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J Pediatr Surg. 2019 Sep;54(9):1820-1824. doi: 10.1016/j.jpedsurg.2018.10.053. Epub 2018 Oct 29.

A Canadian national survey: understanding the differences in management of cryptorchidism among pediatric surgeons and pediatric urologists.

Author information

1
Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: jjk.kim@mail.utoronto.ca.
2
Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Urology, St. Luke's Medical Center, Quezon City, NCR, Philippines.
3
McMaster Children's Hospital and McMaster University, London, Canada.
4
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
5
Departments of Surgery & Pediatrics and Child Health, Children's Hospital, Winnipeg, MB, Canada.
6
Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.

Abstract

BACKGROUND:

This investigation aims to assess the variability in practice patterns regarding management of children with cryptorchidism (UDT) among pediatric urologists (U) and pediatric surgeons (S) practicing in Canada.

METHODS:

All active members of Pediatric Urologists of Canada (PUC) and Canadian Association of Pediatric Surgery (CAPS) were invited to participate in an online multiple-choice type questionnaire with clinical scenarios in management of UDT. Responses were compared between U and S using Fisher's exact test.

RESULTS:

The response rates were 74% and 79% among CAPS members (54/73) and PUC members (27/34) respectively. CAPS members were more likely to order diagnostic ultrasounds prior to surgery (44.4% vs 18.5%, p = 0.027). For palpable testis, most (80%) CAPS members favored the classic inguinal approach, while most PUC members did not demonstrate a clear preference, and were flexible with their approach depending on the position of the palpated testes (55%; p < 0.001). There was no statistically significant difference in preferred approach to unilateral or bilateral nonpalpable testis. However, for both palpable and nonpalpable bilateral UDT, more CAPS members preferred metachronous correction, compared to PUC members who opted to approach them synchronously (p = 0.008, 0.002, respectively).

CONCLUSION:

Preferences with regard to use of diagnostic tools such as US, surgical approach for palpable testes and bilateral UDTs were not consistent between the two surgical specialties who perform orchidopexy across Canada. Both groups were compliant with guideline recommendations, with the exception of utilizing preoperative ultrasounds, which is uniformly not recommended by the most recent guidelines.

LEVEL OF EVIDENCE:

This is a level II evidence study.

KEYWORDS:

Clinical practice guidelines; Cryptorchidism; Pediatric surgery; Pediatric urology; Practice patterns; Undescended testes

PMID:
30528200
DOI:
10.1016/j.jpedsurg.2018.10.053
[Indexed for MEDLINE]

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