Pediatric Urology| Volume 158, P169-173, December 2021

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Referrals for Cryptorchidism: Analyzing for Quality from a Pre-COVID Dataset



      To identify risk factors associated with an inaccurate diagnosis, delayed referral, and/or inappropriate ultrasound in consecutive referrals for an undescended testicle (UDT).


      This study was approved by the institutional review board. Data was prospectively collected for all children referred to University of Oklahoma's pediatric urology service from August 2019 to February 2020. The data was imported into SAS vs 9.4 for analysis. We categorized the “quality” of referral by a point system using 3 factors (no previous ultrasound, ≤18 months, correct location). An optimal referral had an accurate testicular examination, was referred by 18 months of age, and no diagnostic ultrasound.


      We collected 75 referrals. Thirty-nine (52.0%) had confirmed UDT, requiring surgery. Twenty-seven (69.2%) had an accurate initial examination. Forty-one (54.7%) were outside the optimal age. Thirty-four were considered low quality (0-1 qualities) and 41 were high quality (2-3 qualities). Seven (9.3%) were optimal (3/3 qualities). Referrals that needed intervention were statistically more likely to be higher quality.


      Increased quality of UDT referrals directly correlated with the likelihood for treatment. This study reveals a need for more education on UDT referral in the community. By improving referring provider knowledge and skills, we can minimize unnecessary referrals.
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        • Mouriquand PD.
        Undescended testes in children: the paediatric urologist's point of view.
        Eur J Endocrinol. 2008; 159: S83-S86
        • Berkowitz GS
        • Lapinski RH
        • Dolgin SE
        • Gazella JG
        • Bodian CA
        • Holzman IR.
        Prevalence and natural history of cryptorchidism.
        Pediatrics. 1993; 92: 44-49
        • Abdullah NA
        • Pearce MS
        • Parker L
        • Wilkinson JR
        • Jaffray B
        • McNally RJ.
        Birth prevalence of cryptorchidism and hypospadias in northern England, 1993-2000.
        Arch Dis Child. 2007; 92: 576-579
        • Hutson JM
        • Hasthorpe S.
        Testicular descent and cryptorchidism: the state of the art in 2004.
        J Pediatr Surg. 2005; 40: 297-302
        • Hutson JM
        • Terada M
        • Zhou B
        • Williams MP.
        Normal testicular descent and the aetiology of cryptorchidism.
        Adv Anat Embryol Cell Biol. 1996; 132: 1-56
        • Ghirri P
        • Ciulli C
        • Vuerich M
        • et al.
        Incidence at birth and natural history of cryptorchidism: a study of 10,730 consecutive male infants.
        J Endocrinol Invest. 2002; 25: 709-715
        • Yeap E
        • Nataraja RM
        • Pacilli M.
        Undescended testes: what general practitioners need to know.
        Aust J Gen Pract. 2019; 48: 33-36
        • Rohayem J
        • Luberto A
        • Nieschlag E
        • Zitzmann M
        • Kliesch S.
        Delayed treatment of undescended testes may promote hypogonadism and infertility.
        Endocrine. 2017; 55: 914-924
        • Cendron M
        • Keating MA
        • Huff DS
        • Koop CE
        • Snyder 3rd, HM
        • Duckett JW
        Cryptorchidism, orchiopexy and infertility: a critical long-term retrospective analysis.
        J Urol. 1989; 142 (discussion 572): 559-562
        • Pettersson A
        • Richiardi L
        • Nordenskjold A
        • Kaijser M
        • Akre O.
        Age at surgery for undescended testis and risk of testicular cancer.
        N Engl J Med. 2007; 356: 1835-1841
        • Wood HM
        • Elder JS.
        Cryptorchidism and testicular cancer: separating fact from fiction.
        J Urol. 2009; 181: 452-461
        • Radmayr C.
        Management of undescended testes: European Association of Urology/European Society for Paediatric Urology guidelines.
        J Pediatr Urol. 2017; 13: 550
        • Kolon TF
        • Herndon CD
        • Baker LA
        • et al.
        Evaluation and treatment of cryptorchidism: AUA guideline.
        J Urol. 2014; 192: 337-345
        • Tasian G.
        Ultrasound: a poor diagnostic test for cryptorchidism.
        Can Urol Assoc J. 2015; 9: 391
        • Hartigan S
        • Tasian GE.
        Unnecessary diagnostic imaging: a review of the literature on preoperative imaging for boys with undescended testes.
        Transl Androl Urol. 2014; 3: 359-364
        • Bayne AP
        • Alonzo DG
        • Hsieh MH
        • Roth DR.
        Impact of anatomical and socioeconomic factors on timing of urological consultation for boys with cryptorchidism.
        J Urol. 2011; 186: 1601-1605
        • Kokorowski PJ
        • Routh JC
        • Graham DA
        • Nelson CP.
        Variations in timing of surgery among boys who underwent orchidopexy for cryptorchidism.
        Pediatrics. 2010; 126: e576-e582
        • Jiang DD
        • Acevedo AM
        • Bayne A
        • Austin JC
        • Seideman CA.
        Factors associated with delay in undescended testis referral.
        J Pediatr Urol. 2019; 15 (380 e1-380 e6)
        • Bajaj M
        • Upadhyay V.
        Age at referral for undescended testes: has anything changed in a decade?.
        N Z Med J. 2017; 130: 45-49
        • Shields LBE
        • White JT
        • Peppas DS
        • Rosenberg E.
        Scrotal ultrasound is not routinely indicated in the management of cryptorchidism, retractile testes, and hydrocele in children.
        Glob Pediatr Health. 2019; 6 (2333794X19890772)