Current Practice for Cryptorchidism: Survey of Pediatric Urologists

We evaluated current practice patterns in the management and screening of cryptorchidism among pediatric urologists and compared them to the 2014 AUA (American Urological Association) guidelines on cryptorchidism.

A 14-question survey was disseminated to members of the SPU (Society for Pediatric Urology) to assess their current practice patterns.

There were 187 responses (38.4% response rate) with a notable bimodal distribution in respondent practice years, with 39.3% in practice for 10 years or less and 41.4% in practice for more than 20 years. Despite guideline recommendations against the use of ultrasound, the majority of respondents will use it in cases of obesity or bilateral nonpalpable testes (greater than 50%). In the evaluation for bilateral nonpalpable testes most respondents (greater than 80%) perform an endocrine workup. Nevertheless, 55.1% will proceed with surgical exploration even if the workup indicates absence of testicular tissue. Subgroup analysis revealed those in practice for 10 years or less vs greater than 20 years were more likely to perform 2-stage Fowler-Stephens in cases of short vessels (80.8% vs 58.1%) and to perform transscrotal orchiopexy in cases amenable to that approach (79.5% vs 52%). If examination under anesthesia reveals the testicle in the scrotum, 46.5% still perform orchiopexy, citing concerns the testicle will ascend or parental concerns about the diagnosis.

Based on the responses some discordance exists between practice patterns and guideline recommendations. Although surgery may be avoided with endocrine evaluation for suspected anorchia, many respondents will still perform exploration. The evaluation, management and surgical approach in cryptorchidism may be influenced by years in practice.