Factors associated with delay in undescended testis referral

Jiang, Da David; Acevedo, Ariette; Bayne, Aaron; Austin, J. Christopher; Seideman, Casey A.

doi:10.1016/j.jpurol.2019.03.029

Cited by 27 publications

(28 citation statements)

References 24 publications

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“…10 Despite this early evidence, subsequent studies have demonstrated that the referral and treatment pattern for UDT is less than optimal with large percentages of patients undergoing surgical correction outside of the guideline recommended timeframe. 8 , 9 , 11 …”

Section: Discussionmentioning

confidence: 99%

The Impact of Targeted Education of American Urological Association Cryptorchidism Guidelines in a Rural State: Improvement Still Needed

Trump

Elbakry

Haffar

et al. 2021

RRU

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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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Section: Discussionmentioning

confidence: 99%

The Impact of Targeted Education of American Urological Association Cryptorchidism Guidelines in a Rural State: Improvement Still Needed

Trump

Elbakry

Haffar

et al. 2021

RRU

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“…Thus, careful follow‐up is important at least once a year to prevent testicular damage, which may result in infertility and the development of testicular cancer. It is also important to educate families so that surgical intervention is not overlooked before the development of irreversible anomalies in the testes 8 …”

Section: Discussionmentioning

confidence: 99%

“…It is also important to educate families so that surgical intervention is not overlooked before the development of irreversible anomalies in the testes. 8 Management strategies for RT remain controversial. In the present cohort, approximately 50% of the boys were screened during health examinations as babies, and were referred to our institution.…”

Section: Discussionmentioning

confidence: 99%

Trends in treatment outcomes for retractile testis in Japanese boys: A single‐center study

et al. 2020

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Objectives To investigate the natural course of retractile testis by analyzing its prevalence and outcomes. Methods This retrospective study included 215 boys in whom retractile testis was diagnosed after reviewing the medical history and physical examinations of the patients. Orchiopexy was performed once the testis became undescended. We investigated the trends in the prevalence and outcomes of retractile testis and compared clinical factors between cases that resolved spontaneously and those that required orchiopexy. Results Of 215 boys, 145 were finally evaluated. The mean age at diagnosis was 2 years, and 100 boys were aged ≤2 years when they were hospitalized. Seventy‐three boys were referred to our institution through health examinations as babies. The condition improved spontaneously in 89 boys, while 43 boys underwent orchiopexy, and 13 boys remained under follow‐up. The follow‐up period between diagnosis and resolution was significantly longer in the spontaneous resolution group than in the surgical intervention group (P = 0.011). Bilateral retractile testis improved spontaneously in significantly more boys compared to unilateral retractile testis (P = 0.0010). Spontaneous resolution was observed in boys of all ages, but those diagnosed at ≤3 years of age had a significantly higher rate of spontaneous resolution compared to those who were diagnosed at >3 years of age (P = 0.0019). Conclusions Our findings suggest that retractile testis cannot be affirmed as a variant of normal testis. Performing examinations at a young age is critical for preventing misdiagnosis, screening failures, and unnecessary surgery.

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“…Cryptorchidism is a common congenital malformation in pediatric urology which is also known as undescended testis (UDT) or incomplete testicular descent (1)(2)(3). According to the location of the testis, cryptorchidism can be divided into palpable testis and non-palpable testis (NPT), and palpable testis accounts for more than 80% of cryptorchidism cases (4).…”

Section: Introductionmentioning

confidence: 99%

Open controversies on the treatment of undescended testis: An update

et al. 2022

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Cryptorchidism is a common congenital malformation in pediatric urology. Although there have been many studies on the etiology of the disease, it has not been fully clarified, and while its diagnostic and treatment models have gradually approached standardization and systematization, some controversies regarding treatment remain. Additionally, although ultrasound is a non-invasive examination without ionizing radiation, its role in the evaluation of cryptorchidism remains controversial. The main basis for treating cryptorchidism is orchidopexy, and the main view on treatment age is that treatment should be performed between 6 and 12 months after birth, but no more than 18 months after birth. The view on hormone therapy is still controversial because most scholars believe that early surgery is the key to treatment. There are many surgical treatment methods for cryptorchidism, including traditional open surgery and laparoscopic surgery, which provide satisfactory results. In conclusion, the treatment of undescended testis (UDT) had been largely standardized, apart from the treatment of high intra-abdominal testis (IAT), which remains a matter of debate.

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Factors associated with delay in undescended testis referral

Cited by 27 publications

References 24 publications

The Impact of Targeted Education of American Urological Association Cryptorchidism Guidelines in a Rural State: Improvement Still Needed

The Impact of Targeted Education of American Urological Association Cryptorchidism Guidelines in a Rural State: Improvement Still Needed

Trends in treatment outcomes for retractile testis in Japanese boys: A single‐center study

Open controversies on the treatment of undescended testis: An update

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