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(A) Hydrocele marked by a fluctuant painless scrotal swelling. (B) Transillumination reveals a fluid-filled scrotum.
Source publication
Cryptorchidism, or undescended testes, is the most common congenital genitourinary anomaly. A failure or delay of treatment may result in reduced fertility or an increased risk of testicular cancer. The American Urological Association (AUA) recommends that a scrotal ultrasound (SUS) not be performed in the preoperative management of cryptorchidism....
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Citations
... 18 In a survey of 246 paediatricians, reasons for facilitating such imaging included the belief that ultrasound could identify nonpalpable testes and to reassure parents. 19 It is therefore important to note the considerable stress described by some parents who presented to our clinic following outpatient ultrasound. ...
Aim
Evidence‐based guidelines do not recommend imaging in cryptorchidism, but anecdotally most referrals include an ultrasound report. We aimed to assess the frequency, utility and burden of imaging in children referred with presumptive disorders of testicular descent, and to assess trends over a 7‐year period before and after local and international guidelines have been introduced.
Methods
This was a prospective cohort study of children referred to the Queensland Children's Hospital for anomalies of testicular descent between 2015–2017 and 2023–2024. Data were collected regarding demographics, referral details, imaging performed and surgical diagnosis.
Results
A total of 268 children were recruited. Ultrasound frequency has not significantly changed over time (72.8%, 2015–2017; 63.6% 2023–2024; P = 0.11). Currently, 17.6% of families are charged, and 31.9% need to take time off work, for the ultrasound. This is a significant increase from the 2015–2017 cohort. Parents report concern and anxiety, and find it traumatic for their child. Following review, the majority (65.7%) had physiologically normal testes, while 4.9% and 22.4% were diagnosed with bilateral or unilateral cryptorchidism, respectively, and 7.0% had other diagnoses. Ultrasound was concordant with the surgical diagnosis in 25.0% (2015–2017) and 30.7% (2023–2024). Ultrasound did not contribute to diagnosis nor management in any patient.
Conclusions
Despite international and local guidelines, cryptorchid children continue to undergo ultrasound prior to referral. Such ultrasounds do not provide utility, or value for cost. We recommend avoiding their routine use for suspicion of testicular maldescent and working together to improve strategies for translating evidence‐based guidelines into clinical practice.
... When a primary care provider orders imaging, it often does not contribute to decision-making, is not cost-effective, and the results are frequently inconsistent with the physical examination findings by the pediatric surgeon or urologist. This step in management increases the time to referral and delays definitive surgery [7][8][9][10]13,18,20,21,26,31,32]. A Canadian database study in 2017 determined that before evaluation by a pediatric surgeon or urologist, ultrasound (US) was used in 33.5% of provincial referrals and 50% of institutional referrals [19]. ...
Purpose
: Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children.
Methods
: A comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020.
Results
: A total of 825 articles were identified in the initial search, and 260 were included in the final review.
Conclusions
: Pre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.
... [12,13] The use of ultrasound for UDT diagnosis and hormone therapy is against current recommendations and leads to unnecessary postponement. [14,15] We found that about half of our participants reported a lack of physical examination during their routine scheduled immunization visit. Despite any potential recall bias, this percentage is high and excludes the 33% who were not sure if their child had been examined or not. ...
Background
The early detection of undescended testis is the key to minimizing infertility and malignancy risks associated with this condition. Thorough routine physical examination during scheduled visits for vaccines during the first year of a child's life can lead to early detection and referral to a surgeon for evaluation and surgical intervention in a timely manner. We aimed to investigate the role of physical examinations in primary health care for the discovery of undescended testis.
Methods
Anonymous structured interviews were conducted in the waiting areas of a hospital and primary health-care center. Parents were asked about their perceptions of undescended testis and their experience during primary health-care visits for routine vaccinations. A descriptive analysis was carried out, and the percentage of boys who underwent genital examinations in a primary health-care setting was determined.
Results
We interviewed a total of 352 parents, most of whom did not have a child with undescended testis ( n = 322, 91%). Only 25 (7%) reported that a formal clinical genital examination was done at every primary health-care visit, whereas 50 (14%) indicated that their boy had been examined only once among their many vaccination visits. However, 160 (46%) parents stated that their primary health-care provider did not examine their boys' genitalia during any of these visits.
Conclusion
Late detection of undescended testis could result from failure to adhere to the recommended genital clinical examinations of boys during immunization visits for infants among primary health-care providers.
