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Sondermann M, Menzel V, Borkowetz A, Baunacke M, Huber J, Eisenmenger N, Thomas C, Boehm K. Treatment trends for undescended testis and impact of guideline changes a medical health care analysis of orchidopexy and cryptorchidism in Germany between 2006 und 2020. World J Urol 2024; 42:386. [PMID: 38918219 PMCID: PMC11199275 DOI: 10.1007/s00345-024-05095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The last decades revealed new scientific knowledge regarding the fertility and potential malignancy of undescended testis AQ2(UDT). Accordingly, many guidelines changed their recommendation concerning timing of therapy, with the goal of an earlier time of surgery. METHODS We analyzed the number of new diagnosis and performed surgeries in predefined age groups provided by the obligatory annual reports of German hospitals in the reimbursement.INFO"-tool between 2006 and 2020. RESULTS Overall, 124,741 cases were analyzed. We showed a slight increase in performed surgeries in the first year by 2% per year with a main increase till 2011, a constant number of surgeries between first and 4th year and a decrease of surgeries between 5 and 14th year of living with a main decrease till 2009 by 3% per year. CONCLUSION Even if our results illustrate an increasing adaption of the guideline's recommendation, there is still a significant number of patients who receive later treatment. More research about the reasons and circumstances for the latter is needed.
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Affiliation(s)
- Marcus Sondermann
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany.
| | - Viktoria Menzel
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Johannes Huber
- Department of Urology, Universitätsklinikum Gießen-Marburg, Philipps Universität Marburg, Marburg, Germany
| | | | - Christian Thomas
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Katharina Boehm
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany
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AlSahli L, Alabdulsalam A, Mahfouz A, Alnamshan M. Outcomes of Early vs. Late Surgical Intervention in Children With Undescended Testis. Cureus 2024; 16:e56430. [PMID: 38638732 PMCID: PMC11024666 DOI: 10.7759/cureus.56430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Background Undescended testis (UDT) is one of the most common urogenital abnormalities. International guidelines recommend performing orchidopexy no later than 18 months to decrease the risk of complications associated with UDT such as infertility and testicular malignancy. The aim of the study is to evaluate the outcomes of early versus late surgical intervention of UDT and to assess if the optimal age of orchidopexy is met. Methods This is a retrospective cross-sectional study that included 258 pediatric patients' testes with no prior UDT intervention from January 2016 to December 2020. A chart review was used to collect the patients' data. Children included were categorized into two groups based on their age at the time of surgery (group A ≤ 18 months and group B > 18 months). Statistical differences were explored using Pearson's chi-squared test or Fisher's exact test for categorical variables or a Wilcoxon rank sum test for numerical variables. A p-value of <0.05 indicated statistical significance. Results The median age at the presentation among the overall cohort was 14 months. The median age at the presentation for group A was six months and group B was 35 months. Group A included 109 children and group B included 149 children. At the time of the surgery, the median age of patients was 23 months. The median age at orchidopexy for group A was 12 months and the median age for group B was 38 months. The time between diagnosis and surgery was significantly shorter among older children with a median duration of one month versus a median of five months among patients in the ≤18 months group (p = 0.003). The follow-up interval was at three and 12 months. The change in testicular size before and after surgeries was statistically significant, as most small testicles before surgeries had become normal in size after surgeries among the overall cohort (76.6%), patients aged ≤18 months (72.4%), and those aged >18 months (79.2%) (p < 0.001). Conclusion Most of the patients included in this study did not undergo orchidopexy at the optimal age recommended by the international guidelines. However, there was a statistically significant improvement in testicular size following orchidopexy in children with small UDT regardless of age at the time of surgery.
