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Chedrawe ER, Keefe DT, Romao RLP. Diagnosis, Classification, and Contemporary Management of Undescended Testicles. Urol Clin North Am 2023; 50:477-490. [PMID: 37385709 DOI: 10.1016/j.ucl.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
This article provides a comprehensive review regarding undescended testicles and other related conditions. We have included background information summarizing variable clinical presentations, epidemiology, and the implications of undescended testis (UDT) on fertility and malignancy risk. This article has an emphasis on the approach to diagnosis and surgical management for the UDT. The purpose of this review is to provide readers with useful clinical tools for assessing and treating patients with cryptorchidism.
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Affiliation(s)
- Emily R Chedrawe
- Division of Pediatric Urology, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8 Canada; Department of Urology, Dalhousie University, 1276 South Park Street. Room 293, 5 Victoria, Halifax, NS, B3H 2Y9, Canada
| | - Daniel T Keefe
- Division of Pediatric Urology, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8 Canada; Department of Urology, Dalhousie University, 1276 South Park Street. Room 293, 5 Victoria, Halifax, NS, B3H 2Y9, Canada
| | - Rodrigo L P Romao
- Division of Pediatric Urology, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8 Canada; Department of Urology, Dalhousie University, 1276 South Park Street. Room 293, 5 Victoria, Halifax, NS, B3H 2Y9, Canada; Division of Pediatric Surgery and Department of Surgery, IWK Health Centre, Dalhousie University, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8.
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Hallabro N, Hambraeus M, Börjesson A, Salö M. Mapping of referral patterns for undescended testes - Risk factors for referral of children with normal testes. J Pediatr Urol 2023; 19:320.e1-320.e10. [PMID: 36898865 DOI: 10.1016/j.jpurol.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/29/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Accurate referral of boys with suspected undescended testes (UDT) is of importance to preserve fertility and reduce risk of future testicular cancer. While late referral is well studied, there is less knowledge about incorrect referrals, hence, referral of boys with normal testes. OBJECTIVE To evaluate the proportion of UDT referrals that did not lead to surgery or follow-up, and to assess risk factors for referral of boys with normal testes. STUDY DESIGN All UDT referrals to a tertiary center of pediatric surgery during 2019-2020 were retrospectively assessed. Only children with suspected UDT in the referral (not suspected retractile testicles) were included. Primary outcome was normal testes at examination by a pediatric urologist. Independent variables were age, season, region of residence, referring care unit, referrer's educational level, referrer's findings, and ultrasound result. Risk factors for not needing surgery/follow-up were assessed with logistic regression and presented as adjusted odds ratios with a 95% confidence interval (aOR, [95% CI]). RESULTS A total of 378 out of 740 included boys (51.1%) had normal testes. Patients >4 years (aOR 0,53, 95% CI [0,30-0,94]), referrals from pediatric clinics (aOR 0.27, 95% CI [0.14-0.51]) or surgery clinics (aOR 0.06, 95% CI [0.01-0.38]) had lower risk of normal testes. Boys referred during spring (aOR 1.80, 95% CI [1.06-3.05]), by a non-specialist physician (aOR 1.58, 95% CI [1.01-2.48]) or referrer's description of bilateral UDT (aOR 2.34, 95% CI [1.58-3.45]), or retractile testes (aOR 6.99, 95% CI [3.61-13.55]) had higher risk of not needing surgery/follow-up. None of the referred boys that had normal testes had been re-admitted at the end of this study (October 2022). DISCUSSION Over 50% of boys referred for UDT had normal testes. This is higher or equal to previous reports. Efforts to reduce this rate should in our setting probably be directed towards well-child centers and training in examination of testicles. The main limitation of this study is the retrospective design and the rather short follow-up time, which however should have very modest effect on the main findings. CONCLUSION Over 50% of boys referred for UDT have normal testes. A national survey regarding the management and examination of boys testicles has been launched and directed at well-child centers to further evaluate the findings of the current study.
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Affiliation(s)
- Nilla Hallabro
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden
| | - Mette Hambraeus
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden
| | - Anna Börjesson
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden
| | - Martin Salö
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden.
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Factors which delay surgery for undescended testis in Ontario: A retrospective population based cohort study on timing of orchidopexy between 2006 and 2012. J Pediatr Urol 2022; 18:695.e1-695.e7. [PMID: 35970738 DOI: 10.1016/j.jpurol.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Delays in performing orchidopexy (OP) for undescended testis (UDT) result in loss of germ cells. Despite practice guidelines recommending OP by 18 months of age, significant delays in OP occur. This delay may impact fertility and increase the risk of testicular malignancy in boys with UDT. OBJECTIVE The objective of this study is to identify factors associated with delayed OP with the goal of identifying modifiable risk factors. STUDY DESIGN A population-based, retrospective cohort study was conducted using linked databases held at ICES to evaluate factors associated with timing of OP in Ontario for 4339 male newborns undergoing their first OP between 2006 and 2012. Primary outcome was delayed OP (>18 months). Multivariable logistic regression analysis was performed to identify patient, physician, and hospital risk factors for delayed OP. RESULTS Median age at OP was 24 months, while median age at first surgical consult was 20 months (IQR 10-60 months). Older age at first surgical consult (>12 months vs. <9 months, OR 17.83) was identified as the primary risk factor for delayed OP, besides ICU hospitalization (OR 3.42), associated hypospadias (OR 2.30), higher hospital OP volume (OR 1.91), more healthcare visits in first year of life (OR 1.05), and older surgeon age (OR 1.02). DISCUSSION Our findings support reports that OP is often performed past guideline recommendations. Interventions that result in earlier referral for UDT (<6 months) may result in timely OP. Limitations for this study include potential misclassification or missing data within the utilized databases. CONCLUSION The most important barrier to timely OP is delay in first surgical consultation. Aiming for an earlier referral through guideline modifications or education to referring providers may help achieve the goal of timely OP.
