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How Effective Was the 2014 AUA Cryptorchidism Guideline? A Multi-institutional Evaluation
Hillary Weiner1, Julie R Solomon2, Robert Thinnes3
1Stanford University, Palo Alto, California.
Insights
The AUA guidelines did not reduce the age of referral or ultrasound use for cryptorchidism (undescended testis) in boys. Delayed referrals and unchanged imaging rates persist, indicating a need for better guideline dissemination.
Area of Science:
- Pediatric Urology
- Surgical Guidelines
- Medical Practice Evaluation
Background:
- The American Urological Association (AUA) published guidelines in 2014 for evaluating cryptorchidism.
- Cryptorchidism, or undescended testis, requires timely evaluation and treatment.
- Adherence to guidelines is crucial for improving patient outcomes.
Purpose of the Study:
- To assess if the 2014 AUA guidelines reduced the age of referral for cryptorchidism.
- To determine if guideline implementation impacted ultrasound utilization in evaluating boys with cryptorchidism.
- To evaluate trends in pediatric urology referral and diagnostic imaging post-guideline publication.
Main Methods:
- Retrospective review of 3,293 boys with cryptorchidism across 4 academic institutions.
- Data collected for periods before (2013) and after (2015, 2019) AUA guideline release.
- Comparison of median age at evaluation/surgery and pre-referral ultrasound rates.
Main Results:
- No significant change in median age at pediatric urology evaluation between 2013 and 2015 (P=.08).
- A significant increase in median evaluation age observed between 2013 and 2019 (P=.03).
- Pre-referral ultrasound utilization remained consistent, with no significant differences across study years (P>.5).
Conclusions:
- The AUA guidelines have not reduced the age of urological evaluation or imaging rates for cryptorchidism.
- Delayed referrals and consistent imaging utilization suggest barriers to guideline adherence.
- Improved dissemination strategies and investigation of adherence barriers are needed to enhance care for boys with undescended testis.
Introduction:
In 2014, the AUA published guidelines regarding the evaluation of cryptorchidism. This multi-institutional study aims to determine if these guidelines reduced the age of referral and the utilization of ultrasound in boys with cryptorchidism. We hypothesize that delayed referral continues, and utilization of ultrasound remains unchanged.
Methods:
A retrospective review of boys referred for the evaluation of cryptorchidism was performed at 4 academic institutions, collecting data for 1 year prior (2013) and 2 nonconsecutive years following guideline creation (2015 and 2019). Across these time frames, we compared median ages at evaluation and surgery, and rates of patient comorbidities, orchiopexy, and preevaluation ultrasound.
Results:
A total of 3,293 patients were included. The median age at initial pediatric urology evaluation in all cohorts was 39 months (IQR: 14-92 months). Following publication of the AUA Guidelines, there was no difference (P = .08) in the median age at first evaluation by a pediatric urologist between 2013 and 2015, and an increase (P = .03) between 2013 and 2019. Overall, 21.2% of patients received an ultrasound evaluation prior to referral, with no significant difference between 2013 and 2015 (P = .9) or 2019 (P = .5) cohorts.
Conclusions:
Our data suggest that, despite publication of the AUA Guidelines on evaluation and treatment of cryptorchidism, there has been no reduction in the age of urological evaluation or the utilization of imaging in boys with undescended testis. Finding alternative avenues to disseminate these evidence-based recommendations to referring providers and exploring barriers to guideline adherence is necessary to improve care for patients with cryptorchidism.
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