Inappropriate Use of Ultrasound in Management of Pediatric Cryptorchidism

Kanaroglou, Niki; To, Teresa; Zhu, Jingqin; Braga, Luis H.; Wehbi, Elias; Hajiha, Mohammed; Bägli, Darius; Salle, Joao Pippi; Koyle, Martin A.; Lorenzo, Armando J.

doi:10.1542/peds.2015-0222

Cited by 19 publications

(13 citation statements)

References 24 publications

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“…The authors found that 33.5% had at least 1 previous ultrasound and these children with pre-referral ultrasound had an approximate 3-month delay in definitive surgical management. 11 Over a 10-year period, the use of pre-referral ultrasound was increasing over time and was estimated to cost about $270 000 CAD. In the setting of a healthcare system with limited resources, the misuse of ultrasound diverts the use of equipment and time from ultrasound technologists away from the management of conditions for which it is actually indicated.…”

Section: Discussionmentioning

confidence: 99%

Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

Wong

Bansal

Lorenzo

et al. 2015

CUAJ

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Introduction: Although previous evidence has shown that ultrasound is unreliable to diagnose undescended testis, many primary care providers (PCP) continue to misuse it. We assessed the performance of ultrasound as a diagnostic tool for palpable undescended testis, as well as the diagnostic agreement between PCP and pediatric urologists. Methods: We performed a prospective observational cohort study between 2011 and 2013 for consecutive boys referred with a diagnosis of undescended testis to our tertiary pediatric hospital. Patients referred without an ultrasound and those with non-palpable testes were excluded. Data on referring diagnosis, pediatric urology examination and ultrasound reports were analyzed. Results: Our study consisted of 339 boys. Of these, patients without an ultrasound (n = 132) and those with non-palpable testes (n = 38) were excluded. In the end, there were 169 pateints in this study. Ultrasound was performed in 50% of referred boys showing 256 undescended testis. The mean age at time of referral was 45 months. When ultrasound was compared to physical examination by the pediatric urologist, agreement was only 34%. The performance of ultrasound for palpable undescended testis was: sensitivity = 100%; specificity = 16%; positive predictive value = 34%; negative predictive value = 100%; positive likelihood ratio = 1.2; and negative likelihood ratio = 0. Diagnosis of undescended testis by PCP was confirmed by physical examination in 30% of cases, with 70% re-diagnosed with normal or retractile testes. Conclusion: Ultrasound performed poorly to assess for palpable undescended testis in boys and should not be used. Although the study has important limitations, there is an increasing need for education and evidence-based guidelines for PCP in the management of undescended testis.

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Section: Discussionmentioning

confidence: 99%

Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

Wong

Bansal

Lorenzo

et al. 2015

CUAJ

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“…2-5,7 Interestingly, it has been reported that pediatricians in practice fewer than 20 years and those in nonacademic practice are more likely to order US. 1,14,15 Tasian and colleagues described that pediatricians believe that imaging reliably identifies a nonpalpable testis that reassures the family and assists the surgeon with operative planning. 15 It has also been reported that children who undergo US have a 3-month delay in definitive surgery.…”

Section: Discussionmentioning

confidence: 99%

“…15 It has also been reported that children who undergo US have a 3-month delay in definitive surgery. 14 Aggarwal and colleagues provided educational updates to referring providers of infants and children with cryptorchidism insisting that SUS are not recommended for this condition. 16 These authors noted a significant decrease in the proportion of patients having an unnecessary US following the implementation of these educational guidelines.…”

Section: Discussionmentioning

confidence: 99%

Scrotal Ultrasound Is Not Routinely Indicated in the Management of Cryptorchidism, Retractile Testes, and Hydrocele in Children

Shields

White

Peppas

et al. 2019

Global Pediatric Health

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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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“…They are not meant to supercede clinical judgment and management of each patient. 17,24 The most recently published guidelines from the AUA, BAPS and CUA pertaining to UDT contain similar recommendations on management, including the ideal time for surgery, need for preoperative ultrasonography, and approaching the palpable and nonpalpable testes. In addition, Choosing Wisely Canada has recommendations regarding the use of preoperative ultrasonography (Table S3, Appendix 1).…”

Section: Discussionmentioning

confidence: 99%

Variability among Canadian pediatric surgeons and pediatric urologists in the management of cryptorchidism in boys before the publication of major guidelines: a retrospective review of a single tertiary centre

Kim

Chua

Ming

et al. 2019

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Background: Before 2014, there was a lack of recommendations on managing cryptorchidism, or undescended testis (UDT), from a large pediatric urological or surgical organization. We assessed the variability in management of UDT among pediatric urologists and pediatric surgeons at a single tertiary pediatric referral centre before publication of major guidelines. Methods: We performed a retrospective review of the electronic records of patients who underwent primary unilateral or bilateral orchidopexy at our centre between January 2012 and January 2014. Results: A total of 488 patients (616 testes) were identified, of whom 405 (83.0%) and 83 (17.0%) were managed by pediatric urologists and pediatric surgeons, respectively. There was no difference in baseline characteristics, including age seen in clinic or at surgery, testis location/ palpability and availability of preoperative ultrasonograms, of patients seen by the 2 groups. Pediatric surgeons ordered preoperative ultrasonography more often than pediatric urologists (25.3% v. 3.7%, p < 0.001). With palpable UDTs, although both groups used open approaches, pediatric urologists preferred a scrotal approach (56.9%), and pediatric surgeons approached most testes inguinally (98.8%). With nonpalpable UDTs, laparoscopic approaches were preferred by both groups; however, pediatric urologists used a 2-stage Fowler-Stephens approach more often than pediatric surgeons (48.4% v. 15.8%, p < 0.001). Conclusion: There was wide variation in the management of primary UDT between pediatric urologists and pediatric surgeons before the publication of guidelines. The most prominent difference between the 2 groups was in the ordering of preoperative ultrasonography. Future assessment of change in practice patterns may elucidate whether guidelines are an effective tool for standardization of practice. Contexte : Avant 2014, on ne disposait pas de recommandations émanant d'une grande organisation urologique ou chirurgicale pédiatrique pour la prise en charge de la cryptorchidie (absence d'un ou des deux testicules dans le scrotum). Nous avons évalué les divers types de prise en charge de la cryptorchidie chez les urologues et les chirurgiens pédiatriques dans un seul centre tertiaire de référence pédiatrique avant la publication de lignes directrices majeures. Méthodes : Nous avons procédé à une revue rétrospective des dossiers électroniques de patients ayant subi une orchidopexie unilatérale ou bilatérale primaire dans notre centre entre janvier 2012 et janvier 2014. Résultats : En tout, 488 patients (616 testicules) ont été identifiés, dont 405 (83,0 %) et 83 (17,0 %) ont été traités respectivement par des urologues et des chirurgiens pédiatriques. On n'a noté aucune différence quant aux caractéristiques de départ des patients vus par les 2 groupes, telles que l'âge lors de la consultation à la clinique ou lors de la chirurgie, la localisation/ palpabilité des testicules et le recours à l'échogra phie préopératoire. Les chirurgiens pé diatriques ont demandé une échographie préopérato...

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Inappropriate Use of Ultrasound in Management of Pediatric Cryptorchidism

Cited by 19 publications

References 24 publications

Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

Scrotal Ultrasound Is Not Routinely Indicated in the Management of Cryptorchidism, Retractile Testes, and Hydrocele in Children

Variability among Canadian pediatric surgeons and pediatric urologists in the management of cryptorchidism in boys before the publication of major guidelines: a retrospective review of a single tertiary centre

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