Department of Surgery, Children's Mercy, Kansas City, Missouri.
Kansas City University College of Osteopathic Medicine, Kansas City, Missouri.
J Surg Res. 2024 Jul;299:213-216. doi: 10.1016/j.jss.2024.04.024. Epub 2024 May 21.
The American Urological Association guidelines recommend against the performance of ultrasound and other imaging modalities in the evaluation of patients with cryptorchidism before expert consultation. We aimed to examine our institutional experience with cryptorchidism and measure adherence to currently available guidelines.
An institutional review board-approved retrospective review of ultrasound utilization in the evaluation of patients with cryptorchidism was performed from June 1, 2016, to June 30, 2019, at a single tertiary level pediatric hospital.
We identified 1796 patients evaluated in surgical clinics for cryptorchidism. Surgical intervention was performed in 75.2% (n = 1351) of the entire cohort. Ultrasound was performed in 42% (n = 754), most of which were ordered by referring physicians (91% n = 686). Of those who received an ultrasound, surgical intervention was performed in 78% (n = 588). Those 166 patients (22%) who did not undergo surgical intervention were referred with ultrasounds suggesting inguinal testes; however, all had normal physical examinations or mildly retractile testes at the time of consultation and were discharged from the outpatient clinic. There were 597 patients referred without an ultrasound, 81% (n = 483) were confirmed to have cryptorchidism at the time of specialist physical examination and underwent definitive surgical intervention, the remainder (19%, n = 114) were discharged from the outpatient clinics.
Ultrasound evaluation of cryptorchidism continues despite high-quality evidence-based guidelines that recommend otherwise, as they should have little to no bearing on the surgeon's decision to operate or the type of operation. Instead, physical examination findings should guide surgical planning.
美国泌尿外科学会指南建议在专家咨询前，避免对隐睾症患者进行超声和其他影像学检查。我们旨在研究我们在隐睾症方面的机构经验，并衡量对现有指南的遵循程度。
对 2016 年 6 月 1 日至 2019 年 6 月 30 日期间，在一家三级儿科医院的外科诊所中对隐睾症患者进行超声检查的利用情况进行了机构审查委员会批准的回顾性研究。
我们共确定了 1796 名在外科诊所接受隐睾症评估的患者。整个队列中，75.2%（n=1351）的患者进行了手术干预。42%（n=754）的患者进行了超声检查，其中大部分是由转介医生（91%，n=686）开具的。在接受超声检查的患者中，78%（n=588）进行了手术干预。这 166 名（22%）未接受手术干预的患者，超声检查提示腹股沟睾丸；然而，所有患者在就诊时体格检查均正常或睾丸轻度回缩，随后从门诊出院。有 597 名患者未进行超声检查，81%（n=483）在专家体格检查时被确诊为隐睾症，并进行了确定性手术干预，其余（19%，n=114）从门诊出院。
尽管有高质量的循证指南建议避免这种做法，但对隐睾症的超声评估仍在继续，因为这对手术医生的手术决策或手术类型几乎没有影响。相反，体格检查结果应指导手术计划。
