Boyd Grace E, Patel Bhaveshkumar, McBride Craig A
Department of Paediatric Surgery, Queensland Children's Hospital, Brisbane, Queensland, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
J Paediatr Child Health. 2024 Dec;60(12):867-873. doi: 10.1111/jpc.16689. Epub 2024 Oct 17.
Evidence-based guidelines do not recommend imaging in cryptorchidism, but anecdotally most referrals include an ultrasound report. We aimed to assess the frequency, utility and burden of imaging in children referred with presumptive disorders of testicular descent, and to assess trends over a 7-year period before and after local and international guidelines have been introduced.
This was a prospective cohort study of children referred to the Queensland Children's Hospital for anomalies of testicular descent between 2015-2017 and 2023-2024. Data were collected regarding demographics, referral details, imaging performed and surgical diagnosis.
A total of 268 children were recruited. Ultrasound frequency has not significantly changed over time (72.8%, 2015-2017; 63.6% 2023-2024; P = 0.11). Currently, 17.6% of families are charged, and 31.9% need to take time off work, for the ultrasound. This is a significant increase from the 2015-2017 cohort. Parents report concern and anxiety, and find it traumatic for their child. Following review, the majority (65.7%) had physiologically normal testes, while 4.9% and 22.4% were diagnosed with bilateral or unilateral cryptorchidism, respectively, and 7.0% had other diagnoses. Ultrasound was concordant with the surgical diagnosis in 25.0% (2015-2017) and 30.7% (2023-2024). Ultrasound did not contribute to diagnosis nor management in any patient.
Despite international and local guidelines, cryptorchid children continue to undergo ultrasound prior to referral. Such ultrasounds do not provide utility, or value for cost. We recommend avoiding their routine use for suspicion of testicular maldescent and working together to improve strategies for translating evidence-based guidelines into clinical practice.
循证指南不建议对隐睾症进行影像学检查，但据传闻，大多数转诊病例都包含超声报告。我们旨在评估因疑似睾丸下降异常而转诊的儿童进行影像学检查的频率、效用和负担，并评估在引入本地和国际指南前后7年期间的变化趋势。
这是一项对2015 - 2017年和2023 - 2024年转诊至昆士兰儿童医院的睾丸下降异常儿童进行的前瞻性队列研究。收集了有关人口统计学、转诊细节、所进行的影像学检查和手术诊断的数据。
共招募了268名儿童。超声检查的频率随时间未发生显著变化（2015 - 2017年为72.8%；2023 - 2024年为63.6%；P = 0.11）。目前，17.6%的家庭需要为超声检查付费，31.9%的家庭需要请假陪同孩子进行超声检查。这一比例较2015 - 2017年队列有显著增加。家长表示担心和焦虑，并认为这对孩子来说是一种创伤。经复查，大多数（65.7%）儿童的睾丸生理上正常，而分别有4.9%和22.4%被诊断为双侧或单侧隐睾症，7.0%有其他诊断结果。超声检查与手术诊断的一致性在2015 - 2017年为25.0%，在2023 - 2024年为30.7%。超声检查对任何患者的诊断和治疗均无帮助。
尽管有国际和本地指南，但隐睾症儿童在转诊前仍继续接受超声检查。此类超声检查并无实际效用，也不具有成本效益。我们建议避免对疑似睾丸下降异常的情况常规使用超声检查，并共同努力改进将循证指南转化为临床实践的策略。
