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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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
References
[No authors listed] (1995) Recommendations for preventive pediatric health care: committee on practice and ambulatory medicine. J Pediatr 96(2 Pt1): 373
American Academy of Pediatrics (1996) Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. J Pediatr 97:590
Barthold JS (2012) Abnormalities of the testis and scrotum and their surgical management. In: Wein AJ, Kavoussi LR, Novick AC et al (eds) Campbell-Walsh Urology, 10th edn. Elsevier Saunders, Philadelphia, pp 3696–3730
Bayne AP, Alonzo DG, Hsieh MH (2011) Impact of anatomical and socioeconomic factors on timing of urological consultation for boys with cryptorchidism. J Urol 189:1601
Chen Y, Huang W, Huang K (2013) Factors related to the time of cryptorchidism surgery—a nationwide population-based study in Taiwan. J Formos med Assoc 113:915
Dieckmann KP, Pichlmeier U (2004) Clinical epidemiology of testicular germ cell tumors. World J Urol 22(1):2
Docimo SG (1995) The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol 154(3):1148
Hrivatakis G, Astfalk W, Schmidt A (2014) The timing of surgery for undescended testis—a retrospective multicenter analysis. Dtsch Arztebl Int 111:649
Jensen MS, Olsen LH, Thulstrup AM (2011) Age at cryptorchism diagnosis and orchiopexy in Denmark: a population based study of 508, 964 boys born from 1995 to 2009. J Urol 186:1595
Joshi SS, Clayton DB, Pope JC (2014) Spontaneous descent rate of cryptorchis testes: a plea for early referral. J Urol 191:4S
Klaassen Z, Ellington C, Reinstatler L (2014) Lower socioeconomic status is associated with malignancy in patients with undescended testis. J Urol 191(4s):e29
Kokorowski PJ, Routh JC, Graham AD, Nelson CP (2010) Variations in timing of surgery among boys who underwent orchiopexy for cryptorchidism. J Pediatr 126:576
Kollin C, Hesser U, Ritzen EM (2006) Testicular growth from birth to two years of age, and the effect of orchidopexy at age nine months: a randomized, controlled study. Acta Paediatr 95(3):318
Kollin C, Karpe B, Hesser U (2007) Surgical treatment of unilaterally undescended testes: testicular growth after randomization to orchiopexy at age 9 months or 3 years. J Urology 174(4 PT2):1589
Kolon TF, Herndon CDA, Baker LA 2014 Evaluation and treatment of cryptorchidism: AUA Guideline. American Urological Association Education and Research, Inc
Mangione-Smith R, DeCristofarco A, Setodji C (2007) The quality of ambulatory care delivered to children in the United States. N Engl J med 357:1515
McCarthy D, Schoen C, Radley D (2014) State health system performance: a score card. Jama 312(2):131
Nah SA, Yeo CS, How GY (2014) Undescended testis: 513 patients’ characteristics, age at orchidopexy and patterns of referral. Arch Dis Child 99(5):401
Snodgrass W, Bush N, Holzer M (2011) Current referral patterns and means to improve accuracy in diagnosis of undescended testis. J Pediatr 127:382
Springer A, Subramaniam R, Krall C (2013) Orchidopexy patterns in Austria from 1993 to 2009. J Pediatr Urol 9:535
Steckler R, Zaontz M, Skoog S, Rushton G (1995) Cryptorchidism, pediatricians, and family practitioners: patterns of practice and referral. J Pediatr 127(6):948–951
Tekgul S, Dogan HS, Hoebeke P 2014 European Society for Paediatric Urology Guidelines on Paediatric Urology: cryptorchidism. Eur Assoc Urol
Wohlfahrt-Veje C et al (2009) Acquired cryptorchidism is frequent in infancy and childhood. Int J Androl 32:423
Wood HM, Elder JS (2009) Cryptorchidism and testicular cancer: separating fact from fiction. J Urol 181(2):452
Yiee JHU, Saigal CS, Lai J (2012) Timing of orchiopexy in the United States: a quality-of-care indicator. Urology 80(5):1121
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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.
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Communicated by Jaan Toelen
Level of evidence: 3
Economic/Decision Analysis or Modeling Studies
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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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DOI: https://doi.org/10.1007/s00431-017-2946-4