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Curran JA, Gallant AJ, Wong H, Shin HD, Urquhart R, Kontak J, Wozney L, Boulos L, Bhutta Z, Langlois EV. Knowledge translation strategies for policy and action focused on sexual, reproductive, maternal, newborn, child and adolescent health and well-being: a rapid scoping review. BMJ Open 2022; 12:e053919. [PMID: 35039297 PMCID: PMC8765012 DOI: 10.1136/bmjopen-2021-053919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify knowledge translation (KT) strategies aimed at improving sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) and well-being. DESIGN Rapid scoping review. SEARCH STRATEGY A comprehensive and peer-reviewed search strategy was developed and applied to four electronic databases: MEDLINE ALL, Embase, CINAHL and Web of Science. Additional searches of grey literature were conducted to identify KT strategies aimed at supporting SRMNCAH. KT strategies and policies published in English from January 2000 to May 2020 onwards were eligible for inclusion. RESULTS Only 4% of included 90 studies were conducted in low-income countries with the majority (52%) conducted in high-income countries. Studies primarily focused on maternal newborn or child health and well-being. Education (81%), including staff workshops and education modules, was the most commonly identified intervention component from the KT interventions. Low-income and middle-income countries were more likely to include civil society organisations, government and policymakers as stakeholders compared with high-income countries. Reported barriers to KT strategies included limited resources and time constraints, while enablers included stakeholder involvement throughout the KT process. CONCLUSION We identified a number of gaps among KT strategies for SRMNCAH policy and action, including limited focus on adolescent, sexual and reproductive health and rights and SRMNCAH financing strategies. There is a need to support stakeholder engagement in KT interventions across the continuum of SRMNCAH services. Researchers and policymakers should consider enhancing efforts to work with multisectoral stakeholders to implement future KT strategies and policies to address SRMNCAH priorities. REGISTRATION The rapid scoping review protocol was registered on Open Science Framework on 16 June 2020 (https://osf.io/xpf2k).
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Affiliation(s)
- Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Allyson J Gallant
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Kontak
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Etienne V Langlois
- The Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
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Sharma D, Sohn JK, Zillioux JM, Herndon CDA, Corbett ST, Kern NG. Identifying and addressing training deficiencies in the examination of cryptorchidism-a quality improvement study. J Pediatr Urol 2020; 16:61.e1-61.e8. [PMID: 31848108 DOI: 10.1016/j.jpurol.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Accurate and timely diagnosis of cryptorchidism by primary care providers (PCPs) is critical to oncologic and fertility outcomes. Physical exam is the mainstay of diagnosis, but little is known about PCPs' skills in examining cryptorchid patients. Patients referred to surgeons for cryptorchidism often have normal or retractile testes on exam, and delayed or missed diagnosis of cryptorchidism may contribute to advanced age at surgical intervention. Previous studies on cryptorchidism have not investigated the baseline training, confidence, and/or exam skills of providers. OBJECTIVE The authors aimed to define baseline training and provider confidence in the exam of cryptorchid patients and to improve examiner confidence using bedside teaching with a pediatric urologist. Secondarily, baseline training and confidence were correlated to skill. STUDY DESIGN Medical students, family medicine, pediatrics, and urology residents, and pediatric attendings completed surveys on baseline training and self-reported confidence in the examination of cryptorchid patients at an academic institution from 2017 to 2018. N.G.K. (pediatric urologist) proctored examinations of cryptorchid patients and provided standardized grades and individualized feedback. Surveys were readministered after 3 months. Non-parametric comparison tests were performed to determine intervention effect and compare subgroups. RESULTS Ninety-two respondents participated. 62% reported little to no formal training on the scrotal exam, 50% were self-taught, and 20% defined undescended testis incorrectly. Confidence increased with level of training, comparing attendings to residents to students (P < 0.001). Those who learned from a mentor had higher baseline confidence than those who did not (P < 0.01). Baseline confidence and amount of formal training positively correlated with exam skill as graded during proctored sessions (n = 59, P < 0.01). Provider confidence was higher after proctored exams (Fig. 2, n = 32, P < 0.0001). DISCUSSION Significant training deficiencies exist in the examination of cryptorchid patients. A single proctored exam with a pediatric urologist can improve provider confidence and may improve exam skills. A rotation with pediatric urology, including proctored exams of cryptorchid patients, has become standard practice for pediatric trainees at the authors institution as a result of this study. CONCLUSIONS While further studies are required to assess the effectiveness of bedside teaching and its impact on accurate and timely diagnosis of cryptorchidism, implementation of the authors quality improvement recommendations at other teaching institutions would help address training deficiencies in the examination of cryptorchid patients.
