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Management of undescended testis may be improved with educational updates for referring providers
H Aggarwal1, A Rehfuss1, J G Hollowell1
1Division of Urology, Albany Medical College and the Urological Institute of Northeastern New York, 23 Hackett Blvd, Albany, NY 12208, USA.
Insights
Optimal management of undescended testis (UDT) is often delayed. Educational updates for referring providers significantly reduced unnecessary ultrasounds (US) for boys with UDT, improving care.
Area of Science:
- Pediatric Urology
- Andrology
- Medical Education
Background:
- Many boys with undescended testis (UDT) are referred late, often after one year of age.
- Suboptimal management includes delayed consultations and frequent, unnecessary ultrasounds (US).
- Identifying and addressing these issues is crucial for timely and effective UDT treatment.
Purpose of the Study:
- To quantify the extent of delayed referrals and unnecessary US for UDT in a specific region.
- To evaluate the impact of educational interventions for referring providers (RPs) on US utilization.
Main Methods:
- Retrospective chart review of 363 new UDT referrals between January 2010 and June 2012.
- Data collected included patient age at consultation, prior US performance by RPs, and diagnosis (UDT vs. retractile testis).
- Educational updates were provided to RPs, and US rates were monitored throughout the study period.
Main Results:
- Only 17% of boys were seen before one year of age; 62% had a retractile testis, not true UDT.
- Ultrasound (US) was performed in 24% of cases prior to the pediatric urology visit.
- A statistically significant reduction in unnecessary US was observed following the final educational update (p < 0.01).
Conclusions:
- Delayed urology consultation and excessive use of US for UDT are prevalent issues.
- Targeted educational interventions for referring providers can effectively decrease unnecessary diagnostic imaging.
- Improving referral patterns and diagnostic strategies enhances the management of UDT in pediatric patients.
Objective:
A large proportion of boys referred for undescended testis (UDT) is not managed optimally prior to the referral, with the majority seen at >1 year of age and many having unnecessary ultrasound (US). Our objective was to assess the magnitude of these problems in our area and to determine if unnecessary US decreased following interventions to educate referring providers (RPs).
Materials And Methods:
A chart review was done on new patients referred for UDT from January 2010 to June 2012. Data collection included age on date of pediatric urology office visit, whether or not RPs obtained an US, and whether the pediatric urology examination revealed an UDT or retractile testis. Several educational updates for RPs were provided and the proportion having US was tracked during the study period.
Results:
Of 363 boys referred for UDT, only 17% (62) were seen at <1 year of age, and 62% (227) had retractile testis. US had been obtained in 24% (87/363). There was a statistically significant decrease in the proportion of patients having had an unnecessary US following the last update (p < 0.01).
Conclusions:
Delayed urology consultation and unnecessary US for UDT are common in our area. A brief focused educational update was effective in decreasing US in our area.
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