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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1996  |  Volume : 7  |  Issue : 4  |  Page : 383-386
Prevalence of Genital Disorders in Jordanian School Boys


Department of Pediatrics, King Hussein Medical Center, Amman, Jordan

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   Abstract 

A prospective field study was conducted to determine the prevalence rate of cryptorchidism, hypospadias and other genital disorders in school children in the eastern part of Jordan. A total of 2495 school boys from 10 different schools were examined in May-June, 1995. Standardized examination and classification criteria were used. Two general practitioners and two pediatricians carried out the study. The various genital disorders detected during the screening were as follows: Undescended testis, 1.96%; Inguinal hernia, 0.80%; Varicocele, 1.08%; Hydrocele, 0.52%; Hypospadias, 0.92%. The prevalence rates of genital disorders in this study were similar to those reported by others. Early recognition and treatment of genital disorders in school children is mandatory in order to prevent potentially adverse effects.

Keywords: Undescended estis, Genital disorders, Hypospadias.

How to cite this article:
Shahin BH, Habashneh MS, Hazza IA, Switty TA, Aqqad SS, Ammoura AM. Prevalence of Genital Disorders in Jordanian School Boys. Saudi J Kidney Dis Transpl 1996;7:383-6

How to cite this URL:
Shahin BH, Habashneh MS, Hazza IA, Switty TA, Aqqad SS, Ammoura AM. Prevalence of Genital Disorders in Jordanian School Boys. Saudi J Kidney Dis Transpl [serial online] 1996 [cited 2020 Jan 21];7:383-6. Available from: http://www.sjkdt.org/text.asp?1996/7/4/383/39408

   Introduction Top


Genital disorders represent the most common disorder of sexual differentiation in males with one or both testes being undescended in about 0.3%-0.4% of one year old boys [1] . The undescended testis is likely to be smaller than it's mate, is a poor sperm producer and is more susceptible to malignant transformation. It is also frequently associated with abnormalities of the mesonephric derivatives and, in up to 90% of children, with inguinal hernia [2] . A recent report from Britain concluded that the orchidopexy rate may have doubled during the past couple of decades [3] . In addition, a study by the John Radcliffe Hospital Cryp- torchidism Study Group [4],[5] , of some 7,400 infants born in Oxford between November 1984 and November 1988 indicates an increase in the frequency of undescended testes compared with that found earlier [6] .

Varicoceles when present are almost always found on the left side, and although rather common in children, pose problems only in adults with large varicoceles often associated with subnormal fertility [2] . Hypospadias is the most common anomaly of the penis occuring in 1 to 3.3 per 1,000 live births and is generally associated with other geni- tourinary abnormalities including inguinal herniaand undescended testis [2] .

These observations make the screening of school children for the presence of abnormal genitalia an important necessity facilitating early detection and treatment thereby offering chances for normal development of these organs without untoward consequences. Considering these aspects, this study was performed to determine the prevalence of some genital disorders in a population in the eastern part of Jordan.


   Materials and Methods Top


The study population was drawn from school boys in 10 different schools as part of the humanitarian civic action program which is a joint activity between the Royal Medical Services of Jordan and the United States Army. A total of 2,495 school boys, with a mean age of 11 years and a range of 7-16 years, were examined during the three-week study period by the medical team. Of them, 992 subjects were from the Zarga Governor­ate and 1,503 from the Mafraq Governorate in Jordan. This study was conducted during the period May-June 1995 and was approved by the Royal Air force Medical Facility. Informed consent was obtained from the families of all the study children.

The screened population were examined by two general practitioners and two pediatricians who had received standardized training at performing genital examination. The testis were examined for size, retraction, absence, hydrocele and varicocele; the penis for hypospadias and the inguinal area for hernia. We used the same examination technique and definition as used by Scorer [6] and the John Radcliffe Hospital Cryp-torchidism Study Group [4],[5] . We defined a retractile testis as one that could easily be manipulated into scrotum and that would remain in the scrotum at least momentarily. The prevalence rates of each of the anomalies detected were calculated.


