Barriers to Timely Treatment of Undescended Testis in Pakistani Patients: Why Are We Facing Delayed Presentation
DOI:
https://doi.org/10.51253/pafmj.v76iSUPPL-6.13649Keywords:
Cryptorchidism, Infertile, Male, Orchidopexy, PakistanAbstract
Objectives: To explore delayed presentations of cryptorchidism, factors responsible for the delay, and identify modifiable factors, providing region-specific evidence to guide clinical practice and public health interventions.
Study design: Prospective observational study.
Place and Duration of Study: Surgical Unit, MTI Gomal Medical College, Dera Ismail Khan, Pakistan from Oct 2024 to Mar 2025.
Methodology: Data were collected regarding demographic, age at 1st diagnosis, cause of delay in treatment, socioeconomic status, parent’s literacy, laterality and palpability. Patients were grouped into three categories, namely, delay in early diagnosis, delayed referral for treatment and delay due to parents. Data were entered and analysed using Statistical Package for Social Sciences (SPSS), with appropriate descriptive and analytical statistics applied.
Results: Total of 50 patients presenting to the surgical department during the study duration were analysed. Mostly coming from rural areas, majority of patients’ parents were uneducated, and majority of patients were from low socioeconomic background. The mean age at presentation for surgical procedure was 12.7+ 3.4 years. 45(90%) patients’ diagnoses were delayed. Factors for delayed presentation, majority of patients were from rural areas with delay in diagnosis with p value= 0.258. Socioeconomic status of patients was mostly from the low 24(48%) and average 26(52%) ..
Conclusion: Among 50 patients with undescended testis, 45(90%) had delayed early diagnosis (mean age 12.7 + 3.4 years); delays were multifactorial, highlighting the need for early screening, referral improvement and public health interventions.
Downloads
References
1. Abdulrahman ST, Dahlawi M, Almalki MM, Bin Laswad BM, Baaqeel RG, Aljabri HM, et al. Knowledge level of undescended testis in Saudi Arabia: why are we facing delayed presentation? Cureus 2023; 15(7): e42226.https://doi.org/10.7759/cureus.42226
2. Sengar M, Siddiqui Y, Gupta A, Mohta A. Delayed referral for orchidopexy: scrutinising the causes. Trop Doct 2022; 52(1): 27–29.
https://doi.org/10.1177/00494755211044614
3. Alherek A, Ramloutan V. Age at surgery and outcomes of patients with undescended testes at Klerksdorp/Tshepong Complex Hospital, North West, South Africa. Afr Urol 2022; 2(2): 76–80.
https://doi.org/10.7759/cureus.6413
4. Mentessidou A, Gargano T, Lima M, Mirilas P. Laparoscopic versus open orchiopexy for palpable undescended testes: systematic review and meta-analysis. J Pediatr Surg 2022; 57(4): 770–775.
https://doi.org/10.1016/j.jpedsurg.2022.03.016
5. Madni M, Alzimam M, Alfayez A, Alnabri M, Alharbi S, Alanazi K, et al. Factors responsible for late presentation of undescended testis among Hail community and estimation of public awareness about cryptorchidism, Saudi Arabia. Int J Med Dev Ctries 2021; 5: 870–875.
https://doi.org/10.24911/IJMDC.51-1609751630
6. Rizvi SAH, Naqvi SAA, Hussain M, Hashmi A. Delayed presentation of cryptorchidism: experience from a developing country. Pak J Med Sci 2017; 33(3): 593–597.
https://doi.org/10.12669/pjms.333.12478
7. Ahmed R, Akhtar J, Syed MRH Taqvi, Naima Zamir, Safia Bibi. Clinical presentation, diagnostic approach, laparoscopic evaluation and treatment of impalpable testis. J Coll Physicians Surg Pak 2022; 32(4): 478–482. https://doi.org/10.29271/jcpsp.2022.04.478
8. Rehman MH, Ahmad A, Ahmed R, Jabbar S, Rehman H, Jaral MS. A prospective cohort study in pediatric care Rawalpindi to compare orchidopexy with and without sac ligation in terms of post-operative hernia formation. Life Sci 2025; 6(2): 178–183.
https://doi.org/10.37185/LnS.1.1.667
9. Boehme P, Degener S, Wirth S, Geis B, Aydin M, Lawrenz K, et al. Multicenter analysis of acquired undescended testis and its impact on the timing of orchidopexy. J Pediatr 2020; 223: 170–177. https://doi.org/10.1016/j.jpeds.2020.04.037
10. Hamdy MAEK, Shahin MM, Ashour YM, Anwar M. Timing of orchidopexy; efficacy and safety outcomes in patients with cryptorchidism: a systematic review and meta-analysis. Int J Med Arts 2024; 6(10): 4976–4983.
