Undiagnosed Undescended Testis in Young Adults in Saudi Arabia: Examination-Based Prevalence, Sociocultural Barriers to Early Care and Public Health Implications.
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BACKGROUND: Undescended testis (UDT) persisting into adulthood increases risks of infertility and testicular cancer. In Saudi Arabia, delayed diagnosis is common and population prevalence of undiagnosed adult UDT is unknown. This study estimated point prevalence of previously unrecognized UDT among healthy young adult males in Riyadh and explored sociocultural barriers to early care. METHODS: A cross-sectional, examination-based screening was conducted January - August 2025 at Al Kharj Armed Forces Hospital. Simple random sampling recruited 1349 Saudi males aged 18-28 from university, military and community populations. Trained senior surgeons performed standardized genital examinations; inter-examiner agreement was high (k = 0.91). Structured interviews assessed awareness, stigma, and reasons for non-consultation. Prevalence with 95% Wilson confidence intervals and χ2 tests evaluated associations. RESULTS: Mean age was 22.4 ± 2.6 years. Thirty-six participants had previously undiagnosed UDT, yielding a prevalence of 2.67% (95% CI 1.8-3.5%). All cases were unilateral (58.3% right, 41.7% left; p = 0.41). Most UDT were non-palpable (94.4%); associated anomalies were rare (2.8%). Reported reasons for non-consultation included lack of awareness/unnoticed abnormality (66.7%), social stigma (27.8%), and perceived familial normalization (5.6%). CONCLUSIONS: The observed high prevalence of undiagnosed UDT in Riyadh young adults exceeds typical adult estimates, indicating missed opportunities for early detection. Low awareness and sociocultural stigma are the main barriers; urgent actions include targeted education, routine genital screening in child and adolescent health encounters, standardized referral pathways, and individualized oncological surveillance or management for newly diagnosed adults.