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Abnormalities of the External Genitalia and Groins Among Primary School Boys in Bida, Nigeria

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Abnormalities of the External Genitalia and Groins Among Primary School Boys in Bida, Nigeria Abnormalities of the external genitalia and groins among primary school boys in Bida, Nigeria. Adedeji O Adekanye1,2, Samuel A Adefemi1,3, Kayode A Onawola1,2, John A James1,2, Ibrahim T Adeleke1,4, Mark Francis1,2, Ezekiel U Sheshi1,3, Moses E Atakere1,5, Abdullahi D Jibril1,5 1. Centre for Health & Allied Researches (CHAR), Federal Medical Centre Bida, Nigeria 2. Department of Surgery, Federal Medical centre, Bida Nigeria 3. Department of Family Medicine, Federal Medical centre, Bida Nigeria 4. Department of Health Information management, Federal Medical centre, Bida Nigeria 5. Department of Obstetrics & Gynaecology, Federal Medical centre, Bida Nigeria Abstract Background: Abnormalities of the male external genitalia and groin, a set of lesions which may be congenital or acquired, are rather obscured to many kids and their parents and Nigerian health care system has no formal program to detect them. Objectives: To identify and determine the prevalence of abnormalities of external genitalia and groin among primary school boys in Bida, Nigeria. Methods: This was a cross-sectional study of primary school male pupils in Bida. A detailed clinical examination of the external genitalia and groin was performed on them. Results: Abnormalities were detected in 240 (36.20%) of the 663 boys, with 35 (5.28%) having more than one abnormality. The three most prevalent abnormalities were penile chordee (37, 5.58%), excessive removal of penile skin (37, 5.58%) and retractile testis (34, 5.13%). The prevalence of complications of circumcision was 15.40% and included excessive residual foreskin, exces- sive removal of skin, skin bridges and meatal stenosis. Undescended testes were seen in 6 (0.90%) boys, with median age of 9 years and 2 were bilateral. Also, micropenis was detected in 27 (4.07%) of the pupils. Conclusion: Inguino-penoscrotal abnormalities are common in our community (36.20%). Screening of pre-school and school children to detect them should be introduced into the school health programs in Nigeria. Keywords: External genitalia, groin abnormalities, boys. DOI: https://dx.doi.org/10.4314/ahs.v17i4.20 Cite as: Adekanye AO, Adefemi SA, Onawola KA, James JA, Adeleke IT, Francis M, Sheshi EU, Atakere ME , Jibril AD. Abnormal- ities of the external genitalia and groins among primary school boys in Bida, Nigeria. Afri Health Sci.2017;17(4):1120-1125. https://dx.doi. org/10.4314/ahs.v17i4.20 Introduction look like, or out of sheer negligence. The absence of any Abnormalities of the male external genitalia and groins immediate functional derangement usually reinforces are a set of lesions which may be congenital or acquired such indifference to the presence of the abnormalities. but are rather obscured to many kids and their parents. Late presentation may then be inevitable, which may be in This is particularly so where the parents may not be cer- form of life-threatening complications such as strangu- tain of what a normal external genitalia and groin should lated hernia or grave sequelae such as infertility, which is not uncommon in the practice of the lead author (a Urol- Corresponding author: ogist). The optimal time for the treatment of most of Adedeji O Adekanye, these surgically correctable lesions is infancy and child- Centre for Health & Allied Researches, hood. c/o Urology Unit, Department of Surgery, Among the congenital ones are hypospadias, epispadias, Federal Medical Centre, P.M.B. 14, Bida 912001, buried penis, micropenis, ambiguous genitalia, phimosis, Niger State, Nigeria. paraphimosis, aphallia (penile agenesis), diphallia, chord- Tel: +234 803 384 0426, +234 807 949 7070 ee without hypospadia, hernia, hydrocoele, bifid scrotum, Email: [email protected] African © 2017 Adekanye et al. Licensee African Health Sciences. This is an Open Access article distributed under the termsof the Creative commons Health Sciences Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. African Health Sciences Vol 17 Issue 4, December, 2017 1120 ectopic scrotum, cryptorchidism/undescended testis, re- Eight of the 10 schools gave the approval, representing tractile testes, epididymal cyst, etc. 10.6% of all the schools in the community. All male pu- The acquired ones may result from circumcision which pils in the selected schools were included. Informed con- includes excessive residual foreskin, excessive removal sent was obtained from each male pupil’s parents before of skin, meatal stenosis, granuloma, penile torsion, sec- data collection and examination of the external genitalia ondary chordee, skin bridges, glans amputation, inclusion