Current Referral Patterns and Means to Improve Accuracy in Diagnosis of Undescended Testis

Author:

Snodgrass Warren12,Bush Nicol12,Holzer Michael1,Zhang Song3

Affiliation:

1. Departments of Urology and

2. Department of Pediatric Urology, Children's Medical Center, Dallas, Texas

3. Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas; and

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.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference15 articles.

1. The descent of the testis;Scorer;Arch Dis Child,1964

2. Undescended testes: incidence in 1,002 consecutive male infants and outcome at 1 year of age;Thong;Pediatr Surg Int,1998

3. The true incidence of cryptorchidism in Denmark;Cortes;J Urol,2008

4. Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia;American Academy of Pediatrics, Section on Urology;Pediatrics,1996

5. Undescended testes: a consensus on management;Ritzén;Eur J Endocrinol,2008

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