Further evidence for acquired undescended testicle in the UK and its incompatibility with current recommendations in the Hall Report

ObjectiveThe 4th edition of the Hall Report [Hall DMB. Health for all children. Oxford: Oxford University Press; 2003. p. 167] does not expect undiagnosed undescended testicles at the age of 5 years or subsequently to be seen if its advice for diagnosis is carried out. We examine whether that recommendation can be relied upon.MethodA retrospective audit was performed of 228 boys who underwent orchidopexy between January 1992 and December 2003 at the County Hospital Hereford, UK. During that time, 10,048 boys were born at the hospital. Child health records, hospital records and some GP records were used.ResultsA total of 103 boys (45%) were treated before their 5th birthday and 125 (55%) were treated after the age of 5; 93 orchidopexies were performed as a result of diagnosis made at birth or 6 weeks, but 83 were undertaken in boys documented as having scrotally placed testes both at birth and 6 weeks. A further 21 had documentation for scrotal testes either at birth (14) or at 6 weeks (7) but not both. The records of the remaining 31 are either missing or did not yield the information required largely because the Parent Held Child Record was introduced after their time. The literature was reviewed, and the results found to concur with those of other papers, in particular with a recent study from The Netherlands, which led to a new classification of undescended testis drawing attention to ‘acquired undescended testicle’. The progressive nature of this entity was seen from review of the case notes.ConclusionThe natural history of acquired undescended testis means that recommendations as set out in the Hall Report “that no further check after six weeks need be made if the testes are ‘well down’ at that stage” cannot be successful, and all concerned in childhood surveillance will need to be aware of this and remain vigilant at least until puberty. Perhaps a prospective study following the Netherlands design should be undertaken in this country.