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Affiliation(s)
- Devang Sharma
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA
| | - Julia K Sohn
- University of Virginia School of Medicine, Department of Pediatrics, PO Box 801355, Charlottesville, VA, 22908, USA
| | - Jacqueline M Zillioux
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA
| | - C D Anthony Herndon
- Children's Hospital of Richmond at Virginia Commonwealth University, Department of Urology, 8700 Stony Point Parkway, Richmond, VA, 23235, USA
| | - Sean T Corbett
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA
| | - Nora G Kern
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA.
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Shields LBE, White JT, Peppas DS, Rosenberg E. Scrotal Ultrasound Is Not Routinely Indicated in the Management of Cryptorchidism, Retractile Testes, and Hydrocele in Children. Glob Pediatr Health 2019; 6:2333794X19890772. [PMID: 31803796 PMCID: PMC6876163 DOI: 10.1177/2333794x19890772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 11/29/2022] Open
Abstract
Cryptorchidism, or undescended testes, is the most common congenital genitourinary anomaly. A failure or delay of treatment may result in reduced fertility or an increased risk of testicular cancer. The American Urological Association (AUA) recommends that a scrotal ultrasound (SUS) not be performed in the preoperative management of cryptorchidism. This study investigated how likely pediatricians were to perform SUS despite the AUA guidelines. We retrospectively studied 243 patients referred to a single pediatric urology practice for clinically diagnosed testis pathology including undescended testis, hydrocele, and retractile testis over a 4-year period (January 1, 2015, to December 30, 2018). A total of 72 patients (29.6%) underwent a SUS ordered by their pediatrician prior to the pediatric urology visit. Pediatricians should be aware that SUS performed prior to pediatric urological evaluation does not alter management and is associated with a significant financial cost in patients with cryptorchidism or hydrocele.
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Jiang DD, Acevedo AM, Bayne A, Austin JC, Seideman CA. Factors associated with delay in undescended testis referral. J Pediatr Urol 2019; 15:380.e1-380.e6. [PMID: 31072764 DOI: 10.1016/j.jpurol.2019.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Undescended testis (UDT) is one of the most common congenital disorders and is associated with infertility and testicular cancer. Multiple guidelines internationally have recommended orchiopexy by 18 months. Multiple large retrospective studies published in the last decade have found persistent delay in timing of orchiopexy. OBJECTIVE The aim of the study was to determine timing at which UDTs are referred at the tertiary pediatric hospital and assess factors that are associated with delay in UDT referral. STUDY DESIGN Based on clinical observations and previous data, a series of clinical and socio-economic variables were constructed to design a prospective database. All patients who underwent orchiopexy for UDT from March 1, 2017, to August 31, 2018, were reviewed for demographic and clinical data. Referral appointments after 18 months were considered delayed. Factors associated with delay in UDT referral were analyzed using univariate and multivariate analysis with logistic regression. RESULTS One hundred seventy-eight patients underwent orchiopexy for UDT. The median age was 44 months, and 64% of them had delay in referral. On univariate analysis, normal birth testicular examination, diagnosis of 'retractile testicle,' long gap without seeing pediatrician, diagnosis by a new physician, and primary language non-English were associated with delayed UDT referral. On multivariate analysis, delayed referral was associated with normal testicular examination at birth, history of 'retractile testis,' diagnosis not by the regular primary care provider, and other health or social issues that may have led to delay. DISCUSSION This is the first prospective study analyzing timing of referral for boys with cryptorchidism. It was found that timing of treatment of UDT with orchiopexy has not improved over the last decade. Major causes in delay in referral may be due to poor of education of families and lack of routine testicular examinations by referring providers. Secondary ascent may account a significant number of delayed orchiopexy cases. CONCLUSION Most patients at Doernbecher had delayed referral of cryptorchidism. Factors associated with delay were determined. To improve treatment of cryptorchidism, quality-based interventions and the importance of education and routine testicular examinations need to be focused on.
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Affiliation(s)
- D D Jiang
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA
| | - A M Acevedo
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA
| | - A Bayne
- Department of Pediatric Urology, Doernbecher, Portland, OR, USA
| | - J C Austin
- Department of Pediatric Urology, Doernbecher, Portland, OR, USA
| | - C A Seideman
- Department of Pediatric Urology, Doernbecher, Portland, OR, USA.
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Bergbrant S, Omling E, Björk J, Hagander L. Cryptorchidism in Sweden: A Nationwide Study of Prevalence, Operative Management, and Complications. J Pediatr 2018; 194:197-203.e6. [PMID: 29331326 DOI: 10.1016/j.jpeds.2017.09.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/25/2017] [Accepted: 09/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To review the cumulative prevalence, operative management, and complications of treatment for cryptorchidism in Sweden. STUDY DESIGN A nationwide observational study from longitudinal register data of all Swedish-born boys 0-18 years of age, diagnosed with cryptorchidism from 2001 to 2014. Primary outcomes were occurrence and age at primary surgery. Secondary outcomes included type of procedure and surgical site infection. RESULTS Of 20 375 boys diagnosed with cryptorchidism in 2001-2014, 12 766 were surgically treated. The cumulative childhood prevalence was 1.8% (95% CI, 1.5-2.0), with a higher prevalence in boys born prematurely, small for gestational age, or with low birth weight. The median age at treatment decreased from 6.2 years in 2001 to 3.4 years in 2014 (P < .001). Still, 94.1% (95% CI, 92.7-95.6) had surgery after the recommended 1 year of age in 2014. Variations in age at surgery between Swedish counties were great (range, 2.9-5.9 years of age). There were no deaths within 30 days after surgery and the frequency of surgical site infection was low (1.4%; 95% CI, 1.1-1.6). CONCLUSIONS The cumulative childhood prevalence of cryptorchidism was high, and complications were rare. Few boys underwent surgery in a timely manner according to clinical guidelines, and standards of care varied considerably across the country. Further research and collective actions are needed to improve the detection and management of congenital cryptorchidism.