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Affiliation(s)
- Lama AlSahli
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdulaziz Alabdulsalam
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Arwa Mahfouz
- Pediatric Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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Von Cube C, Schmidt A, Krönninger M, Hrivatakis G, Astfalk W, Fuchs J, Ellerkamp V. A closer look to the timing of orchidopexy in undescended testes and adherence to the AWMF-guideline. Pediatr Surg Int 2024; 40:60. [PMID: 38421443 PMCID: PMC10904547 DOI: 10.1007/s00383-024-05659-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND To lower the risk of testicular malignancies and subfertility, international guidelines recommend orchidopexy for undescended testis (UDT) before the age of 12-18 months. Previous studies reported low rates of 5-15% of timely surgery. Most of these studies are based on DRG and OPS code-based data from healthcare system institutions that do not distinguish between congenital and acquired UDT. METHODS In a retrospective study data of all boys who underwent orchidopexy in a university hospital and two outpatient surgical departments from 2009 to 2022 were analyzed. The data differentiates congenital from acquired UDT. RESULTS Out of 2694 patients, 1843 (68.4%) had congenital and 851 (31.6%) had acquired UDT. In 24.9% of congenital cases surgery was performed before the age of 12 months. The median age at surgery for congenital UDT was 16 months (range 7-202). Over the years there was an increased rate of boys operated on before the age of 2 (40% in 2009, 60% in 2022). The median age fluctuated over the years between 21 and 11 months without a trend to younger ages.. The covid pandemic did not lead to an increase of the median age at surgery. The median time between referral and surgery was 46 days (range 1-1836). Reasons for surgery after 12 months of age were a delayed referral to pediatric surgeries (51.2%), followed by relevant comorbidities (28.2%). CONCLUSION Compared to recent literature, out data show that a closer look at details enables a more realistic approach. Still, there is no trend towards the recommended age for surgical treatment observable, but the rate of timely operated boys with congenital UDT is significantly higher than stated in literature.
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Affiliation(s)
- C Von Cube
- Department of Pediatric Surgery and Pediatric Urology, Eberhard Karls University, Tubingen, Germany
| | - A Schmidt
- Department of Pediatric Surgery and Pediatric Urology, Eberhard Karls University, Tubingen, Germany
| | - M Krönninger
- Department of Pediatric Surgery and Pediatric Urology, Eberhard Karls University, Tubingen, Germany
| | - G Hrivatakis
- Outpatient Clinic for Pediatric and Adolescent Surgery, Stuttgart, Germany
| | - W Astfalk
- Outpatient Clinic for Surgery, Reutlingen, Germany
| | - J Fuchs
- Department of Pediatric Surgery and Pediatric Urology, Eberhard Karls University, Tubingen, Germany
| | - V Ellerkamp
- Department of Pediatric Surgery and Pediatric Urology, Eberhard Karls University, Tubingen, Germany.
- Department of Pediatric Surgery, Municipal Hospital Karlsruhe, Karlsruhe, Germany.
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Kaselas C, Florou M, Tirta M, Bitzika S, Sidiropoulou D, Spyridakis I. The Time of Diagnosis and Surgical Treatment of Congenital Cryptorchidism: A Single Center's Observational Study in Greece. Cureus 2024; 16:e51580. [PMID: 38313896 PMCID: PMC10836180 DOI: 10.7759/cureus.51580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
PURPOSE Congenital cryptorchidism or undescended testes (UDT) is one of the most common congenital abnormalities in newborns. Current guidelines recommend that surgical management should be scheduled by the 12th month and no later than the 18th month of the child's life. This is the first study to evaluate the age of diagnosis and surgical treatment of children with UDT in Greece, as well as the compliance with current guidelines worldwide. METHODS A retrospective analysis of patients with UDT who underwent orchidopexy from 2015 to 2019 was conducted. Patient age at diagnosis and orchidopexy and the meantime between were recorded. Patients were separated into groups, based on the diagnosis age: group A, diagnosis until the 11th month; group B, diagnosis between the 12th and 18th month; and group C, diagnosis at >18th month. RESULTS We identified 217 children who were diagnosed with UDT and underwent orchidopexy in our department. The majority of the patients (47.4%) had right-sided UDT, while 25.3% of them had UDT on both sides. There were 89 (41%) children in group A, 20 (9.2%) in group B, and 108 (49.8%) males in group C. The median age at diagnosis was 18 months (range: 1-164 months), while for groups A, B, and C, the median age at diagnosis was five, 15, and 71.5 months, respectively. The median age at orchidopexy was 23 months (range: 6-166 months), and for each aforementioned group, it was 11, 16.5, and 74 months. The median waiting time for the orchidopexy was 84 days (range: 1-692 days), and for each group, it was 157, 42, and 56 days, respectively. The delay between diagnosis and surgery was significantly greater for group A compared to groups B and C (p A versus B = 0.01 and p A versus C< 0.0001), while there was no difference in the delay between groups B and C (p > 0.05). CONCLUSIONS Patient age at diagnosis and applied orchidopexy was within the recommended range for almost half of the patients. The rest of them had delayed diagnosis and surgery due to delayed referral. In delayed cases, the time from diagnosis to treatment was significantly shorter. Early surgical referral leading to prompt treatment will increase compliance with the guidelines and improve the quality and the outcomes of the provided health-care services.
