TY - JOUR
T1 - Current referral patterns and means to improve accuracy in diagnosis of undescended testis
AU - Snodgrass, Warren
AU - Bush, Nicol
AU - Holzer, Michael
AU - Zhang, Song
PY - 2011/2
Y1 - 2011/2
N2 - OBJECTIVES: The goals were to determine current referral patterns for boys suspected of having undescended testis (UDT) and to identify factors to assist primary care providers in distinguishing retractile testes from UDTs on the basis of history, physical examination, or imaging findings. METHODS: By using a standardized history assessment, visual inspection of the scrotum for symmetry, physical examination, and review of previously obtained imaging findings, we performed a prospective observational study with consecutive patients referred to a pediatric urologist for evaluation of UDT. RESULTS: Of 118 boys, 51 (43%) had descended testes, 60 (51%) had UDTs, and 7 (6%) had initially indeterminate findings. Boys with UDT were referred at a median age of 43.3 months. Patients referred at <1 year or >10 years of age were significantly more likely to have UDT than were those referred at 1 to 10 years of age. History of UDT at birth, prematurity, and scrotal asymmetry strongly increased the risk of UDT. Genital ultrasonography had been performed for 25% of patients, incorrectly indicating UDT for 48%. CONCLUSIONS: Most boys were referred well beyond the recommended age of <12 months for orchiopexy. Only one-half of the patients had UDT, with most errors in diagnosis being made for boys 1 to 10 years of age, which suggests difficulty distinguishing UDT from retractile testis. Positive birth history findings, prematurity, and scrotal asymmetry predicted UDT and can be used by primary care physicians in their assessment before referral. Genital ultrasonography did not distinguish UDTs from retractile testes.
AB - OBJECTIVES: The goals were to determine current referral patterns for boys suspected of having undescended testis (UDT) and to identify factors to assist primary care providers in distinguishing retractile testes from UDTs on the basis of history, physical examination, or imaging findings. METHODS: By using a standardized history assessment, visual inspection of the scrotum for symmetry, physical examination, and review of previously obtained imaging findings, we performed a prospective observational study with consecutive patients referred to a pediatric urologist for evaluation of UDT. RESULTS: Of 118 boys, 51 (43%) had descended testes, 60 (51%) had UDTs, and 7 (6%) had initially indeterminate findings. Boys with UDT were referred at a median age of 43.3 months. Patients referred at <1 year or >10 years of age were significantly more likely to have UDT than were those referred at 1 to 10 years of age. History of UDT at birth, prematurity, and scrotal asymmetry strongly increased the risk of UDT. Genital ultrasonography had been performed for 25% of patients, incorrectly indicating UDT for 48%. CONCLUSIONS: Most boys were referred well beyond the recommended age of <12 months for orchiopexy. Only one-half of the patients had UDT, with most errors in diagnosis being made for boys 1 to 10 years of age, which suggests difficulty distinguishing UDT from retractile testis. Positive birth history findings, prematurity, and scrotal asymmetry predicted UDT and can be used by primary care physicians in their assessment before referral. Genital ultrasonography did not distinguish UDTs from retractile testes.
KW - Orchiopexy
KW - Retractile testis
KW - Undescended testis
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U2 - 10.1542/peds.2010-1719
DO - 10.1542/peds.2010-1719
M3 - Article
C2 - 21262892
AN - SCOPUS:79551523760
SN - 0031-4005
VL - 127
SP - e382-e388
JO - Pediatrics
JF - Pediatrics
IS - 2
ER -