Factors associated with delay in undescended testis referral

D. D. Jiang, A. M. Acevedo, A. Bayne, J. C. Austin, Casey Seideman

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Undescended testis (UDT) is one of the most common congenital disorders and is associated with infertility and testicular cancer. Multiple guidelines internationally have recommended orchiopexy by 18 months. Multiple large retrospective studies published in the last decade have found persistent delay in timing of orchiopexy. Objective: The aim of the study was to determine timing at which UDTs are referred at the tertiary pediatric hospital and assess factors that are associated with delay in UDT referral. Study design: Based on clinical observations and previous data, a series of clinical and socio-economic variables were constructed to design a prospective database. All patients who underwent orchiopexy for UDT from March 1, 2017, to August 31, 2018, were reviewed for demographic and clinical data. Referral appointments after 18 months were considered delayed. Factors associated with delay in UDT referral were analyzed using univariate and multivariate analysis with logistic regression. Results: One hundred seventy-eight patients underwent orchiopexy for UDT. The median age was 44 months, and 64% of them had delay in referral. On univariate analysis, normal birth testicular examination, diagnosis of ‘retractile testicle,’ long gap without seeing pediatrician, diagnosis by a new physician, and primary language non-English were associated with delayed UDT referral. On multivariate analysis, delayed referral was associated with normal testicular examination at birth, history of ‘retractile testis,’ diagnosis not by the regular primary care provider, and other health or social issues that may have led to delay. Discussion: This is the first prospective study analyzing timing of referral for boys with cryptorchidism. It was found that timing of treatment of UDT with orchiopexy has not improved over the last decade. Major causes in delay in referral may be due to poor of education of families and lack of routine testicular examinations by referring providers. Secondary ascent may account a significant number of delayed orchiopexy cases. Conclusion: Most patients at Doernbecher had delayed referral of cryptorchidism. Factors associated with delay were determined. To improve treatment of cryptorchidism, quality-based interventions and the importance of education and routine testicular examinations need to be focused on.[Figure presented]

Original languageEnglish (US)
JournalJournal of Pediatric Urology
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Cryptorchidism
Orchiopexy
Referral and Consultation
Testis
Multivariate Analysis
Education
Congenital, Hereditary, and Neonatal Diseases and Abnormalities
Reproductive History
Pediatric Hospitals
Testicular Neoplasms
Tertiary Care Centers
Infertility
Primary Health Care
Appointments and Schedules
Language
Retrospective Studies
Logistic Models
Economics
Demography
Parturition

Keywords

  • Cryptorchidism
  • Delay in referral
  • Timing
  • Undescended testis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

Cite this

Factors associated with delay in undescended testis referral. / Jiang, D. D.; Acevedo, A. M.; Bayne, A.; Austin, J. C.; Seideman, Casey.

In: Journal of Pediatric Urology, 01.01.2019.

Research output: Contribution to journalArticle

Jiang, D. D. ; Acevedo, A. M. ; Bayne, A. ; Austin, J. C. ; Seideman, Casey. / Factors associated with delay in undescended testis referral. In: Journal of Pediatric Urology. 2019.
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AB - Introduction: Undescended testis (UDT) is one of the most common congenital disorders and is associated with infertility and testicular cancer. Multiple guidelines internationally have recommended orchiopexy by 18 months. Multiple large retrospective studies published in the last decade have found persistent delay in timing of orchiopexy. Objective: The aim of the study was to determine timing at which UDTs are referred at the tertiary pediatric hospital and assess factors that are associated with delay in UDT referral. Study design: Based on clinical observations and previous data, a series of clinical and socio-economic variables were constructed to design a prospective database. All patients who underwent orchiopexy for UDT from March 1, 2017, to August 31, 2018, were reviewed for demographic and clinical data. Referral appointments after 18 months were considered delayed. Factors associated with delay in UDT referral were analyzed using univariate and multivariate analysis with logistic regression. Results: One hundred seventy-eight patients underwent orchiopexy for UDT. The median age was 44 months, and 64% of them had delay in referral. On univariate analysis, normal birth testicular examination, diagnosis of ‘retractile testicle,’ long gap without seeing pediatrician, diagnosis by a new physician, and primary language non-English were associated with delayed UDT referral. On multivariate analysis, delayed referral was associated with normal testicular examination at birth, history of ‘retractile testis,’ diagnosis not by the regular primary care provider, and other health or social issues that may have led to delay. Discussion: This is the first prospective study analyzing timing of referral for boys with cryptorchidism. It was found that timing of treatment of UDT with orchiopexy has not improved over the last decade. Major causes in delay in referral may be due to poor of education of families and lack of routine testicular examinations by referring providers. Secondary ascent may account a significant number of delayed orchiopexy cases. Conclusion: Most patients at Doernbecher had delayed referral of cryptorchidism. Factors associated with delay were determined. To improve treatment of cryptorchidism, quality-based interventions and the importance of education and routine testicular examinations need to be focused on.[Figure presented]

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