Accuracy of Referral for Undescended Testes in Paediatric Patients Referred to Specialist Paediatric Surgical...

Undescended testes (UDT) are a common congenital disorder in boys, yet delays in diagnosis and referral still occur, especially in low-and middle-income countries where access to specialist care may vary. Our study aimed to examine the accuracy and timing of referrals of UDT to paediatric surgical services across different healthcare settings and to evaluate knowledge regarding UDT among paediatric and family medicine trainees.

A prospective cohort study was conducted from January to December 2022 involving patients referred for UDT at three paediatric surgical centres representing urban and rural health-system structures. Diagnostic accuracy was confirmed by paediatric surgeons. Referral beyond 12 months of age was considered delayed. An anonymised survey assessing knowledge of diagnosis and management of UDT was distributed to paediatric and family medicine trainees.

Two hundred and one boys were referred for UDT. Median age at referral was 8 months (1-24), and median age at review was 14 months (6-26). Most referrals were from community clinics (42%), followed by paediatricians (31%), in-hospital (18%), and private general practitioners (GP, 9%). 50% were confirmed UDT. Diagnostic accuracy was significantly related to patient age < 1 year (p = 0.001), unilaterality (p < 0.001), impalpability (p = 0.037), and UDT identified at birth (p = 0.004). Our survey showed that 22% of trainees would refer after 12 months of age and another 12% would refer after obtaining imaging.

Delayed UDT referrals remain and may reflect clinician knowledge gaps and differences in referral pathways across a geographically extensive and heterogeneous healthcare system. Targeted education among referring healthcare professionals and locally tailored referral pathways may improve referral timeliness and accuracy.