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Affiliation(s)
- Susanna Bergbrant
- Lund University, Skåne University Hospital, World Health Organization Collaborating Center for Surgery and Public Health, Department of Clinical Sciences Lund, Pediatric Surgery, Lund, Sweden
| | - Erik Omling
- Lund University, Skåne University Hospital, World Health Organization Collaborating Center for Surgery and Public Health, Department of Clinical Sciences Lund, Pediatric Surgery, Lund, Sweden
| | - Jonas Björk
- Lund University, Skåne University Hospital, Department of Laboratory Medicine, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Lars Hagander
- Lund University, Skåne University Hospital, World Health Organization Collaborating Center for Surgery and Public Health, Department of Clinical Sciences Lund, Pediatric Surgery, Lund, Sweden.
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Alsowayan OS, Basalelah JH, Alzahrani AM, Alshaibani AM, Alalyani NS, Alsubiani TA, AlMadi MK. Age at presentation of undescended testicles: a single-center study in Saudi Arabia. Ann Saudi Med 2018; 38:137-139. [PMID: 29620548 PMCID: PMC6074362 DOI: 10.5144/0256-4947.2018.137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The undescended testis (UDT) is the most common genital anomaly encountered in pediatrics with an estimated incidence of 1% to 4% in full-term and 1% to 45% in preterm newborn boys. Over the years, studies on progressive histological deterioration and cancer risk has led to a change in recommendations for when orchidopexy should be done. OBJECTIVES Determine age at presentation of patients for UDT to a specialist in Saudi Arabia, age of operation and whether the recommended targeted time frame has been met. DESIGN Descriptive retrospective medical record review. SETTINGS University hospital setting in urban location. SUBJECTS AND METHODS The records of patients presenting to our center with UDT between the years 1996-2015 were reviewed for data on the age at presentation and age of operation. MAIN OUTCOME MEASURES Age at time of evaluation and at time of surgical intervention compared with the international standard. SAMPLE SIZE 331 cases. RESULTS Out of the cases included, 195 met the inclusion criteria. The median age of presentation was 13.7 (range: 0-123.2) months. The median age at time of orchiopexy was 25 (range: 7.5-130.2) months. The median waiting time for elective surgery was 4.8 months ( less than 1 day to 49.4 months). CONCLUSION Despite the international recommendation of carrying out orchidopexy between the ages of 6-12 months, the targeted recommended time frame is not met in Saudi Arabia. This is mainly related to late referral age and the long waiting time for elective surgery. LIMITATIONS Small sample size and retrospective design. CONFLICT OF INTEREST None.
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Affiliation(s)
| | | | | | | | | | | | - Maha Khalid AlMadi
- Maha Khalid AlMadi, Department of Urology, Imam Abdulrahman Bin Faisal University,, Dammam 31311, Saudi Arabia, T: 966567818922, mmadi@ iau.edu.sa, ORCID: http://orcid. org/0000-0002-7639-6668
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Williams K, Baumann L, Shah A, Abdullah F, Johnson EK, Oyetunji TA. Age at orchiopexy for undescended testis in the United States. J Pediatr Surg 2017; 53:S0022-3468(17)30642-5. [PMID: 29102151 DOI: 10.1016/j.jpedsurg.2017.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Undescended testis (UDT) is the most common congenital anomaly of the male genitalia. The American Urological Association guidelines recommend orchiopexy by age 18months to ameliorate the risk of subfertility. The study aim was to assess adherence to these guidelines on a national level. METHODS We retrospectively reviewed both the State Ambulatory Surgery Database (SASD) in 2012 and the Pediatric Health Information System (PHIS) for 2015. All patients aged 18years or less with a diagnosis of UDT who underwent orchiopexy were included. Demographic data including age at repair as well as surgical subspecialty and payer status were extracted. RESULTS Analysis of the 2012 SASD for New Jersey, Florida, and Maryland yielded 1654 patients. The majority were white, 791 (48.3%), with a median age at repair of 4years (IQR 1-8). Most patients, 1048 (64%), had orchiopexy later than age 2. A total of 844 males were identified from the PHIS database. Of these, 63% were white. The median age at repair was 5years (IQR 1-9). There were 577 (68%) patients older than 2years at orchiopexy. CONCLUSION Almost 70% of boys with undescended testes in the United States are undergoing orchiopexy at least 6months later than the recommended age. TYPE OF STUDY Retrospective. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kibileri Williams
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
| | - Lauren Baumann
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
| | - Adil Shah
- Howard University Hospital, 2041 Georgia Avenue NW, Washington DC, 20060