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Affiliation(s)
- Christos Kaselas
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
| | - Maria Florou
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
| | - Maria Tirta
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Sophia Bitzika
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
| | - Daphne Sidiropoulou
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
| | - Ioannis Spyridakis
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
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Awadh S, Tran J, Schwake C, Ellison JS. Assessment of Prior Well Child Checks in Children With Concerns for Testicular Position: Opportunities for Early Referral From an Integrated Health System. Urology 2023; 177:169-174. [PMID: 37196830 DOI: 10.1016/j.urology.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To assess, through an integrated primary and specialty care pediatric health system, the association of well-child checks prior to referral with final urological diagnosis with the aim to identify opportunities for earlier referral of care. METHODS We performed a retrospective review of children referred from primary care to urology for undescended testis (UDT) within our integrated primary-specialty care health system in 2019, comparing children who had undescended testicles to those with either normal or retractile testicles based on the final urology examination. Demographics, including age, comorbidities, and the status of prior well-child check (WCC) within primary care, were reviewed. Outcomes of age at referral and surgical intervention for UDT were compared across referral categories. RESULTS Stratifying by final diagnosis of 88 children included in the analysis, children with UDT were referred much later (85months, interquartile ranges 31-113) than children without UDT on final diagnosis (33months, interquartile ranges 15-74, P = .002). Furthermore, children with UDTs had a greater proportion with prior abnormal WCCs (N = 21/41, 51%) than those without UDT (N = 8/47, 17%) (P < .001). CONCLUSION Children with prior abnormal WCCs were more likely to have a final diagnosis of UDT, with prior abnormalities being documented approximately 12months prior to referral, indicating opportunities for improved referral patterns to urology.
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Affiliation(s)
- Sami Awadh
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Jacqueline Tran
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jonathan S Ellison
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI; Division of Pediatric Urology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI.
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Japan's comprehensive undescended testis screening program: incidence of ascending testis after screening. Pediatr Surg Int 2022; 39:35. [PMID: 36469123 DOI: 10.1007/s00383-022-05331-8] [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] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Screening for undescended testis (UDT) in Japan is performed as a neonate, then at 1, 3, 10, and 18 months old, and 3 years old. Incidence of ascending testis (AT) after screening was reviewed. METHODS All orchiopexy/orchiectomy at a single institute between July 2005 and June 2022 were reviewed retrospectively. RESULTS 376 boys had 422 procedures; 54/422 (12.8%) were in 48 boys ≥ 4 years old (mean age: 6.7 years; range: 4-13); testes were normal (n = 22; 40.7%), small (n = 25; 46.2%), or atrophied (n = 7; 1.3%). There were 47 orchiopexies and 7 orchiectomies for atrophy. Incidence of AT in boys ≥ 4 years old was 24/422 (5.7%). Of these, 16/422 (3.8%) developed after normal descent and 8/422 (1.9%) were associated with retractile testis (AT + RET). Other indications included delayed treatment for UDT (n = 13), late referral by pediatricians (n = 10), and iatrogenic UDT (n = 6). Surgical intervention in boys ≥ 4 years old (12.8%) was less than that reported in the West (range: 30-50%) as was AT: (5.7% versus 15.4%) and AT + RET (1.9% versus 13.8%). CONCLUSIONS Comprehensive UDT screening probably contributed to the lower incidence of surgery and AT (especially AT + RET) in boys ≥ 4 years old.
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Gates RL, Shelton J, Diefenbach KA, Arnold M, St Peter SD, Renaud EJ, Slidell MB, Sømme S, Valusek P, Villalona GA, McAteer JP, Beres AL, Baerg J, Rentea RM, Kelley-Quon L, Kawaguchi AL, Hu YY, Miniati D, Ricca R, Baird R. Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review. J Pediatr Surg 2022; 57:1293-1308. [PMID: 35151498 DOI: 10.1016/j.jpedsurg.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children. METHODS A comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020. RESULTS A total of 825 articles were identified in the initial search, and 260 were included in the final review. CONCLUSIONS Pre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.