https://doi.org/10.21608/ijma.2024.386097
11. Dave S, Clark J, Chan EP, Richard L, Liu K, Wang Z, et al. Factors which delay surgery for undescended testis in Ontario: a retrospective population-based cohort study on timing of orchidopexy between 2006 and 2012. J Pediatr Urol 2022; 18(5): 695.e1–695.e7.
https://doi.org/10.1016/j.jpurol.2022.07.017
12. McBride CA, Patel B, Xu E, Bairagi A. Assessing for cryptorchidism via telehealth is not always accurate: a paediatric cohort study. Front Urol 2022;2:993528.
https://doi.org/10.3389/fruro.2022.993528
13. Bonane A, Nshimiyimana A, Nzeyimana I, Nyirimodoka A, Muhawenimana A. Predictors of delayed consultation in undescended testis patients at a Rwandan referral hospital. Rwanda Med J 2022; 79(4): 78–84. https://doi.org/10.4314/rmj.v79i4.8
14. Ilyas F, Aslam M, Ali S, Nazir MI. Torsion of a cryptorchid testicle in a toddler. Uro-Technol J 2024; 8(1): 6-8.
https://doi.org/10.31491/UTJ.2024.03.017
15. Pakkasjärvi N, Taskinen S. Surgical treatment of cryptorchidism: current insights and future directions. Front Endocrinol 2024; 15: 1327957. https://doi.org/10.3389/fendo.2024.1327957
16. Ullah M, Amin H, ul Wahab MR, Ullah M, Nawab H, Khan SJ, et al. Delayed presentation of undescended testes. J Popul Ther Clin Pharmacol 2025; 32(5): 1565–1571.
https://doi.org/10.53555/3nzshj41
17. Sholtes CB, Tranthem LA, Nakamura F, Canalichio K, Goedde M, Choi K. A contemporary review of cryptorchidism management in adults: a rare presentation of bilateral cryptorchidism presenting as pelvic pain in an adult patient. Cureus 2024; 16(1): e52933.
https://doi.org/10.7759/cureus.52933
18. Boehme P, Geis B, Doerner J, Wirth S, Hensel KO. Shortcomings in the management of undescended testis: guideline intention vs reality and the underlying causes. BJU Int 2018; 122(4): 644–653.
https://doi.org/10.1111/bju.14171
19. Zhao T, Deng F, Jia W, Gao X, Li Z, Tang X, et al. Ambulatory orchidopexy is a potential solution to improve the rate of timely repair in cryptorchid boys: an 8-year retrospective study of 4,972 cases. Front Pediatr 2021; 9: 671578.
https://doi.org/10.3389/fped.2021.671578
20. Zvizdic Z, Islamovic B, Milisic E, Jonuzi A, Vranic S. Changing trends in the referral and timing of treatment for congenital cryptorchidism: a single-center experience from Bosnia and Herzegovina. J Pediatr Surg 2020; 55(9): 1965–1968. https://doi.org/10.1016/j.jpedsurg.2019.08.013
21. Janardhana A, Daryanto B, Gumilar OB. Analysis of factor influencing delayed referral of undescended testis. Open Access Maced J Med Sci 2023; 11(E): 76–79.
https://doi.org/10.3889/oamjms.2023.8649
22. Irfan Munir M, Akmal M, Mahboob Subhani G, Hassan Javed S, Ali Jafari A, Tahir Bashir Malik M. Disorders of sexual development: presentation and categorization at Allied Hospital / Punjab Medical College Faisalabad. Ann Punjab Med Coll 2020; 14(1): 70-73. https://doi.org/10.29054/apmc/2020.837
23. Malik H, Farooq O, Zafar TZ, Iqbal T, Zafar MT, Shah SK. Diagnostic accuracy of ultrasound and correlation with surgical outcomes in children with undescended testes. Biol Clin Sci Res J 2025; 6(6): 231-234. https://doi.org/10.54112/bcsrj.v6i6.1856
24. Naz N, Walid A, Rahim A, Lajpat K. Utility of diffusion-weighted magnetic resonance imaging to detect non-palpable undescended testis. Pak J Med Sci 2024; 40(9): 2069–2073. https://doi.org/10.12669/pjms.40.9.8905
Downloads
Published
License
Copyright (c) 2026 Nawazish Ali, Jawairia Nawaz , Furqan Ullah khan, Muhammad Junaid Shah, Iram Bashir , Muneeba Attique, Muhammad Arshad, Mohammad Osama
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
