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

Abstract

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...

Primary Abdominal Cocoon with Right Intra-Abdominal Cryptorchidism: A Case Report

“…The etiologies and pathogenesis are unknown, part of patients with the absence of the greater omentum which are related to the congenital developmental abnormalities, the possible reason is that the greater omentum descends and wraps the intestine to form the smooth and dense cocoon membrane (13). Cryptorchidism mainly manifests as the absence of testicle in the affected scrotum (4,5,14), CT could accurately show the location of cryptorchidism in the abdominal cavity (15), and this disease may be related to the obstruction of testicular descent during embryonic development (14). In this case, he was admitted to the hospital due to unexplained intermittent abdominal pain, preoperative CT showed suspicious abdominal cocoon and right cryptorchidism.…”

Analysis of Factor Influencing Delayed Referral of Undescended Testis

“…The rate of delay in referring patients with UDT to health facilities for correction is still relatively high [2]. This incident is not only in developing countries such as Indonesia, developed countries such as Canada, Germany, and New Zealand also face the same problem [2], [3], [4].…”

Comparison of the perspectives of the pediatric surgeons and pediatric urologists in management of cryptorchidism in Saudi Arabia

“… 1 , 2 Most of the patients with cryptorchidism will have spontaneous descend of the testes during the first 3 months of their life and nearly 0.8-1.1% of male infants have persistent cryptorchidism. 3 , 4 Early surgery is recommended to prevent infertility and malignancy in the patients with persistent cryptorchidism. 5 Both pediatric surgeons and pediatric urologists could manage cryptorchidism, and the strategy used for management of the condition depends on the surgeons’ experience.…”