Lim Li Yan, Nah Shireen A, Lakshmi Narasimhan K, Yap Te-Lu, Jacobsen Anette S, Low Yee, Ong Caroline C P
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore.
J Paediatr Child Health. 2015 Nov;51(11):1109-14. doi: 10.1111/jpc.12911. Epub 2015 May 4.
Studies report that most boys with undescended testis(UDT) are referred and operated beyond the recommended age of 1 year, possibly due to lack of awareness of treatment guidelines. We investigate the level of knowledge of UDT among potential referring health-care providers.
We devised a survey on the clinical features and appropriate management of UDT. Using convenience sampling, we approached health-care professionals with regular contact with paediatric patients and final year medical students. Respondents were allowed to remain anonymous. They were categorised according to specialty and level of experience/training.
Of 1179 approached, 203 responded. Thirty-six (24%) of 149 qualified doctors had never seen a case of UDT. Median score was 6 (range 1-9). There was no significant difference in scores when comparing specialty. Mean scores decreased significantly in trend according to level of experience. When questioned regarding timings of referral and orchidopexy, 24% of qualified doctors would not refer until 9 months of age, and 66% thought orchidopexy should be done after 1 year old. Half would stop examining for UDT after 2 years old.
Inexperience with UDT and outdated knowledge may contribute to delays in referral for UDT. Many would stop examining for UDT at 2 years old, placing undue reliance on accurate physical examination in early childhood and indicating lack of awareness of the ascending testis. Community health initiatives must emphasise recent changes in guidelines for management of UDT.
研究报告称，大多数隐睾症（UDT）男孩在超过建议的1岁年龄后才被转诊并接受手术，这可能是由于对治疗指南缺乏认识。我们调查了潜在转诊医疗保健提供者对UDT的了解程度。
我们设计了一项关于UDT临床特征和适当管理的调查。采用便利抽样法，我们联系了经常接触儿科患者的医疗保健专业人员和医学专业最后一年的学生。受访者可保持匿名。他们根据专业和经验/培训水平进行分类。
在1179名被调查者中，203人做出了回应。149名合格医生中有36人（24%）从未见过UDT病例。中位数得分为6分（范围为1 - 9分）。比较专业时，得分没有显著差异。根据经验水平，平均得分呈显著下降趋势。当被问及转诊和睾丸固定术的时机时，24%的合格医生直到9个月大才会转诊，66%的医生认为睾丸固定术应在1岁以后进行。一半的人在2岁后会停止对UDT的检查。
对UDT缺乏经验和知识过时可能导致UDT转诊延迟。许多人在2岁时就会停止对UDT的检查，过度依赖幼儿期的准确体格检查，这表明对睾丸上升缺乏认识。社区卫生倡议必须强调UDT管理指南的最新变化。
