Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Urology, University of Minnesota, Minneapolis, MN, USA.
J Pediatr Urol. 2021 Oct;17(5):736.e1-736.e6. doi: 10.1016/j.jpurol.2021.06.017. Epub 2021 Aug 12.
Cryptorchidism, or undescended testis (UDT), is identified in 1% of boys by one year of age and carries long term risks of infertility and testicular neoplasia. In 2014, the American Urological Association (AUA) released a guideline statement stating that patients with UDT should be referred to a urologist by 6 months of age in order to facilitate timely surgical correction. This study is the follow-up to a 2010 study assessing referral patterns to our university center from primary care providers.
In this new study, we aim to identify changes in referral patterns in response to the establishment of the 2014 AUA guidelines and to understand how our referring physicians stay abreast of current knowledge regarding UDT.
A 9 question anonymous survey regarding UDT referral patterns was sent to providers who had previously referred a patient to our pediatric urology practice. The results were categorized by specialty and were compared to the similar survey from 2010.
Surveys were sent to 500 physicians with 138 (27.6%) responses received. Less than half of respondents reported that they would refer a boy with unilateral or bilateral palpable UDT by 6 months of age (37.0% and 38.4% respectively). This was not significantly different than the 2010 survey (p = 0.68 and 0.27 respectively). Two-thirds of physicians would refer a patient with unilateral nonpalpable UDT within the recommended time frame (68.8%); this was also unchanged from 2010 (p = 0.87). There was an improvement in respondents who would refer immediately for bilateral nonpalpable testes from 49.8% in 2010 to 53.6% in 2017 (p = 0.01). Residency training was most commonly cited as the primary source of knowledge regarding UDT although 89.3% of respondents citing this were >5 years removed from residency training.
Delayed referral patterns were reported by the majority of providers for palpable UDT and by greater than one-third of providers for nonpalpable UDT. There was minimal change in referral patterns between 2010 and 2017 despite the release of the AUA cryptorchidism guidelines in 2014. In both 2010 and 2017, residency training was identified as the primary source of knowledge regarding management of UDT.
These findings suggest an unmet need for education regarding contemporary management of UDT for the primary care physicians in our community.
隐睾症（UDT）在一岁时可在 1%的男童中被发现，其具有导致不孕和睾丸肿瘤的长期风险。2014 年，美国泌尿外科学会（AUA）发布了一份指南声明，指出 UDT 患者应在 6 个月大时转介给泌尿科医生，以便及时进行手术矫正。本研究是对 2010 年评估初级保健提供者向我们大学中心转诊模式的一项研究的后续研究。
在这项新的研究中，我们旨在确定对 2014 年 AUA 指南的建立的回应中转诊模式的变化，并了解我们的转诊医生如何了解 UDT 的最新知识。
向之前曾将患者转介至我们小儿泌尿科的医生发送了一份关于 UDT 转诊模式的 9 个问题的匿名调查。结果按专业进行分类，并与 2010 年的类似调查进行了比较。
向 500 名医生发送了调查，收到了 138 份（27.6%）回复。不到一半的受访者表示他们会在 6 个月大时将单侧或双侧可触及的 UDT 男孩转介（分别为 37.0%和 38.4%）。这与 2010 年的调查结果没有显著差异（p=0.68 和 0.27 分别）。三分之二的医生会在推荐的时间范围内将单侧不可触及的 UDT 患者转介（68.8%）；这与 2010 年的结果相同（p=0.87）。从 2010 年的 49.8%到 2017 年的 53.6%，会立即为双侧不可触及的睾丸转介的受访者有所增加（p=0.01）。尽管 2014 年发布了 AUA 隐睾症指南，但 residency training 仍是大多数医生表示他们了解 UDT 的主要来源，尽管有 89.3%的受访者表示这是在他们完成 residency training 5 年以上的时间。
大多数医生报告说对于可触及的 UDT 存在延迟转诊模式，而对于不可触及的 UDT，有超过三分之一的医生存在延迟转诊模式。尽管 2014 年发布了 AUA 隐睾症指南，但 2010 年和 2017 年之间的转诊模式几乎没有变化。在 2010 年和 2017 年，residency training 都被确定为了解 UDT 管理的主要知识来源。
这些发现表明，我们社区的初级保健医生在当代 UDT 管理方面存在未满足的教育需求。
