Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
J Pediatr Urol. 2023 Oct;19(5):521.e1-521.e7. doi: 10.1016/j.jpurol.2023.03.025. Epub 2023 Mar 28.
Patients with penile conditions comprise a significant proportion of any pediatric urology practice, and physical examination is the mainstay of diagnosis for such conditions. While the rapid adoption of telemedicine (TM) facilitated access to pediatric urology care during the pandemic, the accuracy of TM-based diagnosis for pediatric penile anatomy and pathology has not been studied. Our aim was to characterize the diagnostic accuracy of TM-based evaluation of pediatric penile conditions by comparing diagnosis during the initial virtual visit (VV) with a subsequent in-person visit (IPV). We also sought to assess the agreement between scheduled and actual surgical procedure performed.
A single-institution prospective database of male patients less than 21 years of age who presented for evaluation of penile conditions between August 2020 and December 2021 was analyzed. Patients were included if they had an IPV with the same pediatric urologist within 12 months of the initial VV. Diagnostic concordance was based on a surgeon-reported survey of specific penile diagnoses, completed at both initial VV and follow-up IPV. Surgical concordance was assessed based on the proposed versus billed CPT code(s).
Median age among 158 patients was 10.6 months. The most frequent VV diagnoses were penile adhesions (n = 37), phimosis (n = 26), "other" (n = 24), post-circumcision redundancy (n = 18), and buried penis (n = 14). Initial VV and subsequent IPV diagnoses were concordant in 40.5% (64/158); 40/158 (25%) had partial concordance (at least one diagnosis matched). There was no difference in age, race, ethnicity, median time between visits, or device type between patients with concordant vs. discordant diagnoses. Of 102 patients who underwent surgery, 44 had VV only while 58 had IPV prior to surgery. Concordance of scheduled versus actual penile surgery was 90.9% in those patients who only had a VV prior to surgery. Overall, surgery concordance was lower among those with hypospadias repairs vs. non-hypospadias surgery (79.4% vs. 92.6%, p = 0.05).
Among pediatric patients being evaluated by TM for penile conditions, there was poor agreement between VV-based and IPV-based diagnoses. However, besides hypospadias repairs, agreement between planned and actual surgical procedures performed was high, suggesting that TM-based assessment is generally adequate for surgical planning in this population. These findings leave open the possibility that, among patients not scheduled for surgery or IPV, certain conditions might be misdiagnosed or missed entirely.
患有阴茎疾病的患者在任何小儿泌尿科实践中都占很大比例，而体格检查是此类疾病诊断的主要依据。虽然远程医疗（TM）的快速采用方便了在大流行期间获得小儿泌尿科护理，但 TM 对小儿阴茎解剖结构和病理学的诊断准确性尚未得到研究。我们的目的是通过比较初始虚拟就诊（VV）期间和随后的门诊就诊（IPV）期间的诊断，来描述 TM 评估小儿阴茎疾病的诊断准确性。我们还评估了计划手术与实际手术之间的一致性。
分析了 2020 年 8 月至 2021 年 12 月期间因阴茎疾病就诊的年龄小于 21 岁的男性患者的单机构前瞻性数据库。如果患者在初始 VV 后 12 个月内与同一位小儿泌尿科医生进行了 IPV，则将其纳入研究。诊断一致性基于在初始 VV 和随访 IPV 时由外科医生报告的特定阴茎诊断的调查。根据提议的和计费的 CPT 代码评估手术一致性。
158 例患者的中位年龄为 10.6 个月。最常见的 VV 诊断是阴茎粘连（n=37）、包茎（n=26）、“其他”（n=24）、包皮环切术后冗余（n=18）和埋藏阴茎（n=14）。初始 VV 和后续 IPV 诊断在 40.5%（64/158）的患者中是一致的；40/158（25%）的患者存在部分一致性（至少有一个诊断相符）。在具有一致和不一致诊断的患者之间，年龄、种族、民族、就诊时间中位数或设备类型没有差异。在 102 例接受手术的患者中，44 例仅接受了 VV，而 58 例在手术前接受了 IPV。仅接受 VV 的患者中，计划手术与实际手术的一致性为 90.9%。总体而言，与非尿道下裂手术相比，尿道下裂修复术的手术一致性较低（79.4%比 92.6%，p=0.05）。
在通过 TM 评估阴茎疾病的小儿患者中，基于 VV 和基于 IPV 的诊断之间存在较差的一致性。但是，除了尿道下裂修复术之外，计划手术与实际手术之间的一致性很高，这表明 TM 评估通常足以用于该人群的手术计划。这些发现表明，在未安排手术或 IPV 的患者中，某些疾病可能会被误诊或完全漏诊。
