Undescended testes may be overlooked in learning impaired

Last Updated: 2015-02-25

By David Douglas

NEW YORK (Reuters Health) - A small case series suggests that inadequate physical screening may lead to unidentified undescended testes (UDT) in teenage boys with learning disabilities, according to UK researchers.

"Carers cannot be relied on to identify all health issues and there is no substitute for health assessments and physical examination," Dr. Anne R. Haire, of Kaleidoscope Children's Resource Centre, London, told Reuters Health by email.

In a February 2 online paper in Archives of Disease in Childhood, Dr. Haire and colleagues note that the condition "is one of the most common congenital abnormalities in male infants, affecting about 6% of full-term male newborns."

Early identification is important because UDT can lead to significantly reduced fertility and a threefold increased risk of testicular cancer. Prepubertal orchidopexy can reduce the risk.

However, the condition is being missed. The researchers report on nine boys aged 12 to 17 years they referred to pediatric surgeons between 2004 and 2008. Seven had unilateral UDT. The remaining two had an atrophied testis that appeared undescended on examination but was found by ultrasound scan. Altogether seven of the boys had cerebral palsy and the other two had autism and behavior problems.

Acquired UDT may be likely in most, say the researchers. But the late identification is highly significant as all had "been seen by a community pediatrician previously, and most had significant medical input in early life and regular assessments throughout."

This, they add, suggests "that routine examination for testicular descent in this high-risk group is not happening."

In children with severe learning disabilities, in particular those with cerebral palsy, the investigators conclude, "Examination for testicular descent should become a routine part of the medical examination until there is a record that both testes are in place after the age of school entry."

In fact, Dr. Haire added, this issue was identified many years ago but "things get forgotten over time."

The authors report no external funding or disclosures.

SOURCE: http://bmj.co/1MRMiHS

Arch Dis Child 2015.