and groin of their wards. The parents were also informed cyst, urethro-cutaneous fistula etc. of the availability of Specialists in our hospital who could Previous studies on these abnormalities reported prev- handle the treatment of those with anomalies. alence as low as 6.65% and as high as 18.31%, among primary school male pupils aged 6-12 years.1,2 A detailed clinical examination of the external genitalia In Nigeria, there is no formal setup or program in our and groin of the male pupils was done. The examination health care system for the detection of these abnormal- of the boys was performed by the two urologists and oth- ities. The observed pattern of presentation of patients er physicians among the authors. These physicians who with these abnormalities at our health facility is that of are trainee surgeons learned the methods of examination late presentation in adulthood, presentation with com- from the urologists over a few pilot sessions. Also, pos- plications and grave sequelae, incidental detection of the itive or suspicious cases were re-examined by the urolo- lesions during treatment of other conditions, etc; There- gists for confirmation. Findings were recorded on data fore, the present study sought to identify congenital and forms for subsequent data input and analysis, using SPSS acquired abnormalities of male external genitalia and version 17. In all, a total of 966 boys’ parents were given groin among primary school pupils in Bida, and deter- the consent forms but 663 (68.6 %) boys were included in mine their prevalence. the study and these were the ones whose parents gave the consent and had complete data for analysis. Methods This was a cross-sectional study carried out among male Results primary school pupils in Bida, North Central Nigeria. By Most of the boys (90 %) were ≤13years, with a mean systematic random sampling, 10 were selected out of the age of 9.4 ± 3.0 years. Abnormalities were detected in 75 primary schools in Bida. 240 (36.20%) of the 663 boys, with 35 (5.28%) having Ethical approval was obtained from the ‘Ethics Com- more than one abnormality. The three most prevalent mittee” (IRB) of the Hospital for the study. Approval abnormalities were penile chordee (37, 5.58%), excessive from the management of the selected schools was also removal of penile skin (37, 5.58%) and retractile testis obtained for the study to be carried out among its pupils. (34, 5.13%) [Table 1]. TableTable 1: 1: Inguino Inguino--scrotalscrotal and and penile penile abnormalities abnormalities among among Bida Bida school school boys boys AbnormalitiesAbnormalities FrequencyFrequency %% Frequency Frequency MeanMean AgeAge(Min;Max(Min;Max) )- - yrsyrs InguinoscrotalInguinoscrotal UndescendedUndescended testis testis 66 0.900.90 88.17.17 (4;1 (4;100) ) RetractileRetractile testis testis 3434 5.135.13 8.8.4747 (5 (5;1;144) ) InguinalInguinal hernia hernia 99 1.361.36 11.11.3333 (8;18) (8;18) HydrocoeleHydrocoele 99 1.361.36 10.2210.22 (7;16) (7;16) VaricocoeleVaricocoele 44 0.600.60 13.2513.25 (10;15 (10;15) ) EpididymalEpididymal cyst cyst 11 0.150.15 14.014.000 GroinGroin scars scars 22 0.300.30 9.9.5050 ( 9(9;10);10) PenilePenile HypospadiaHypospadia 33 0.450.45 7.677.67 (5;10) (5;10) ChordeeChordee 3737 5.585.58 10.5910.59 (5;15 (5;15) ) TorsionTorsion 4343 6.496.49 10.0710.07 (4;16 (4;16) ) ExcessiveExcessive residual residual skin skin 2929 4.374.37 8.838.83 (3;15 (3;15) ) ExcessiveExcessive removal removal of of skin skin 3737 5.585.58 8.498.49 (4;17 (4;17) ) SkinSkin bridges bridges 1919 2.872.87 10.0010.00 (6;15 (6;15) ) MeatalMeatal stenosis stenosis 1717 2.562.56 9.659.65 (4;14 (4;14) ) MicropenisMicropenis 2727 4.074.07 8.678.67 (3;17 (3;17) ) Min Min – – Minimum Minimum Max Max – – Maximum Maximum Yrs Yrs – – Years Years 1121 African Health Sciences Vol 17 Issue 4, December, 2017 Of the 34 boys with retractile testis, 9 (26.50%) were on inguinal hernia was detected in 9 (1.36%) of 663 boys, 4 the right, 15 (44.12%) on the left and 10 (29.41%) were on the right side and 5 on the left [Fig.1].The only case bilateral [Fig. 1]. Hydrocoele was detected in 9 (1.36%) of epididymal cyst (0.15%) was detected on the left side. of the 663 boys, 3 (33.33%) of the 9 were on the right Our findings revealed 3 (0.45%) of the 663 boys had side and 6 (66.67%) on the left side, with 1 (11.11%) of hypospadia, 37 (5.58%) had chordee, [Right lateral-7, the latter being an encysted hydrocoele [Table 1, Fig.1]. Left lateral-24, Ventral-1, Dorsal-2, 3 not stated] and 43 Undescended testes were seen in 6 (0.90%) boys, with (6.49%) had penile torsion [24 with <45 degree, 10 with median age of 9 years (range of 4 – 10) and 2 were bi- 45-90 degree and 1 with > 90 degree of torsion, 8 with lateral. Varicocoele was seen in 4 (0.60%) boys, 1 on the no measurement].
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