Can J Surg 2019 Mar 22;62(3):1-6. Epub 2019 Mar 22.
From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Kim, Lee); the Division of Urology, The Hospital for Sick Children, Toronto, Ont. (Kim, Chua, Ming, Lee, Kesavan, Kahn, Lorenzo, Bagli, Farhat, Papanikolaou, Koyle); the School of Medicine, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland (Kesavan); the Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ont., (Langer); and the Department of Surgery, University of Toronto, Toronto, Ont. (Langer, Lorenzo, Bagli, Farhat, Papanikolaou, Koyle).
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.