Testicular Surveillance Post-Orchidopexy and its Impact on Early Diagnosis of Testicular Cancer
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ORIGINAL ARTICLE
Testicular Surveillance Post-Orchidopexy and its Impact on Early Diagnosis of Testicular Cancer Ahmed Osama Mohamed 1
&
Kevin Murtagh 2 & Roger Kockelbergh 2 & Khalid ElMalik 1
Received: 14 April 2020 / Accepted: 7 July 2020 # Indian Association of Surgical Oncology 2020
Abstract Paediatric surgeons are expected to counsel patients about the potential risk of cancer post-orchidopexy and the need to selfexamine in adulthood. The study objectives were to examine if such advice is being given and identify the stage of cancer at presentation in adult patients with history of orchidopexy. This was a 5-year observational, retrospective collaborative study between a tertiary paediatric surgical unit and its regional adult testicular cancer service, examining the nature of counselling given by paediatric surgeons to orchidopexy patients and their carers and estimating the local incidence of testicular cancer in adults with previous orchidopexy during the same period. Orchidopexy was performed in 228 patients with a mean follow-up of 11.9 months. Twenty-two patients had documented advice to self-examine from puberty onwards. The advice was not influenced whether the surgery was staged or single (p = 0.39). During the 5 years, 133 adults were diagnosed with testicular cancer, 6 (4.5%) were cases of previous cryptorchidism, seminoma (n = 5) and non-seminoma germ cell tumour (n = 1). In our study, the incidence of cryptorchidism in testicular cancer was 4.5%, with all cancer patients presenting with early disease despite documented advice to self-examine being low (9.7%). Keywords Orchidopexy . Testicular cancer . Testicular surveillance . Self-assessment advice
Introduction Undescended testis (UDT) is a commonly encountered condition in paediatric surgery and the most common disorder diagnosed at birth. Congenital UDT is one that has failed to reach a scrotal position at birth while acquired UDT is when a testis re-ascends from a scrotal position [1]. In full-term boys, the incidence of UDT accounts to 1– 4.6%. Prematurity and low birth weight are considered strong risk factors. Spontaneous descent is presumed to occur up until the 6th month of life in 35–43% of all affected children [2]. If a testis has not concluded its descent at the age of 6 months (corrected for gestational age), the consensus is to
perform the surgery between 6 and 12 months, although some reports can also occur within the first 3–6 months [3]. Boys who are treated for an undescended testis have an increased risk of developing testicular malignancy. Screening and self-examination both during and after puberty are therefore recommended [4]. We aimed to find out the nature of self-assessment advice given to patients, if any, at their final follow-up post-orchidopexy and correlate that with the stage of testicular cancer in patients with history of orchidopexy presenting to our adult testicular cancer service in the same period of time.
Methods * Ahmed Osama Mohamed [email protected] 1
Department of Paediatric Surger
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