How Effective Was the 2014 AUA Cryptorchidism Guideline? A Multi-institutional Evaluation. Urol Pract 2023 Nov;10(6):605-610
Date
07/27/2023Pubmed ID
37498314DOI
10.1097/UPJ.0000000000000437Scopus ID
2-s2.0-85180266830 (requires institutional sign-in at Scopus site)Abstract
INTRODUCTION: In 2014, the AUA published guidelines regarding the evaluation of cryptorchidism. This multi-institutional study aims to determine if these guidelines reduced the age of referral and the utilization of ultrasound in boys with cryptorchidism. We hypothesize that delayed referral continues, and utilization of ultrasound remains unchanged.
METHODS: A retrospective review of boys referred for the evaluation of cryptorchidism was performed at 4 academic institutions, collecting data for 1 year prior (2013) and 2 nonconsecutive years following guideline creation (2015 and 2019). Across these time frames, we compared median ages at evaluation and surgery, and rates of patient comorbidities, orchiopexy, and preevaluation ultrasound.
RESULTS: A total of 3,293 patients were included. The median age at initial pediatric urology evaluation in all cohorts was 39 months (IQR: 14-92 months). Following publication of the AUA Guidelines, there was no difference (P = .08) in the median age at first evaluation by a pediatric urologist between 2013 and 2015, and an increase (P = .03) between 2013 and 2019. Overall, 21.2% of patients received an ultrasound evaluation prior to referral, with no significant difference between 2013 and 2015 (P = .9) or 2019 (P = .5) cohorts.
CONCLUSIONS: Our data suggest that, despite publication of the AUA Guidelines on evaluation and treatment of cryptorchidism, there has been no reduction in the age of urological evaluation or the utilization of imaging in boys with undescended testis. Finding alternative avenues to disseminate these evidence-based recommendations to referring providers and exploring barriers to guideline adherence is necessary to improve care for patients with cryptorchidism.
Author List
Weiner H, Solomon JR, Thinnes R, Pinsky B, Ferreri C, Singleterry M, Bahamonde A, Awadh S, Tran J, Paradis AG, Vetter J, Brooks A, Lund S, Kuwaya D, Juhr D, Wendt L, Eyck PT, Traxel E, Kraft KH, Ellison JS, Storm DWAuthor
Jonathan Scott Ellison MD Associate Professor in the Urologic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
ChildChild, Preschool
Cryptorchidism
Humans
Infant
Male
Orchiopexy
Referral and Consultation
Retrospective Studies
Ultrasonography