Introduction: Hydrocele defined by collection of fluid around the testicle between testicle & tunica vaginalis. Its common in children & adults, many peoples may affect by this disease every year. Its occur approximately at ratio of 1:10 in children’s after birth. Untreated cases should result to infertility, orchitis, epididymitis and finally testicles atrophy. Incidental averages are different from 6% to 30% by human kinds. All of male persons from birth to dying may affect by hydrocele. Method: this is a prospective and descriptive study which data collected by inspection, evaluation & assessment of patients who were examined and become bedded in Balkh regional hospital mazar e Sharif during 1st 3 months of 1402 year. The all collected data analyzed by specific statistical method (SPSS). Aim: occurrences of hydrocele according to age & sex during 1st 3month of 1402 year. Results: this study was performed over 1496 patients who come to Balkh regional hospital and bedded. From bedded patients, 893 case were males and remaining 601 case were females. 156 patients (17.5%) of bedded male had hydrocele and remaining 737 case (82.5%) were bedded during other diseases. From 156 hydrocele cases; 76 case (48.7%) seen in adults and other 80 case (51.3%) were children (ratio 100:95). Among 76 bedded adult patients who had hydrocele, 22cases were operated successfully and others treated none operatively by various reasons. Among 80 cases of children who had hydrocele, 35 patients operated & other treated none operatively. Hydrocele consist 8.9% of male bedded patient and include 0.9% of all referral patients in Balkh regional hospital Mazar e Sharif during 1st 3month of 1402 year. Otherwise, from male bedded patients, hydrocele include 17.5% that 8.5% were adult and 8.9% were children. 28.9% of adult patients were operated & 71.1% treated none operatively (the ratio 1:2.5). 43.7% of children that had hydrocele operated successfully & remaining 56.3% were not operating (ratio were 1:1.3). the right sided hydrocele was more seen in group of 6-10 year (14 case /40%), and lowest were 11-15 aging group (10 case of 35 case). Conclusion: Hydrocele is a disease which commonly seen in children and adults. It can affect individuals in any age. Hydrocele more commonly seen (16.3%) in 11 year of age and then in 3 and 8 age also common. Occurrences are approximately same in children and adults. Right sided hydrocele is funded 2 time more than left sided hydrocele. 69% of 35 cases were seen within inguinal hernia.
Aim:
Scrotal ultrasounds are utilised in some primary care settings for suspected cryptorchidism, despite inaccuracies. We aim to identify the correlation between ultrasound and primary care provider (PCP) findings of undescended testicles (UDTs) as a potential source of confirmation bias.
Methods:
Males referred for suspected UDT by PCPs who underwent scrotal ultrasound and paediatric urologist examination from 2014 to 2019 were included. Correlation between PCP and ultrasound findings and diagnostic accuracy were evaluated. Logistic regression was utilised to determine associations between patient factors and UDT misdiagnosis.
Results:
Out of 145 testes, ultrasound corroborated PCPs' UDT diagnoses 87.6% of the time, 49.6% of which were confirmed as UDT by paediatric urologists. Ultrasound had a false positivity rate of 81.0% and specificity of 19.0%. Ultrasound versus paediatric urologist findings regarding testicle location were significantly different (P < 0.0001). Patients aged ≥8 years old had 5.2 times greater odds of being misdiagnosed with UDT than patients <8 years old (95% confidence interval: 1.6-16.7; P < 0.002) by PCP and ultrasound.
Conclusion:
Scrotal ultrasound highly corroborated PCPs' UDT diagnoses. Older patients were more likely to be misdiagnosed with UDT by PCP and ultrasound. As ultrasounds rarely refute PCP examinations for suspected UDTs and are highly inaccurate, confirmation bias may explain the use of ultrasound in the workup of UDT.
Examination of the scrotum is an essential skill for emergency, surgical and general practice (GP) clinicians. However, the examination poses a number of challenges due to its intimate nature and wide range of potential pathologies, resulting in many UK trainees feeling uncomfortable and underconfident in this skill. This article aims to address this issue by training clinicians in a stepwise, structured approach.
Objective
To identify risk factors associated with an inaccurate diagnosis, delayed referral, and/or inappropriate ultrasound in consecutive referrals for an undescended testicle.
Methods
This study was approved by the institutional IRB. 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 exam, was referred by 18 months of age, and no diagnostic ultrasound.
Results
We collected 75 referrals. 39 (52.0 %) had confirmed UDT, requiring surgery. 27 (69.2 %) had an accurate initial exam. 41 (54.7 %) were outside the optimal age. 34 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.
Conclusion
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.