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Affiliation(s)
- Robert L Gates
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States
| | - Julia Shelton
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA, United States
| | - Karen A Diefenbach
- Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States
| | - Meghan Arnold
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | | | - Elizabeth J Renaud
- Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI, United States
| | - Mark B Slidell
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, United States
| | - Stig Sømme
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - Patricia Valusek
- Pediatric Surgical Associates, Children's Minnesota, Minneapolis, MN, United States
| | | | - Jarod P McAteer
- Providence Pediatric Surgery, Sacred Heart Children's Hospital, Spokane, WA, United States
| | - Alana L Beres
- University of California, Davis, Sacramento CA, United States
| | - Joanne Baerg
- Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | | | - Lorraine Kelley-Quon
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Akemi L Kawaguchi
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yue-Yung Hu
- Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children's Center, Roseville, CA, United States
| | - Robert Ricca
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States.
| | - Robert Baird
- Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, United States
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Trump T, Elbakry AA, Haffar A, McClelland D, Morley C, Al-Omar O. The Impact of Targeted Education of American Urological Association Cryptorchidism Guidelines in a Rural State: Improvement Still Needed. Res Rep Urol 2021; 13:437-443. [PMID: 34235100 PMCID: PMC8254607 DOI: 10.2147/rru.s316563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background The American Urological Association published guidelines in 2014 regarding management of undescended testicles (UDT). Despite these guidelines, prior studies have indicated discordance between guidelines and actual practice, especially in rural states. This study aims to identify if educating referring providers improves management of UDT. Methods Patients with UDT referred to our institution were divided into two groups: those referred prior to (Group 1) and after (Group 2) targeted education. A retrospective review was performed to compare the groups in terms of age at time of referral and surgery, laterality, specialty, and practice setting of referring provider, and whether or not ultrasound (US) was performed prior to referral. Results A total of 100 patients were identified in Group 1 and 168 in Group 2. No significant differences were noted between groups regarding age, variability of referring provider, or those receiving US prior to referral. Median age at referral was 20.7 months (range=0-194) and 33 months (range=0-205.1) in Groups 1 and 2, respectively (p=0.26). Sixty-two (37%) patients underwent surgical evaluation within 18 months of age or younger in Group 1 compared to 39 (39%) in Group 2 (p=0.73). Private practice pediatricians comprised the majority of referring providers in both cohorts. US was performed prior to referral in 41% of patients in Group 1 compared to 35.8% in Group 2 (p=0.51). The number of US ordered prior to referral significantly decreased from 10 (50%) to six (19%) following education among academic providers (p=0.02). No significant difference was found following education for private practice physicians (p=0.27). Conclusion Targeted education did not improve age at referral in the short-term, which may reflect suboptimal healthcare access. Additionally, more research is needed to evaluate whether more diverse targeted education provided on a regular basis to both physician and mid-level providers would have a meaningful impact.
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Affiliation(s)
- Tyler Trump
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Amr A Elbakry
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Ahmad Haffar
- West Virginia University School of Medicine, Morgantown, WV, USA
| | | | - Chad Morley
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Osama Al-Omar
- West Virginia University Department of Urology, Morgantown, WV, USA
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Jay MA, Arat A, Wijlaars L, Ajetunmobi O, Fitzpatrick T, Lu H, Lei S, Skerritt C, Goldfeld S, Gissler M, Gunnlaugsson G, Hrafn Jónsson S, Hjern A, Guttmann A, Gilbert R. Timing of paediatric orchidopexy in universal healthcare systems: international administrative data cohort study. BJS Open 2020; 4:1117-1124. [PMID: 32706149 PMCID: PMC7709362 DOI: 10.1002/bjs5.50329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/24/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND International guidelines in 2008 recommended orchidopexy for undescended testis at 6-12 months of age to reduce the risk of testicular cancer and infertility. Using administrative data from England, Finland, Ontario (Canada), Scotland and Sweden (with data from Victoria (Australia) and Iceland in supplementary analyses), the aim of this study was to investigate compliance with these guidelines and identify potential socioeconomic inequities in the timing of surgery before 1 and 3 years. METHODS All boys born in 2003-2011 with a diagnosis code of undescended testis and procedure codes indicating orchidopexy before their fifth birthday were identified from administrative health records. Trends in the proportion of orchidopexies performed before 1 and 3 years of age were investigated, as were socioeconomic inequities in adherence to the guidelines. RESULTS Across all jurisdictions, the proportion of orchidopexies occurring before the first birthday increased over the study period. By 2011, from 7·6 per cent (Sweden) to 27·9 per cent (Scotland) of boys had undergone orchidopexy by their first birthday and 71·5 per cent (Sweden) to 90·4 per cent (Scotland) by 3 years of age. There was limited evidence of socioeconomic inequities for orchidopexy before the introduction of guidelines (2008). Across all jurisdictions for boys born after 2008, there was consistent evidence of inequities in orchidopexy by the first birthday, favouring higher socioeconomic position. Absolute differences in these proportions between the highest and lowest socioeconomic groups ranged from 2·5 to 5·9 per cent across jurisdictions. CONCLUSION Consistent lack of adherence to the guidelines across jurisdictions questions whether the guidelines are appropriate.
