INTRODUCTION: Cryptorchidism is the most common genitourinary disorder in male neonates, with an incidence of 2-5% in term neonates and 30% in preterm infants. Known complications of this condition include impaired fertility and an increased risk of malignancy. This leads to a high frequency of imaging tests, specifically ultrasonography. Use of ultrasound aims to identify non-palpable testis, however current literature does not support such an approach.
GOALS: To evaluate the efficacy of clinical follow-up of cryptorchidism in neonates and to evaluate the need for ultrasonography.
METHODS: This prospective study was performed at the Lis Maternity Hospital in the Tel Aviv Sourasky Medical Center during a 14 month period. During that period some 4,500 male neonates were born at our hospital. Every newborn was examined within 8 hours of delivery by a pediatrician skilled in neonatal physical examinations. Excluded from the study were preterm infants, neonates in which prenatal examination demonstrated genitourinary abnormalities and neonates with additional congenital abnormalities. Healthy term babies in which one or both testes were not palpable were re-examined within a day by a senior neonatologist (M.B.) to establish their diagnosis, and then reexamined daily by the same physician until their discharge from the hospital. Babies who had one or both testis which were not palpable on discharge were followed-up weekly at a hospital clinic for 2 more weeks.
RESULTS: Of 4,500 male neonates born during the study period, 41 (0.9%) were diagnosed with a non-palpable testis, and 8 (0.18%) had bilateral non-palpable testes; 5 babies were lost to followup and excluded from the analysis; 26 of 44 testes (29%) became palpable before discharge from the nursery, by the 3rd day of life. After a weekly follow up from discharge, 13 (29%) additional testes became palpable over the 4-14th day of life. Overall, 88% of non-palpable testes became palpable by 14 days of age.
CONCLUSIONS: Close clinical follow-up during the first weeks after birth allows localizing most congenitally non-palpable testing and clarifying the need for performing imaging studies not routinely necessary to diagnose and refer babies with cryptorchidism for further treatment.
|Published - 1 Jan 2016