Late diagnosis of cryptorchidism: a failure of medical screening?

A retrospective review of hospital and available community records of 47 children undergoing orchidopexy in a district hospital was undertaken to determine adequacy of screening for cryptorchidism and factors associated with late referral. Twenty eight of these boys were previously examined on 108 occasions. Diagnosis was missed on 32 occasions and the record of 38 clinical examinations did not include position of testes. In the case of 16 boys (four under school age and 12 of school age) appropriate action was not taken once the diagnosis was made. Diagnosis was reliably made in school aged children but in children under the age of 1 year cryptorchidism was frequently missed by the examining doctor. It is suggested that criteria for diagnosis and referral should be agreed in any surveillance programme. Junior doctors in hospital responsible for routine clinical examination of children during admission and clinical medical officers or general practitioners during routine clinical examination of boys should be clearly instructed to examine and record the position of the testes.