Date of Award
2020
Document Type
Dissertation
Degree Name
Master of Medicine (MMed)
First Supervisor/Advisor
Dr. Fariha Fazal
Second Supervisor/Advisor
Dr. Mugambi Machoki Stanley
Department
General Surgery (East Africa)
Abstract
BACKGROUND: Undescended Testis is the most common urological congenital anomaly with significant burden of disease especially in our local context. Management relies on early diagnosis, in the perinatal period, and prompt referral to an appropriate surgical unit. Spontaneous descent, while possible, doesn’t occur beyond 6 months and thus surveillance should not proceed beyond this age. Current guidelines recommend surveillance up to 6 months, referral by 9 months and, most importantly, orchidopexy by 1 year of age. Despite these clear guidelines, achieving them has proven difficult globally with low rates of orchidopexy by 1 year. The most common cited cause has been late referral. Therefore, we sought to study if the pattern of referral, specifically internal versus external referral pattern, is associated with better rates of orchidopexy by 1 year.
OBJECTIVE: To determine the association between the age at orchidopexy and patients born and referred from within this tertiary hospital versus those born and referred from outside this tertiary hospital.
METHODOLOGY: A case-control study of all patients who presented to the Paediatric Surgical Unit at Aga Khan University Hospital, Nairobi (AKUHN) and underwent orchidopexy over 5 years, between January 2014 and December 2018.
RESULTS: A total of 126 patients were eligible for inclusion into the study. 34 patients were born in this tertiary hospital (AKUHN group) and 92 patients were born outside this tertiary hospital (Non-AKUHN group). Orchidopexy before 1 year was achieved in 44.12% of the AKUHN group versus 8.70% in the Non-AKUHN group (OR: 8.289; 95% 3.07 – 22.36). Notably, 89.16% of patients in the Non-AKUHN group first presented in clinic after age 12 months and 38.04% had orchidopexy after age 5 years.
CONCLUSIONS: In this study, the internal referral group were more likely to undergo orchidopexy within the recommended age as per guidelines. The external referral group presented much later to the Paediatric Surgical group; often presenting well past 12 months. The AKUHN group were referred earlier resulting in a generally better age at orchidopexy before 1 year rate. Time to surgery was not a factor in the late age at orchidopexy vi This late referral in the external referral group could not be adequately addressed from this study due to missing records to assess when these children were first seen by a healthcare worker. Despite better performance in the AKUHN group, there were gaps in rates of UDT diagnosis and a poor trend over the study period of the average at orchidopexy in this group.
RECOMMENDATIONS: The internal referral network was more effective in ensuring patients underwent orchidopexy at a timely age. This network could still benefit from investigation and strengthening pathways within it to improve diagnostic rate and timely orchidopexy rate. The external referral group showed very poor performance and our recommendation would be a deeper assessment of the knowledge, attitudes and practices imparted on the guardians by the facilities and healthcare providers involved in the care of these patients.
Recommended Citation
Njoroge, M. K. (2020). Referral patterns affecting age at orchidopexy for undescended testis at a tertiary hospital in Nairobi. (Unpublished master's dissertation). Aga Khan University, East Africa.