| | - Fizan Abdullah
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
| | - Emilie K Johnson
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
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Schneuer FJ, Holland AJA, Pereira G, Jamieson S, Bower C, Nassar N. Age at Surgery and Outcomes of an Undescended Testis. Pediatrics 2016; 137:e20152768. [PMID: 26801912 DOI: 10.1542/peds.2015-2768] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Undescended testis (UDT) is the most common genital anomaly in boys. Current guidelines recommend surgery before 12 months of age to maximize fertility and potentially reduce the risk of future malignancy. We investigated the prevalence of UDT and examined rates of surgery and age at surgery in an Australian population. METHODS UDT was identified from all live-born infants in New South Wales, Australia, from 2001 to 2011 using routinely collected record-linked birth and hospital data. The prevalence of UDT, surgery rates, age at surgery, postsurgical outcomes, and risk factors for surgery performed later than the recommended age were evaluated. RESULTS There were 10 875 (2.1%) boys with a recorded diagnosis of UDT. Corrective surgery was performed in 4980 (45.8%), representing a cumulative prevalence of 9.6 per 1000 male births. Five percent of surgeries were orchidectomies, and 9% of boys had revision surgery. Median age at surgery was 16.6 months (interquartile range 11.8 to 31.0 months), decreasing from 21 months for boys born in 2001 to 13 months for boys born in 2010. Among those boys having surgery before 36 months (n = 3897), 67% had corrective surgery after the recommended 12 months of age; socioeconomic disadvantage, regional/remote area of residence, and lack of private health insurance were risk factors for having corrective surgery after 12 months. CONCLUSIONS One in 50 boys born are diagnosed with UDT; two-thirds had no report of corrective surgery. The age at surgery is decreasing; however, two-thirds of surgeries are performed after 12 months of age.
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Affiliation(s)
- Francisco Javier Schneuer
- Clinical and Population Perinatal Health Research, Kolling Institute, The University of Sydney, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia; Menzies Centre for Health Policy, School of Public Health, Sydney Medical School,The University of Sydney, New South Wales, Australia and
| | - Andrew J A Holland
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Bentley, Western Australia; and
| | - Sarra Jamieson
- Telethon Kids Institute, The University of Western Australia, Crawley, Western Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Crawley, Western Australia
| | - Natasha Nassar
- Clinical and Population Perinatal Health Research, Kolling Institute, The University of Sydney, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia; Menzies Centre for Health Policy, School of Public Health, Sydney Medical School,The University of Sydney, New South Wales, Australia and
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Lim LY, Nah SA, Lakshmi NK, Yap TL, Jacobsen AS, Low Y, Ong CCP. Undescended testis: Level of knowledge among potential referring health-care providers. J Paediatr Child Health 2015; 51:1109-14. [PMID: 25939451 DOI: 10.1111/jpc.12911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2015] [Indexed: 11/27/2022]
Abstract
AIM Studies report that most boys with undescended testis(UDT) are referred and operated beyond the recommended age of 1 year, possibly due to lack of awareness of treatment guidelines. We investigate the level of knowledge of UDT among potential referring health-care providers. METHOD We devised a survey on the clinical features and appropriate management of UDT. Using convenience sampling, we approached health-care professionals with regular contact with paediatric patients and final year medical students. Respondents were allowed to remain anonymous. They were categorised according to specialty and level of experience/training. RESULTS Of 1179 approached, 203 responded. Thirty-six (24%) of 149 qualified doctors had never seen a case of UDT. Median score was 6 (range 1-9). There was no significant difference in scores when comparing specialty. Mean scores decreased significantly in trend according to level of experience. When questioned regarding timings of referral and orchidopexy, 24% of qualified doctors would not refer until 9 months of age, and 66% thought orchidopexy should be done after 1 year old. Half would stop examining for UDT after 2 years old. CONCLUSIONS Inexperience with UDT and outdated knowledge may contribute to delays in referral for UDT. Many would stop examining for UDT at 2 years old, placing undue reliance on accurate physical examination in early childhood and indicating lack of awareness of the ascending testis. Community health initiatives must emphasise recent changes in guidelines for management of UDT.