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Affiliation(s)
- M. A. Jay
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - A. Arat
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity StudiesStockholmSweden
| | - L. Wijlaars
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - O. Ajetunmobi
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | | | | | - S. Lei
- Murdoch Children's Research Institute, The Royal Children's HospitalAustralia
| | - C. Skerritt
- Bristol Royal Hospital for ChildrenBristolUK
| | - S. Goldfeld
- Murdoch Children's Research Institute, The Royal Children's HospitalAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - M. Gissler
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Information Services DepartmentFinnish Institute for Health and WelfareHelsinkiFinland
| | - G. Gunnlaugsson
- Faculty of Sociology, Anthropology and FolkloristicsUniversity of IcelandReykjavíkIceland
| | - S. Hrafn Jónsson
- Faculty of Sociology, Anthropology and FolkloristicsUniversity of IcelandReykjavíkIceland
| | - A. Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity StudiesStockholmSweden
| | - A. Guttmann
- Child Health Evaluative SciencesCanada
- Division of Paediatric Medicine, Hospital for Sick ChildrenCanada
- ICESCanada
- Dalla Lana School of Public HealthCanada
- Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
| | - R. Gilbert
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
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10
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Mohammad Alnoaiji MS, Alrashidi TN, Ghmaird AS, Alsalem SS, Alanazi MS, Albazei AI, Alenzi MO, Aljuhani MA, Alotaibi RS, Alanazi SA, Althomali AM, Almohammadi AM, Alshahrani EH. Age at Surgery and Outcomes of Undescended Testes at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia. Cureus 2019; 11:e6413. [PMID: 31886102 PMCID: PMC6921998 DOI: 10.7759/cureus.6413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/18/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to investigate the age at diagnosis and surgery of undescended testes and patients' outcomes. Methods This is a retrospective study that reviewed the files of patients who underwent orchidopexy at the King Salman Armed Forces Hospital (KSAFH), Tabuk, Saudi Arabia (SA), between January 1, 2015, and March 30, 2019. All children from birth until 13 years old who were admitted within the specified time frame and underwent orchidopexy were included in this study. The gathered data were analyzed through the Statistical Package for Social Sciences software (SPSS, version 23; SPSS Inc., Chicago, IL, USA). Results A total of 175 patients were included in this study. The rate of orchidopexy at our institution was 12.2%. The median ages at diagnosis and surgery were 12 and 24 months, respectively. The median duration between diagnosis and surgery was eight months. The most common site of undescended testis was inguinal (80.6%). Bilateral undescended testes were recorded in 24.6% of cases, and 25.7% of cases were impalpable. The size of the undescended testis was average in half the cases, small in 44.6% and atrophic in 6.4% of cases. Postoperative complications were reported in 4.0% of cases. Cox regression analysis revealed that the age at diagnosis was a significant risk factor affecting the time of surgery. Conclusion The findings of this study revealed that most cases of undescended testes in Tabuk were operated beyond the age recommended by international guidelines. The age at diagnosis seems to significantly affect the time of surgery.
