Current referral patterns and means to improve accuracy in diagnosis of undescended testis

Warren Snodgrass, Nicol Bush, Michael Holzer, Song Zhang

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalPediatrics
Volume127
Issue number2
DOIs
StatePublished - Feb 2011

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Cryptorchidism
Referral and Consultation
Testis
Physical Examination
Ultrasonography
History
Orchiopexy
Reproductive History
Scrotum
Primary Care Physicians
Observational Studies
Primary Health Care
Parturition
Prospective Studies
Pediatrics

Keywords

  • Orchiopexy
  • Retractile testis
  • Undescended testis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Current referral patterns and means to improve accuracy in diagnosis of undescended testis. / Snodgrass, Warren; Bush, Nicol; Holzer, Michael; Zhang, Song.

In: Pediatrics, Vol. 127, No. 2, 02.2011.

Research output: Contribution to journalArticle

Snodgrass, Warren ; Bush, Nicol ; Holzer, Michael ; Zhang, Song. / Current referral patterns and means to improve accuracy in diagnosis of undescended testis. In: Pediatrics. 2011 ; Vol. 127, No. 2.
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abstract = "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.",
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