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Affiliation(s)
- Li Yan Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shireen A Nah
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | | | - Te-Lu Yap
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | - Anette S Jacobsen
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | - Yee Low
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
| | - Caroline C P Ong
- Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore
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Factors related to the time to cryptorchidism surgery—A nationwide, population-based study in Taiwan. J Formos Med Assoc 2014; 113:915-20. [DOI: 10.1016/j.jfma.2013.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 05/28/2013] [Accepted: 06/04/2013] [Indexed: 11/21/2022] Open
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15
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Nah SA, Yeo CSW, How GY, Allen JC, Lakshmi NK, Yap TL, Jacobsen AS, Low Y, Ong CCP. Undescended testis: 513 patients' characteristics, age at orchidopexy and patterns of referral. Arch Dis Child 2014; 99:401-6. [PMID: 24225274 DOI: 10.1136/archdischild-2013-305225] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Undescended testis (UDT) affects 1-6% of males. Current recommendations are to correct maldescent by 1 year of age. We identify the population characteristics of children referred and managed for UDT, age at referral and orchidopexy, and patterns of referral. DESIGN, SETTING AND PATIENTS Retrospective 5-year review of all patients operated for UDT from 2007 to 2011 in our institution. Patient demographics, neonatal diagnosis of UDT, age at referral, referral source and age at first orchidopexy were recorded. Data are reported as median (range). RESULTS There were 513 boys with 576 undescended gonads; 450 (88%) had unilateral UDT. Congenital (present at birth) UDT was diagnosed in 287 (56%) children. Seventy-nine (15%) were premature births, 41 (8%) had associated major genitourinary abnormalities. Median age at referral was 1.1 (0-16.2) years; median age at first orchidopexy was 1.6 (0-17.2) years. When corrected for age, those with a history of prematurity and associated major genitourinary malformations were referred and operated on earlier. There was no difference in age at referral and orchidopexy when comparing unilateral versus bilateral maldescent, and palpability of UDT. Of those with congenital UDT, 70% were operated at beyond 1 year of age. Those referred from public tertiary hospitals were younger than those referred from community clinics (p<0.0001) and private healthcare institutions (p=0.003). CONCLUSIONS Despite early diagnosis in many patients with UDT, most are referred and operated after 1 year of age, even in congenital UDT. Premature babies, those with major genitourinary anomalies, and those seen in public tertiary hospitals are referred earlier. Community health initiatives must emphasise prompt referral to allay the impact of delayed surgery.
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Affiliation(s)
- Shireen A Nah
- Department of Paediatric Surgery, KK Women's & Children's Hospital, , Singapore, Singapore
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Yiee JH, Saigal CS, Lai J, Copp HL, Churchill BM, Litwin MS. Timing of orchiopexy in the United States: a quality-of-care indicator. Urology 2012; 80:1121-6. [PMID: 23107402 PMCID: PMC3753094 DOI: 10.1016/j.urology.2012.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 07/30/2012] [Accepted: 08/06/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate whether orchiopexies are occurring later than recommended by American Academy of Pediatrics 1996 guidelines (around age 1). Adherence to guidelines is poorly studied. METHODS The main cohort consisted of 4103 boys insured from birth (Innovus i3, insurance claims database). The complementary cohort consisted of 17 010 insured and noninsured boys (Pediatric Health Information System, PHIS). The inclusion criteria was age ≤ 5 years at time of International Classification of Disease, 9th revision-defined cryptorchidism diagnosis. The primary outcome was timely surgery (orchiopexy by age 18 months). RESULTS In Innovus, 87% of boys who underwent an orchiopexy had a timely orchiopexy. Of those who did not undergo surgery (n = 2738), 90% had at least 1 subsequent well-care visit. Those who underwent timely surgery were referred to a surgeon at a younger age compared with those who underwent late surgery (4.1 vs 16.1 months, P < .00005). Predictors of timely surgery were number of well-care visits (odds ratio 1.5, 95% confidence interval 1.3-1.7), continuity of primary care (odds ratio 1.9, 95% confidence interval 1.3-2.7), and use of laparoscopy (odds ratio 4.5, 95% confidence interval 1.4-14.9). Family/internal medicine as referring provider was predictive of delayed surgery (odds ratio 0.5, 95% confidence interval 0.3-0.8). In the Pediatric Health Information System, 61% of those with private insurance had timely surgery compared with 54% of those without private insurance (P < .0001). CONCLUSION We found an unexpectedly high adherence to guidelines in our continuously insured since birth Innovus population. Primary care continuity and well-care visits were associated with timely surgery. Further studies can confirm these findings in nonprivately insured patients with the ultimate goal of instituting quality improvement initiatives.
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Affiliation(s)
- Jenny H Yiee
- Department of Urology, University of California Los Angeles, Los Angeles, California 90095-1738, USA.
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Bruijnen CJP, Vogels HDE, Beasley SW. Age at orchidopexy as an indicator of the quality of regional child health services. J Paediatr Child Health 2012; 48:556-9. [PMID: 22017249 DOI: 10.1111/j.1440-1754.2011.02202.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Early treatment for primary undescended testis (UDT) is necessary to prevent testicular degeneration and improve fertility. The general recommended age for orchidopexy is before 2 years of age. Comparing the age distribution of orchidopexy between different services may give an indirect indication of the quality of the child health services, since timely diagnosis and referral will lead to boys undergoing orchidopexy at the optimal age. This paper reviews the age distribution of boys having orchidopexies for UDT between 1997 and 2006 in the South Island of New Zealand and the state of Victoria, Australia: 64.2% of boys on the South Island and 48.0% of boys in Victoria had orchidopexies before the age of 5. There was a considerable difference in the proportions of children from 0 to 4 years and from 10 to 14 years between the two regions. No distinct trend in age was seen in either population during the period reviewed. These results show that many boys do not receive treatment for UDT at the optimal age. Age at orchidopexy may be an indicator of the quality (in terms of diagnosis, access and timeliness) of a region's paediatric surgical service and may identify where attention should be paid if earlier diagnosis and referral is to be achieved.