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Affiliation(s)
| | | | | | | | - Malak S Alanazi
- Otolaryngology Head and Neck Surgery, University of Tabuk, Tabuk, SAU
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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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Gundeti MS. Guidelines vs reality of practice (two sides of the same coin) and lifelong learning! BJU Int 2018; 122:527-528. [PMID: 30251472 DOI: 10.1111/bju.14460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mohan S Gundeti
- Pediatric Urology (Surgery), The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.,MFM (Ob/Gyn) and Pediatrics, The University of Chicago Medicine & Biological Sciences, Chicago, IL, USA.,Pediatric Urology, Comer Children's Hospital, Chicago, IL, USA
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Boehme P, Geis B, Doerner J, Wirth S, Hensel KO. Shortcomings in the management of undescended testis: guideline intention vs reality and the underlying causes - insights from the biggest German cohort. BJU Int 2018; 122:644-653. [DOI: 10.1111/bju.14171] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Philip Boehme
- Witten/Herdecke University; Department of Paediatrics, Centre for Clinical and Translational Research (CCTR); Wuppertal University Hospital; Wuppertal Germany
- Cardiovascular Research; Bayer Pharma AG; Wuppertal Germany
| | - Berit Geis
- Institute of Medical Biometry and Epidemiology (IMBE); Faculty of Health; Witten/Herdecke University; Witten Germany
| | - Johannes Doerner
- Witten/Herdecke University; Department of Surgery, Centre for General and Visceral Surgery; HELIOS University Hospital Wuppertal; Wuppertal Germany
| | - Stefan Wirth
- Witten/Herdecke University; Department of Paediatrics, Centre for Clinical and Translational Research (CCTR); Wuppertal University Hospital; Wuppertal Germany
| | - Kai O. Hensel
- Witten/Herdecke University; Department of Paediatrics, Centre for Clinical and Translational Research (CCTR); Wuppertal University Hospital; Wuppertal Germany
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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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Zundel S, Blumenstock G, Herrmann-Werner A, Trueck M, Schmidt A, Wiechers S. Undescended testis? How best to teach the physical examination. J Pediatr Urol 2016; 12:406.e1-406.e6. [PMID: 27575492 DOI: 10.1016/j.jpurol.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Undescended testis in boys is common. Guidelines recommend surgical treatment between the ages of 6 months and 2 years; nevertheless, orchidopexy is frequently performed at later ages. One reason is the belated diagnosis due to a perceived difficulty in the physical examination (PE) and correct localization of the testis. OBJECTIVES We aimed to find an effective method for teaching the physical examination of the testis in a child. STUDY DESIGN An interdisciplinary team developed teaching sessions, including an educational video and a simulator. Medical students (n = 133) were randomized into three groups: self-study only, video, and video and simulator. The sessions were carried out and quantitative feedback was collected from the teachers and students. The learning achievements of the different groups were assessed with an objective structured clinical examination (OSCE). The differences in mean OSCE results between all three groups were tested using one-way analysis of variance (ANOVA). For multiple pairwise comparisons, a closed testing procedure was performed using unpaired t-tests. RESULTS The self-study only group acquired the poorest results in the OSCE, with a mean score of 5.1 out of 10. The video-only-group reached a mean of 6.7, and the video-and-simulator group performed best with a mean score of 8.5. The differences between all three groups were found to be statistically significant, with P = 0.007. The attached figure illustrates this data. If analyzed in pairs, this difference was particularly apparent between the groups self-study only vs video and simulator, with P = 0.002. Qualitative feedback revealed doubtful effectiveness for educational videos, but positive reactions to training on a simulator. DISCUSSION The poor results of the self-study-only group were in accordance with the literature, where textbook learning was found not to increase OSCE results. The effectiveness of video tutorials remains doubtful; studies focusing on this teaching method are divergent and the present students' feedback supports this data. The effective teaching with the simulator has been proven for other skills (i.e. ultrasound skills). The analyzed cohort for this study was small, and the study should be repeated at different institutions and with larger numbers of students to assure generalizability. CONCLUSIONS Low-fidelity pediatric simulators with palpable testis are available and are able to improve examining skills in medical students. We hope the presented study inspires medical educators in their teaching of the PE of the pediatric testis.
