Advances in Life Science and Technology www.iiste.org ISSN 2224-7181 (Paper) ISSN 2225-062X (Online) Vol.54, 2017 82 Treatment Approach of Cryptorchidism in Developing Country Baton Kelmendi 1* Fisnik Kurshumliu 2 Hysni Jashari 1 Dafina Matoshi 3 Sokol Buba 4 Marinela Kumaraku 5 1.Pediatric Surgeon, Department of Pediatric Surgery-University Clinical Center of Kosova 2.Pathologist, Institute of Pathology, Medical School of University Clinical Center of Kosova 3.Anesthesiologist, Department of Anesthesia and Intensive Care-University Clinical Center of Kosova 4.Pediatric Surgeon, Mother Teresa University Hospital Centre and Professor at U. of Medicine Tirana 5.Pediatrician, Mother Teresa University Hospital Centre, Tirana, Albania Abstract The history of testicular descent is closely connected with the expression of masculinity and as such can be traced back to ancient Egypt. Research into testicular descent was initiated by Haller and Hunter. It was Hunter who discovered that the testes descend during embryonal life from dorsal abdominal wall into the scrotum. In the study conducted by “John Radcliffe Hospital” the incidence of cryptorchidism is 1.58%, spontaneous descent occurred postnatal in the first three months, and beyond that time, it was rare[1, 2]. As with other pathologies treatment and timing had changed during the years.Very important part of modern medical infrastructure is a functioning informative system, where the data about patients are registered. In the postwar developing country (Kosovo), rebuilding medical care and information system required a lot of effort and time. When the whole medical system needs to be rebuild and equipped, informative system is not in top priorities. What in normal circumstances can be one click away like history of patients, medical chart, lab exams, imagery studies, becomes lot of paper work that can easily be lost. Mainly difficulties were with patients in rural areas where awareness and access to specialist is not well covered. Providing medical care in these conditions can be quite challenging. The study was started after noticing that the patients that were diagnosed with cryptorchidism lost precious time until they were treated. In our series the mean age of patients was higher than recommended age for treating cryptorchidism. Ideal age for treating cryptorchidism is from 6 month to 2 years of life. First signs of damage to testes are identified at about 6 month of age. We decided to study this pathology in 3 years period, after starting awareness program and systematic controls in schools and kindergartens.Conclusion: After starting systematic controls and awareness program, mean age of the patients diagnosed and treated for cryptorchidism is in decline. Keywords: Cryptorchidism, Testes, Orchiopexy, Hormones, Medical risks, Modern treatment. Introduction Cryptorchidism (from the Greek kryptos, meaning” hidden” and “orchis” meaning testis) refers from the absence of testis to the scrotum. Undescended testis is best defined as testis that cannot be manipulated to the bottom of the scrotum without undue tension on the spermatic cord. A normally descended testis resides spontaneously in the lower scrotum. Cryptorchidism can be unilateral or bilateral. The positions of the undescended testis can be divided into those arrested in the line of normal descend (Intra-abdomina, canalicular, superficial inguinal pouch and prescrotal), and those in truly ectopic positions (pubo-penile, femoral, perianal) which are rare. Isolated cryptorchidism is the most common congenital anomaly of the male genitalia. The history of treating for cryptorchidism dates back to more than 200 years ago. Attempts at surgical correction of the undescended testis began in the early 1880s, culminating in the first successful orchiopexy by Thomas Annandale in 1877. Cryptorchidism can be treated with hormones, which in general gives results less than 30% [3] and with operation in which depending on the location of the testes, skills of surgeon and timing of surgery, complication are less than 5% [4]. At present there are no accurate data available as to whether orchidopexy in early infancy reduces the risk of subsequent testicular cancer, but when looking at all men with testis tumor, a relative risk for those with a history of unilateral cryptorchidism is 15-fold or 33-fold for bilateral undescended testes, with the risk of cancer being highest with the intra-abdominal testes [5, 6, 7]. In this pathology (cryptorchidism) except the position of the testis there are no other symptoms, there is no pain that refers patient to the doctor. In the 50s it was preferred that the operation should be performed around puberty, modern approach prefers operation from 6 month until 2 years after birth. First sign of damage to the testes are identified by pathology examination after 6 month of age [8]. This fore is crucial awareness of parents and updating staff of primary care level with newest trends on treatment. Treatment of cryptorchidism is based on the assumption that early intervention will prevent secondary degeneration of the testes caused by high temperature to which the undescended testes are exposed. The scrotal testis, normally positioned testes is 3°C to 4°C cooler than the intra- abdominal core temperature [9, 10]. Results and Discussion: The survey of our patients began in 2010 and continued through the 2013, during this time 523 patients were brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by International Institute for Science, Technology and Education (IISTE): E-Journals