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Impact of Anatomical and Socioeconomic Factors on Timing of Urological Consultation for Boys With Cryptorchidism. J Urol 2011; 186:1601-5. [DOI: 10.1016/j.juro.2011.03.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Indexed: 11/24/2022]
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Snodgrass W, Bush N, Holzer M, Zhang S. Current referral patterns and means to improve accuracy in diagnosis of undescended testis. Pediatrics 2011; 127:e382-8. [PMID: 21262892 PMCID: PMC3025418 DOI: 10.1542/peds.2010-1719] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals were to determine current referral patterns for boys suspected of having undescended testis (UDT) and to identify factors to assist primary care providers in distinguishing retractile testes from UDTs on the basis of history, physical examination, or imaging findings. METHODS By using a standardized history assessment, visual inspection of the scrotum for symmetry, physical examination, and review of previously obtained imaging findings, we performed a prospective observational study with consecutive patients referred to a pediatric urologist for evaluation of UDT. RESULTS Of 118 boys, 51 (43%) had descended testes, 60 (51%) had UDTs, and 7 (6%) had initially indeterminate findings. Boys with UDT were referred at a median age of 43.3 months. Patients referred at <1 year or >10 years of age were significantly more likely to have UDT than were those referred at 1 to 10 years of age. History of UDT at birth, prematurity, and scrotal asymmetry strongly increased the risk of UDT. Genital ultrasonography had been performed for 25% of patients, incorrectly indicating UDT for 48%. CONCLUSIONS Most boys were referred well beyond the recommended age of <12 months for orchiopexy. Only one-half of the patients had UDT, with most errors in diagnosis being made for boys 1 to 10 years of age, which suggests difficulty distinguishing UDT from retractile testis. Positive birth history findings, prematurity, and scrotal asymmetry predicted UDT and can be used by primary care physicians in their assessment before referral. Genital ultrasonography did not distinguish UDTs from retractile testes.
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Affiliation(s)
- Warren Snodgrass
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Nicol Bush
- Departments of Urology and ,Department of Pediatric Urology, Children's Medical Center, Dallas, Texas
| | | | - Song Zhang
- Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas; and
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Kokorowski PJ, Routh JC, Graham DA, Nelson CP. Variations in timing of surgery among boys who underwent orchidopexy for cryptorchidism. Pediatrics 2010; 126:e576-82. [PMID: 20732947 PMCID: PMC3102510 DOI: 10.1542/peds.2010-0747] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Current clinical guidelines recommend that orchidopexy be performed by the age of 1 in patients with congenital undescended testis. We sought to examine trends in surgical timing and to determine what factors are associated with age at surgery. METHODS The Pediatric Health Information System (PHIS) is a national database of >40 freestanding children's hospitals. We searched the PHIS to identify boys with cryptorchidism who underwent orchidopexy between 1999 and 2008. Patient age at orchidopexy was evaluated, and we used multivariate models to determine factors associated with timing of surgery. RESULTS We identified 28 204 children who underwent orchidopexy at PHIS hospitals. Of these, 14,916 (53%) were white, and 17,070 (61%) had public insurance. Only 5031 patients (18%) underwent orchidopexy by the age of 1 year; only 12,165 (43%) underwent orchidopexy by the age of 2 years. These figures remained stable over time (P=.32). After adjusting for patient clustering, race (P<.001) and insurance status (P<.001) remained associated with patient age at orchidopexy; however, the treating hospital (P<.001) was the most important factor in predicting the timing of the procedure. CONCLUSIONS Only 43% had surgery by 2 years of age, which suggests that either significant numbers of boys with congenital cryptorchidism do not undergo surgery in a timely fashion or late-onset testicular ectopy is more common than generally recognized. Factors associated with the timing of orchidopexy include patient race, insurance status, and the hospital in which surgery is performed.
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Affiliation(s)
| | - Jonathan C. Routh
- Department of Urology, Children’s Hospital Boston, Massachusetts,Harvard Pediatric Health Services Research Fellowship Program, Harvard Medical School, Boston, Massachusetts
| | - Dionne A. Graham
- Clinical Research Program, Children’s Hospital Boston, Massachusetts
| | - Caleb P. Nelson
- Department of Urology, Children’s Hospital Boston, Massachusetts
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Golabek T, Kiely E. Patterns of referral and treatment of undescended testis: a 12-year experience in a single centre. Ir J Med Sci 2010; 179:511-4. [DOI: 10.1007/s11845-010-0553-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 08/10/2010] [Indexed: 11/28/2022]
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Bonney T, Southwell B, Donnath S, Newgreen D, Hutson J. Orchidopexy trends in the paediatric population of Victoria, 1999-2006. J Pediatr Surg 2009; 44:427-31. [PMID: 19231549 DOI: 10.1016/j.jpedsurg.2008.10.099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 10/24/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE In recent times, much concern has been expressed in the media about male reproductive health. Undescended testis is a significant contributor to male infertility and testicular cancer. The recommended management is orchidopexy. Recent studies in the United Kingdom have shown a decline in orchidopexy rates in the paediatric population. An analysis of the orchidopexy rate in Victoria was therefore conducted to determine whether a similar trend existed and what factors may contribute toward this. METHODS Data were extracted from hospital records using operation codes for orchidopexies for all patients between 0 and 18 years in the state of Victoria. Victorian population data were collected from the Australian Bureau of Statistics. Data were grouped into orchidopexy age groups 0 to 4, 5 to 9, and 10 to 18 and compared across calendar years using graphical and statistical analysis. MAIN RESULTS On average, the rate of operations on 0 to 4-year-old patients reduced by 2.1% each year over the period; the 95% confidence interval for the rate of reduction was 0.4% to 3.8% (P < 0.014). The rate of operations on 5 to 9-year-old patients reduced by 6.3% each year over the period; the 95% confidence interval for the rate of reduction was 3.7% to 8.8% (P < .005). The rate of operations on 10 to 14-year-old patients reduced by 5.7% each year over the period; the 95% confidence interval for the rate of reduction was 1.9% to 9.3% (P = .003). CONCLUSION In the state of Victoria, there has been a true decline in the number of orchidopexy operations done in the paediatric population. This may represent a true decline in the incidence of disease, a failure of diagnosis, or a failure of management. Further investigation will therefore be required to determine the cause of current trends as the outcome may have significant consequences on male reproductive health.