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Affiliation(s)
- S Zundel
- Department of Pediatric Surgery, University Hospital of Tuebingen, Tuebingen, Germany.
| | - G Blumenstock
- Department of Medical Biometry, University of Tuebingen, Tübingen, Germany
| | - A Herrmann-Werner
- Department of Psychosomatic Medicine and Medical Faculty, University Hospital of Tuebingen, Multidisciplinary Skills Lab "DocLab", Tübingen, Germany
| | - M Trueck
- Department of Pediatric Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - A Schmidt
- Department of Pediatric Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - S Wiechers
- Department of Pediatric Hematology, Oncology and General Pediatrics, University Hospital of Tuebingen, Tuebingen, Germany
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Cho A, Ball M, Read K, Tharmapoopathy P, Ross AR, Mathur A, Minocha A, Tsang T, Kulkarni M. Educational survey of regional general practitioner's management of paediatric patients with undescended testis. J Pediatr Urol 2016; 12:151.e1-7. [PMID: 26777063 DOI: 10.1016/j.jpurol.2015.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Recent recommendations have lowered the ideal age of surgery for undescended testis (UDT) to 3-6 months of age. However, many publications demonstrate that age at surgery is still above the recommended age of 1 year as originally suggested in 1996. AIM Through a web-based educational survey, we aimed to combine questions regarding General Practioner's (GPs) management of these patients with educational slides with advice to update them with current recommendations. METHODS The regional GPs were invited by email and letter to undertake the web-based questionnaire devised using SurveyMonkey(®). Educational slides were shown after each questionnaire slide. Feedback was immediate and a one-page summary was emailed to the GP on completion. A pre- and post-educational intervention audit was undertaken to ascertain the change in age of referral for patients <5 years of age. RESULTS 144 (36%) of 401 GPs undertook this survey. 84% were happy assessing infants (<1year) with UDT. 16% were unhappy discussing management with parents for palpable UDT. 52% were happy discussing malignant risk with parents. 80% thought that ultrasonography was routinely used. Optimal referral time was thought to be 6-12 months (42%) and time of surgery was 1-2 years (50%). 72% would refer a patient with palpable UDT after 6 months of age. Only 41% were happy to assess testicular size at puberty. 98% found this format of an educational survey was helpful. The average age of referral for patients <5 years improved significantly after educational intervention from 2.8 years in 2010 to 1.25 years in 2013 (p < 0.01). DISCUSSION With an interactive survey, we were able assess and also educate the regional GPs with regard to management of paediatric patients with UDT. There is a varied range of knowledge and practice demonstrated which we hoped to standardise and thereby increase efficiency and decrease the age of referral. A large majority would refer patients with UDT after 6 months of age that would make the target of surgery <6 months unachievable unless they are aware of current recommendations. This study is limited by a 36% response rate but that is comparable to other surveys. Also, referrals come from other sources that were not included. The causal effect of the educational survey is hypothesised. CONCLUSION This educational survey has confirmed the varied management by GPs. The referral age was demonstrated to be reduced after this intervention and this process was widely accepted by GPs that undertook the educational survey.
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Affiliation(s)
- Alexander Cho
- Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK.
| | | | | | | | - Andrew R Ross
- Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK
| | - Azad Mathur
- Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK
| | - Ashish Minocha
- Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK
| | - Thomas Tsang
- Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK
| | - Milind Kulkarni
- Department of Paediatric Surgery, Norfolk & Norwich University Hospital, Norwich, UK
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Abstract
PURPOSE OF REVIEW This article summarizes the latest evidence on the risk factors, management and outcomes of undescended testes (UDTs). RECENT FINDINGS UDTs remain common, with increasing evidence that acquired UDT or the ascending testis syndrome should be considered part of the spectrum of this disease. Prompt diagnosis and early referral for surgical evaluation and treatment would seem most likely to result in an optimal functional and cosmetic outcome. Hormonal treatment, rather than orchidopexy, remains popular in some centers, despite a lack of good evidence to support its efficacy, although it may have an important adjunct role in optimizing fertility. Although often performed, ultrasound does not generally assist in the diagnosis and management of UDT, with enhanced education of primary care physicians more likely to facilitate early referral. The testis, rather than quiescent, appears biologically active in the male infant, with increasing evidence of an adverse impact on future spermatogenesis and fertility in men with a UDT. SUMMARY Male infants with a UDT should be diagnosed and referred early for surgical evaluation. It seems likely that the optimal timing for surgery should be before the boy's first birthday. There remains a need for high-quality, long-term outcomes data to guide optimal management.
