Assessment of referral patterns for boys with suspected undescended testes and identification of risk factors to aid diagnosis

J A O'Kelly; K J Breen; R Amoateng; L Scanlon; E J Redmond; E A Kiely

doi:10.1016/j.surge.2021.05.002

Assessment of referral patterns for boys with suspected undescended testes and identification of risk factors to aid diagnosis

Surgeon. 2022 Aug;20(4):e100-e104. doi: 10.1016/j.surge.2021.05.002. Epub 2021 Jun 12.

Authors

J A O'Kelly¹, K J Breen², R Amoateng², L Scanlon², E J Redmond², E A Kiely²

Affiliations

¹ Department of Urology, Cork University Hospital, Wilton, Cork, Ireland. Electronic address: johnokelly@rcsi.ie.
² Department of Urology, Cork University Hospital, Wilton, Cork, Ireland.

PMID: 34130889
DOI: 10.1016/j.surge.2021.05.002

Abstract

Introduction: Undescended testis (UDT) is a clinical diagnosis and a common reason for referral to paediatric urology outpatients. Our aim was to assess current referral patterns at our unit and to identify predictive factors that may better aid primary care physicians (PCP) in diagnosing UDT based on history and physical exam.

Methods: A retrospective analysis of referrals to outpatients from 2014 to 2016 was performed to assess current referral patterns including referral source, age, reason for referral and outcome following assessment by a single consultant paediatric urologist.A prospective analysis of new referrals was performed to identify predictive factors which may aid in the diagnosis of UDT including gestational age, presence of scrotal asymmetry and previously obtained imaging.

Results: From 2014 to 2016, 259 boys were referred with suspected UDT. The majority of referrals were received from PCPs (62%) followed by Neonatology (29%), Paediatrics (8%) and general surgery (1%). Median age at time of assessment was 29 (5-180) months. One hundred and eight (41.7%) boys were diagnosed with UDT.There were 74 boys assessed prospectively. Median age at assessment was 24.5 (6-171) months. We identified 3 predictors of a diagnosis of UDT; history of prematurity (p = 0.001), UDT mentioned to the parents at birth (p = 0.027) and scrotal asymmetry on examination (p < 0.001). Greatest diagnostic inaccuracy was found in boys referred beyond one year of age (27.7%). In this cohort, the absence of all three risk factors was associated with a negative predictive value of 94.1%.

Conclusion: The majority of boys with suspected UDT are referred beyond the age recommended for orchidopexy (6-12 months). The majority of boys referred for assessment did not have UDT. We have identified three predictive factors that may aid referring physicians when assessing boys, particularly those older than 1 year.

Keywords: Cryptorchidism.; Orchidopexy; Paediatric urology; Retractile; Testis; Undescended.

MeSH terms

Child
Cryptorchidism* / complications
Cryptorchidism* / diagnosis
Cryptorchidism* / surgery
Female
Humans
Infant
Infant, Newborn
Male
Orchiopexy
Referral and Consultation
Retrospective Studies
Risk Factors