   Results Top


A total of 132 subjects (5.3%) out of screened population were detected to have genital abnormalities, and their analysis yielded the following results.

Forty nine students were found to have undescended testis with a prevalence rate of 1.96%. Forty two patients had unilateral undescended testis (11 on the left side and 31 n the right side), while 7 had bilateral undescended testis [Table - 1].

A total of 27 subjects were found to have varicoceles with a prevalence rate of 1.08%. All the varicoceles were on the left side [Table - 1].

Thirteen subjects were found to have hydroceles with a prevalence rate of 0.52% [Table - 1].

A total of twenty subjects were found to have inguinal hernias with a prevalence rate of 0.8%. Of these, 17 (85%) had unilateral inguinal hernia (6 on the right side and 11 on the left side), while three (15%) had bilateral inguinal hernias [Table - 1].

Twenty three subjects were found to have hypospadias with a prevalence rate of 0.92%. Glandular hypospadias was found in 15 (65.2%), coronal hypospadias in five (21.7%), and shaft hypospadias in three subjects (13.1%) [Table - 1].


   Discussion Top


Children comprise 40-50% of the population of Jordan and screening this population for various abnormalities is helpful in making policies regarding primary health care. Early and efficient ways to detect external genital abnormalities are of paramount importance since early intervention by surgery or other methods may help the child to live a normal life in future. Our findings indicate that 5.2% of school children were having genital abnormalities.

Different prevalence rates for undes­cended testis have been reported in studies involving different age-groups. In a study involving 31,609 males aged 7-17 years, the prevalence of undescended testis was reported to be 1.7% [7] . Our finding of a 1.96% prevalence rate in children of the same age ­group conforms with the findings of this group. In another study involving 1,642 infants at birth it was found that one or both testis were undescended in 30.3% of premature infants (weight <2.5 kg) and 3.4% in 1500 full-term infants [7] . Scorer, on the basis of a cohort study of some 3,600 infants in London in the late 1950's, found that the prevalence rate of undescended testis was 0.8% at the age of one year [6] . Campbell (1959) examined 25,000 adult males; he found the prevalence of undescended testis to be 0.28% [8] .

Estimate of the prevalence rates of cryptorchidism from other studies are less comparable. Matlai and Beral [9] have reported a prevalence rate of less than 0.2% in the 1983 genital malformation registry. Hjertkvist, et al, using a national birth registry in Sweden for the period 1973 to 1982, estimated that 0.5% of 1-year old boys were cryptorchid [10] . Since reporting of minor malformations is often inaccurate, these are undoubtedly underestimates. In a study by Buemann, et al. [11] during the 1950s in Sweden, the prevalence rate of undescended testis at birth among neonates weighing more than 2,500 g was estimated to be somewhere between 1% and 1.8%. Cour-Palais, [12] who re-examined boys in whom undescended testis had been diagnosed in a survey in Middlesex, England, during the early 1960!s, found that a high proportion had retractile testes and that the true rate of undescended testes was 0.76% at age five. Similarly, Baumrucker, [13] who investigated the position of the testis in 10,000 US army recruits between the age of 18 and 37, reported a prevalence rate of 0.8%. In contrast to these figures, a study from New Zealand [14] reported that 4.1% of 509 boys examined at age five in school were cryptorchid and that 3.7% had an orchidopexy by the age of nine. We believe that the differences in the prevalence in these studies were mostly due to the difference in their age group studied. The prevalence of undescended testis may decrease with age.

The prevalence of varicocele in our study was 1.08%. This was in contrast to 16% found in 1072 Danish school boys ages 10-19 years [15] . The prevalence of hypospadias in our study was 0.92%. Other studies have estimated the prevalence of hypospadias as 13.9 per 10,000 births, with glandular hypospadias in 62%, coronal in 25% and shaft hypospadias in 13% of the cases [15] . The prevalence of inguinal hernia in our study was 0.8% compared to 1-4% prevalence in males as reported by King, et al with 50-60% occurring on the right side, 30% of the left and 10% with bilateral involvement [16] .


