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Rural versus urban compliance in the management of cryptorchidism: is there a difference?

Abstract

The authors compared the age and referral patterns of pediatric patients undergoing surgical intervention for cryptorchidism at a rural, West Virginia University, versus urban, Johns Hopkins University, tertiary center. A retrospective review of patients undergoing surgical evaluation for cryptorchidism was performed. Patients treated for reasons unrelated to cryptorchidism or referred for multiple urologic diagnoses were excluded. The patients at each institution were then divided into four groups based on their corrected gestational age at time of surgery. Referral times and provider specialties were also obtained. A total of 131 cases at the urban center and 100 cases at the rural center were identified. At the rural center, the average age of referral and surgery were 48.3 and 53.8 months, respectively, compared to 59.6 and 65.2 months at the urban center. Only 40% of patients at the rural site and 29% at the urban institution underwent intervention at less than 18 months of age. There was no significant difference in time of referral to surgery between the institutions. The majority of referrals were made by private practice pediatricians.

Conclusion: In this study, a pattern of delayed referral and intervention was observed at both institutions despite differing geographic regions and heterogeneous patient populations. It is important that referring providers realize that scrotal U/S does not change management of UDT and should not delay prompt referral.

What is known:
Significant referral delay is a challenging issue in the management of cryptorchidism.
Ultrasound is not a valid method for the detection of cryptorchidism.
What is new:
The rural and urban management of cryptorchidism is not that different.
More emphasis should be put on the detection management of cryptorchidism.

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Fig. 1

Abbreviations

AAP:

American Academy of Pediatrics

AUA:

American Urologic Association

CPT:

Current Procedural Terminology

EUA:

European Association of Urology

JHU:

Johns Hopkins University

PHIS:

Pediatric Health and Information System

PCP:

Primary care physician(s)

U/S:

Ultrasound

UDT:

Undescended testicle(s)

UDAP:

Urologic Diseases in America Project

VUR:

Vesicoureteral reflux

WVU:

West Virginia University

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Author information

Dana Point: Dr. Point conceptualized and designed the study, collected data from one site, analyzed the data, drafted the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted.

Chad Morley: Dr. Morley collected data from one site, analyzed the data, aided in drafting the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted.

Ali Tourchi: Dr. Tourchi, Reddy, and Sirisreetreerux collected data from one site, reviewed and revised the manuscript, and approved the final manuscript as submitted.

Sunil Reddy: Dr. Reddy collected data from one site, reviewed and revised the manuscript, and approved the final manuscript as submitted.

Pokket Sirisreetreerux: Dr. Sirisreetreerux collected data from one site, reviewed and revised the manuscript, and approved the final manuscript as submitted.

John Gearhart: Dr. Gearhart conceptualized the study and supervised data collection and analysis at one of the sites. He critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

Osama AL-Omar: Dr. AL-Omar supervised the study design, data collection, and analysis of the data. He critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

Correspondence to Osama AL-Omar.

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No funding was secured for this study.

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The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Level of evidence: 3

Economic/Decision Analysis or Modeling Studies

Communicated by Jaan Toelen

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Point, D., Morley, C., Tourchi, A. et al. Rural versus urban compliance in the management of cryptorchidism: is there a difference?. Eur J Pediatr 176, 1067–1073 (2017). https://doi.org/10.1007/s00431-017-2946-4

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Keywords

  • Orchiopexy
  • Cryptorchidism
  • Referral
  • Urban