and the remaining three right NPT. The age ranged from 1.2 to 29 years with a median of 5 years. Eleven out of the 22 internal inguinal rings were open. The position of the testes was canalicular (2), peeping (2), low abdominal (6), high abdominal (6), blind-ended vas (1), absent vas and vessels (5). No further intervention was needed for the six agenetic/atrophic testes. Standard open orchiopexy was done for the two canalicular testes. Eight testes were brought down by one stage laparoscopic orchiopexy while four were brought down by staged laparoscopic Fowler-Stephens procedure. Laparoscopic orchiectomy was done in two patients (a grossly dysmorphic testes [nubbin] and a high abdominal testis in a 29-year-old). Orchiopexy was successful in 11 out of 15 fixed testes. Of the unsuccessful ones, three testes were atrophic (volume less than what it was initially) while two were high scrotal (one testes has both complications). There was no conversion to open abdominal surgery. All patients were discharged within 24 h of surgery.

Conclusion:

Laparoscopy provides for a better management of NPT by combining diagnosis and intervention in the same sitting with a good success rate and minimal postoperative morbidity.