   Conclusion Top


Since there are no data on the prevalence rate of genital abnormalities in Jordan, this study provides current estimate of the prevalence rate. Screening programs are well-established methods in epidemiologic practice to show various figures related to prevalence rates of abnormalities under study. Finding high prevalence rates of genital disorders may encourage public awareness of the problem with emphasis on primary health care for early detection. This will help in avoiding complications, with the associated socio-economic burden on the subject as well as the general population. Further studies are encouraged including other age-groups and areas of Jordan.

 
   References Top

1.Frey HL, Rajfer J. Incidence of cryptorchidism. Urol Clin North Am 1982;9:327  Back to cited text no. 1  [PUBMED]  
2.Vaughan, Mckay, Behraman, Nelson Text book of Paediatric 1975 by W.B. Saunders Company P. 1569-1578.  Back to cited text no. 2    
3.Chilvers C, Pike MC, Forman D, Fogelman K, Wadsworth ME. Apparent doubling of frequency of undescended testis in England and Wales in 1962-81. Lancet 1984;2:330-2.  Back to cited text no. 3  [PUBMED]  
4.Cryptorchidism: an apparent substantial increase since 1960. John Radcliffe Hospital Cryptorchidism Study* Group. Br Med J Clin Res Ed 1986;293:1401-4.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Cryptorchidism: a prospective study of 7,500 consecutive male births, 1984-8. John Radcliffe Hospital Cryptorchidism Study Group. Arch Dis Child 1992;76:892-9.  Back to cited text no. 5    
6.Scorer CG. The descent of the testis. Arch Dis Child 1964;39:605-9.  Back to cited text no. 6  [PUBMED]  
7.Scorer CG, Farrington GH. (1971) Congenital deformities of the testis and epididymis. Better-Worth, London.  Back to cited text no. 7    
8.Campbell HE. Incidence of Malignant growth of the undescended testis; critical and statistical study. Arch Surgery 1942;44:353-69.  Back to cited text no. 8    
9.Matlai P, Beral V. Trends in congenital malformations of external genitalia. Lancet 1985;l:108.  Back to cited text no. 9    
10.Hjertkvist M, Damber JE, Bergh A. Cryptorchidism: a registry based study in Sweden on some factors of possible aetiological importance. J Epidemiol Community Health 1989;43:324-9.  Back to cited text no. 10  [PUBMED]  
11.Buemann B, Henriksen H, Villumsen AL, Westh A, Zachau-Christianses B. Incidence of undescended testis in the newborn. Acta Chir Scand1961;283:289-93.  Back to cited text no. 11    
12.Cour-Palais IJ. Spontaneous descent of the testicle. Lancet 1966;1:1403-5.  Back to cited text no. 12  [PUBMED]  
13.Baumrucker GO. Incidence of testicular pathology. Bull US Army Med Dept 1946;5:312-4.  Back to cited text no. 13    
14.Simpson AS, Laugesen M, Silva PA, Stewart C, Walton J. The prevalence of retained testis in Dunedin. N Z Med J 1985;98:758-60.  Back to cited text no. 14  [PUBMED]  
15.Rauitch M, Welch KJ, Benson CD, Aberdeen E,Randolph JG Pediatric Surgery Third Edition 1984 year book Medical Publisher Inc. 1355-56.  Back to cited text no. 15    
16.King and Belmann. Clinical Paediatric Urology 1985 Vol. 2, 2nd edition, by W.B. Saunders Co.,868.  Back to cited text no. 16    

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Correspondence Address:
Issa A Hazza
Department of Pediatrics, King Hussein Medical Center, P.O. Box 960955, Amman 11196
Jordan
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PMID: 18417767

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