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- Title
Variability among Canadian pediatric surgeons and pediatric urologists in the management of cryptorchidism in boys before the publication of major guidelines: a retrospective review of a single tertiary centre.
- Authors
Kim, Jin K.; Chua, Michael E.; Ming, Jessica M.; Lee, Min Joon; Kesavan, Amre; Kahn, Nathaniel; Langer, Jacob C.; Lorenzo, Armando; Bagli, Darius; Farhat, Walid A.; Papanikolaou, Frank; Koyle, Martin A.
- Abstract
Background: Before 2014, there was a lack of recommendations on managing cryptorchidism, or undescended testis (UDT), from a large pediatric urological or surgical organization. We assessed the variability in management of UDT among pediatric urologists and pediatric surgeons at a single tertiary pediatric referral centre before publication of major guidelines. Methods: We performed a retrospective review of the electronic records of patients who underwent primary unilateral or bilateral orchidopexy at our centre between January 2012 and January 2014. Results: A total of 488 patients (616 testes) were identified, of whom 405 (83.0%) and 83 (17.0%) were managed by pediatric urologists and pediatric surgeons, respectively. There was no difference in baseline characteristics, including age seen in clinic or at surgery, testis location/palpability and availability of preoperative ultrasonograms, of patients seen by the 2 groups. Pediatric surgeons ordered preoperative ultrasonography more often than pediatric urologists (25.3% v. 3.7%, p < 0.001). With palpable UDTs, although both groups used open approaches, pediatric urologists preferred a scrotal approach (56.9%), and pediatric surgeons approached most testes inguinally (98.8%). With nonpalpable UDTs, laparoscopic approaches were preferred by both groups; however, pediatric urologists used a 2-stage Fowler–Stephens approach more often than pediatric surgeons (48.4% v. 15.8%, p < 0.001). Conclusion: There was wide variation in the management of primary UDT between pediatric urologists and pediatric surgeons before the publication of guidelines. The most prominent difference between the 2 groups was in the ordering of preoperative ultrasonography. Future assessment of change in practice patterns may elucidate whether guidelines are an effective tool for standardization of practice.
- Subjects
PEDIATRIC surgeons; UROLOGISTS; CRYPTORCHISM; ORCHIOPEXY; ULTRASONIC imaging; SURGICAL clinics; ELECTRONIC records
- Publication
Canadian Journal of Surgery, 2019, Vol 62, Issue 3, p169
- ISSN
0008-428X
- Publication type
Article
- DOI
10.1503/cjs.014017