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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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Hensel KO, Caspers T, Jenke AC, Schuler E, Wirth S. Operative management of cryptorchidism: guidelines and reality--a 10-year observational analysis of 3587 cases. BMC Pediatr 2015; 15:116. [PMID: 26357871 PMCID: PMC4566496 DOI: 10.1186/s12887-015-0429-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background Undescended testis (UDT) is the most common disorder in pediatric surgery and one of the most important risk factors for malignancy and subfertility. In 2009 local guidelines were modified and now recommend treatment to be completed by the age of 1. Aim of this study was to analyze age distribution at the time of orchidopexy, whether the procedure is performed according to guideline recommendations and to assess primary care pediatricians’ attitude regarding their treatment approach. Methods We retrospectively analyzed 3587 patients with UDT regarding age at orchidopexy between 2003 and 2012 in 13 German hospitals. Furthermore, we conducted an anonymized nation-wide survey among primary care pediatricians regarding their attitude toward management of UDT. Results Before modification of the guideline 78 % (n = 1245) of the boys with UDT were not operated according to guideline recommendations. After the modification that number rose to 95 % (n = 1472). 42 % of the orchidopexies were performed on patients aged 4 to 17 years. 46 % of the primary care pediatricians were not aware of this discrepancy and 38 % would only initiate operative management after the first year of life. In hospitals with pediatric surgery departments significantly more patients received orchidopexy in their first year of life (p < .001). Conclusion The guideline for UDT in Germany has not yet been implemented sufficiently. Timing of orchidopexy must be optimized in order to improve long-term prognosis. Both primary care providers and parents should be educated regarding the advantages of early orchidopexy in UDT. Prospective studies are needed to elucidate the high rate of late orchidopexies. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0429-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kai O Hensel
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Children's Hospital, Centre for Clinical & Translational Research (CCTR), Faculty of Health, Witten/Herdecke University, Heusnerstr. 40, D-42283, Wuppertal, Germany.
| | - Tawa Caspers
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Children's Hospital, Centre for Clinical & Translational Research (CCTR), Faculty of Health, Witten/Herdecke University, Heusnerstr. 40, D-42283, Wuppertal, Germany.
| | - Andreas C Jenke
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Children's Hospital, Centre for Clinical & Translational Research (CCTR), Faculty of Health, Witten/Herdecke University, Heusnerstr. 40, D-42283, Wuppertal, Germany.
| | - Ekkehard Schuler
- Institute for Quality Management, HELIOS Kliniken GmbH, Berlin, Germany.
| | - Stefan Wirth
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Children's Hospital, Centre for Clinical & Translational Research (CCTR), Faculty of Health, Witten/Herdecke University, Heusnerstr. 40, D-42283, Wuppertal, Germany.
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Beasley SW. Understanding the responsibilities and obligations of the modern paediatric surgeon. J Pediatr Surg 2015; 50:223-31. [PMID: 25638607 DOI: 10.1016/j.jpedsurg.2014.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/02/2014] [Indexed: 11/25/2022]
Abstract
The modern paediatric surgeon needs to be competent in multiple domains that extend well beyond their clinical and technical expertise. This article, based on the Journal of Pediatric Surgery Lecture at the BAPS Congress (2014), explores some of these less well understood responsibilities and obligations, including professionalism, leadership, effective clinical teaching, and research. The consequence of falling short in these areas includes risks to our profession as a whole as well as compromising our ability to provide our patients with the best clinical care. Paediatric surgeons have a responsibility to influence the configuration of services to improve the quality of care and equity of access to specialist services for all children in their region. Evidence presented shows how a well-organised and funded regional paediatric surgical service allows children to receive quality treatment closer to home and is reflected in better clinical outcomes, less unnecessary surgery, and fewer complications. A paradigm for support to emerging countries as they increase the capacity and infrastructure of their paediatric surgical services is proposed. The way we judge ourselves and others should relate to our performance across the full scope of roles that a responsible and committed paediatric surgeon is expected to display.
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Affiliation(s)
- Spencer W Beasley
- Christchurch School of Medicine and Health Sciences, University of Otago, Clinical Director of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
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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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