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Affiliation(s)
- Tamara Bonney
- Murdoch Childrens Research Institute, Victoria 3052, Australia.
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Martin JDC. Further evidence for acquired undescended testicle in the UK and its incompatibility with current recommendations in the Hall Report. J Pediatr Urol 2006; 2:392-7. [PMID: 18947643 DOI: 10.1016/j.jpurol.2006.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 03/15/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The 4th edition of the Hall Report [Hall DMB. Health for all children. Oxford: Oxford University Press; 2003. p. 167] does not expect undiagnosed undescended testicles at the age of 5 years or subsequently to be seen if its advice for diagnosis is carried out. We examine whether that recommendation can be relied upon. METHOD A retrospective audit was performed of 228 boys who underwent orchidopexy between January 1992 and December 2003 at the County Hospital Hereford, UK. During that time, 10,048 boys were born at the hospital. Child health records, hospital records and some GP records were used. RESULTS A total of 103 boys (45%) were treated before their 5th birthday and 125 (55%) were treated after the age of 5; 93 orchidopexies were performed as a result of diagnosis made at birth or 6 weeks, but 83 were undertaken in boys documented as having scrotally placed testes both at birth and 6 weeks. A further 21 had documentation for scrotal testes either at birth (14) or at 6 weeks (7) but not both. The records of the remaining 31 are either missing or did not yield the information required largely because the Parent Held Child Record was introduced after their time. The literature was reviewed, and the results found to concur with those of other papers, in particular with a recent study from The Netherlands, which led to a new classification of undescended testis drawing attention to 'acquired undescended testicle'. The progressive nature of this entity was seen from review of the case notes. CONCLUSION The natural history of acquired undescended testis means that recommendations as set out in the Hall Report "that no further check after six weeks need be made if the testes are 'well down' at that stage" cannot be successful, and all concerned in childhood surveillance will need to be aware of this and remain vigilant at least until puberty. Perhaps a prospective study following the Netherlands design should be undertaken in this country.
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Affiliation(s)
- J D C Martin
- Child Health Department, Herefordshire Primary Care NHS Trust, Vaughan Building, County Hospital, Ruckhall Lane Belmont, Hereford HR2 9RP, UK.
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Rätsep A, Kalda R, Oja I, Lember M. Family doctors' knowledge and self-reported care of type 2 diabetes patients in comparison to the clinical practice guideline: cross-sectional study. BMC FAMILY PRACTICE 2006; 7:36. [PMID: 16776847 PMCID: PMC1513575 DOI: 10.1186/1471-2296-7-36] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 06/16/2006] [Indexed: 11/16/2022]
Abstract
Background It is widely believed that providing doctors with guidelines will lead to more effective clinical practice and better patient care. However, different studies have shown contradictory results in quality improvement as a result of guideline implementation. The aim of this study was to compare family doctors' knowledge and self-reported care of type 2 diabetes patients with recommendation standards of the clinical practice guideline. Methods In April 2003 a survey was conducted among family doctors in Estonia. The structured questionnaire focused on the knowledge and self-reported behavior of doctors regarding the guideline of type 2 diabetes. The demographic and professional data of the respondents was also provided. Results Of the 354 questionnaires distributed, 163 were returned for a response rate of 46%. Seventy-six percent of the responded doctors stated that they had a copy of the guideline available while 24% reported that they did not. Eighty-three percent of the doctors considered it applicable and 79% reported using it in daily practice. The doctors tended to start treatment with medications and were satisfied with treatment outcomes at higher fasting blood glucose levels than the levels recommended in the guideline. Doctors' self-reported performance of the tests and examinations named in the guideline, which should be performed within a certain time limit, varied from overuse to underuse. Blood pressure, serum creatinine, eye examination and checking patients' ability to manage their diabetes were the best-followed items while glycosylated hemoglobin and weight reduction were the most poorly followed. Doctors' behavior was not related to the fact of whether they had the guideline available, whether they considered it applicable, or whether they actually used it. Conclusion Doctors' knowledge and self-reported behavior in patient follow-up of type 2 diabetes is very variable and is not related to the reported availability or usage of the guideline. Practice guidelines may be a useful source of information but they should not be overestimated.
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Affiliation(s)
- Anneli Rätsep
- Polyclinic and Family Medicine Department, University of Tartu, Tartu, Estonia
| | - Ruth Kalda
- Polyclinic and Family Medicine Department, University of Tartu, Tartu, Estonia
| | - Ivika Oja
- General Practice of Laeva, Laeva, Tartu County, Estonia
| | - Margus Lember
- Department of Internal Medicine, University of Tartu, Tartu, Estonia
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