Purpose While the nonpalpable testis represents only a small portion of all cryptorchid testes, it remains a clinical challenge for pediatric urologists. Many controversies about the best evaluation and management exist. This narrative review serves as an update on what is known about the nonpalpable testis: etiology, pre-operative evaluation, the best surgical management, novel techniques, and ongoing controversies. Materials and Methods A Pubmed® and MEDLINE® search limited to January 2000 to January 2017 was performed using relevant key terms. Of 367 articles, a total of 115 manuscripts were considered for inclusion based on an a priori design. Utilizing a narrative review format, an update on the evaluation and management of the nonpalpable testis including novel concepts and techniques was synthesized. Results The nonpalpable testis should be evaluated by physical exam only. Imaging is not indicated for the routine case. The optimal surgical approach and technique remains debated, but several novel techniques have been described. Due to the rarity of the nonpalpable testis, randomized controlled trial and other quality comparisons are difficult. Therefore, several controversies in management remain. Conclusions The evaluation and management of the nonpalpable testis remains difficult and some aspects remain debated. Future research should focus on multi-institutional collaborative trials to determine the optimal operative management.

Purpose We examined the ambulatory health care visit utilization of spina bifida children, adults who transitioned to adult care, and adults who continued to seek care in a pediatric setting. Methods We evaluated utilization over a one-year period for SB patients who visited any outpatient medical clinic within an integrated health care system. Patients were categorized as pediatric (<18) or adult (≥ 18). Adults were divided into those who did not fully transition to adult care (DNT) and patients who fully transitioned (adult). Frequency and type of health care utilization were compared. Sub-analysis was performed for patients aged 18–25 to examine variables associated with successful complete transition to adult care. Results Over one year, 382 children, 88 DNT, and 293 adult SB patients had 4,931 clinic visits. Children had greater ambulatory care utilization (7.25 visits/year) compared to fully transitioned adults (5.33 visits/year, p=0.046). Children more commonly visited surgery clinics (52.3% of visits) and adults more commonly visited medical clinics (48.9%) (p<0.005). Adult transitioned patients were more likely to be female (p=0.004). Of patients 18–25 years old, those who did not transition to adult care had similar outpatient visit types but higher utilization of inpatient and emergency care than those who transitioned. Conclusions SB children utilized more ambulatory care than adults and were more likely to visit a surgical specialist. Adult SB patients who successfully transitioned to adult care were more likely to be female and patients who failed to transition were more likely to have more inpatient and emergency care.

With increasing rates of deliveries and young age at delivery for women with SB, it is imperative that pediatric and transitional urologists initiate discussions on sexual and reproductive health beginning in adolescence.

Compared to women without SB, those with SB deliver more frequently by cesarean section and have higher odds of morbidity associated with cesarean delivery, but not vaginal delivery.

Summary Introduction More pediatric patients seem to present to the emergency department (ED) for non-urgent matters after urologic procedures than adult patients. Under new and expanding healthcare reform, pediatric urologists may be penalized for these visits. We compare our 30-day postoperative bounceback rates to the ED and the acuity of the concerns in these populations. Materials and methods All urology consults at our institution are maintained on a prospectively tracked database. We identified all patients who presented to our adult or pediatric ED between July 2013 and June 2015 within 30 days of a urologic procedure. We investigated the patient demographics including age, race, insurance, distance from the home zip code to the ED, procedures performed, chief complaint in the ED, diagnosis, and treatment required. Results In our pediatric group, there were 67 visits for 56 patients (19 female, 37 male, mean age 6.8 years), which represents an overall bounceback incidence of 2.7%. Of those, 19% required admission (0.60% overall readmission rate), 10% underwent a procedure (0.32% reoperative rate, 18% required catheter manipulation/placement, 13% were given a prescription (most commonly for constipation), 6% required local wound care, and 33% were reassured only. Most pediatric patients had private insurance (62.5%) and those with private insurance or who were uninsured tended to require only reassurance compared to those with Medicare/Medicaid (p = 0.053). In the adult population, there were 369 visits in 310 patients (111 female, 199 male, mean age 55.4 years) for an incidence of 4.4%. Of those, 42% were admitted (2.2% overall readmission rate), 14% underwent a procedure (0.74% reoperative rate), 11% required catheter manipulation/placement, 14% were given medication (most commonly antibiotics and narcotics), 4% were given local wound care, and 12% were reassured. Most adult patients had Medicare/Medicaid (48.7%), but insurance type was not related to treatment required (p = 0.382). On multivariable analysis, pediatric patients, closer proximity to the hospital, and earlier postoperative day at presentation to the ED were predictive of requiring only reassurance. Conclusions Compared to adults, pediatric patients are less likely to return to the ED postoperatively (p < 0.001), but they are significantly more likely to require only reassurance (p < 0.001) while adults are significantly more likely to require hospital admission (p < 0.001). In both groups, nearly one-third of patients required only catheter care or medication. This difference could have significant implications for new healthcare policy.

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