Educational survey of regional general practitioner's management of paediatric patients with undescended testis

Cho, Alexander; Ball, Martin J.; Read, Katherine; Tharmapoopathy, Pavithira; Ross, Andrew R.; Mathur, Azad; Minocha, Ashish; Tsang, Thomas; Kulkarni, Milind

doi:10.1016/j.jpurol.2015.11.010

Cited by 11 publications

(13 citation statements)

References 16 publications

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“…For one-stage mid-penile/proximal hypospadias repair, the trend of Qmax change by time showed that proximal TIP remained steady low in the first 36 months then a significant increase in the Qmax values was found, while Onlay showed significant increase in the Qmax after 2 years and afterward (Figure 2B). These findings were comparable in some points with a recent study carried out on 25 TIP cases, 18 Onlay cases, and nine Duckett cases for proximal hypospadias 1. In that study, at 12 years postoperative follow-up, the authors found median Qmax values of 18.5, 13.8, and 16.6 mL/s for proximal TIP, Onlay, and Duckett, respectively.…”

Section: Discussionsupporting

confidence: 82%

“…In that study, at 12 years postoperative follow-up, the authors found median Qmax values of 18.5, 13.8, and 16.6 mL/s for proximal TIP, Onlay, and Duckett, respectively. Obstructive pattern (Qmax <5th percentile) was higher in TIP than Onlay (84.6% vs 31.8%, p < 0.01) in the early follow-up that disappeared with age >13 years old, where 80–100% of cases were >5th percentile 1. In the present study, we did not notice this improvement with the five Duckett cases.…”

Section: Discussioncontrasting

confidence: 70%

“…The urinary functional outcome is of great importance as a long-term outcome. Modern tactics in hypospadias repair encompass an increasing interest in the evaluation of urethral function after repair 1. As urinary flow measurements reflect both urethral and bladder functions, if we consider that most patients with hypospadias have normal bladder contractility, the findings in urinary flow rates as well as the shape of the flow curve might reflect urethral function 2.…”

Section: Introductionmentioning

confidence: 99%

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<p>Chronological Changes In Uroflowmetry After Hypospadias Repair: An Observational Study</p>

Al-Adl

Omar

Mohey

et al. 2019

RRU

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AimUrinary flow after urethroplasty is of paramount importance. The aim of this study is to evaluate the progression of uroflowmetry (UF) parameters after different distal and proximal hypospadias repair techniques.MethodsIn this cohort study, cases that underwent primary hypospadias repair at our institution between March 2010 and December 2018 were included when uncomplicated, asymptomatic and toilet-trained. UF findings and post void residual were described after each specific technique.ResultsIn all, 88 patients were eligible. Time to last UF ranged from 35 to 138 months postoperatively. Significant increase started 36 months after distal tubularized incised plate urethroplasty (TIP) and afterwards than Mathieu technique. While was noticed 24 and 36 months after Onlay technique and proximal TIP, respectively; however, TIP showed steady significant increase atall time intervals. Duckett repair exhibited insignificant change in maximum flow rate (Qmax) values, buccal mucosal graft (BMG) and inner preputial graft (IPG), significant increase in the Qmax values after 6 and 24 months, respectively, then remained steady high. Transposed preputial flap (TPF) showed significant increase at 6–12 months only, then remained steady lower than the other two techniques. Obstructed flow was 37% after distal TIP, 30% after Mathieu, 25% after proximal TIP, 66.7% after Duckett repair, and 33.3% after TPF. There were no obstructed cases after BMG and IPG.DiscussionImprovement by time varied between techniques. After repair most cases are below the 50th percentile, implying that the reconstructed urethra is not functioning as a normal urethra. Staged repair for proximal hypospadias is preferable to a heroic one-stage procedure.ConclusionChoice of the surgical technique for hypospadias repair had impact on the improvement of Qmax values. TIP improved 36 months postoperatively. However, for proximal cases staged graft repair had earlier improvement and higher Qmax values than proximal TIP and Onlay techniques.

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Section: Discussionsupporting

confidence: 82%

Section: Discussioncontrasting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

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<p>Chronological Changes In Uroflowmetry After Hypospadias Repair: An Observational Study</p>

Al-Adl

Omar

Mohey

et al. 2019

RRU

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“…Current urologic guidelines recommend that all boys with cryptorchidism without spontaneous testicular descent by 6 months of age be referred to an appropriate specialist for evaluation, with surgical intervention performed by 18 months [1]. However, despite these recommendations, contemporary data suggests that there is delay in diagnosis and treatment in many patients [9][10][11][12]. Williams et al found that 48% of patients had repair at a median age of 4 years and 64% underwent orchiopexy after age 2 years [13].…”

Section: Shortcomings In Current Management Of Undescended Testesmentioning

confidence: 99%

A practical guide to cryptorchidism for the primary care physician

Lovin¹,

Khater²,

Mata³

2019

fmpcr

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Cryptorchidism, also known as undescended testis, affects 3-5% of full term male infants at birth and 23% of preterm or low birth weight infants. Current guidelines recommend that all boys with cryptorchidism without testicular descent by 6 months of age be referred to an appropriate specialist for evaluation, with surgery preferably performed by 18 months. We aim to examine areas of controversy still being debated by reviewing published articles, in order to provide primary providers with a practical guide to diagnosis and management of the undescended testis. Our review examined published articles from 2000 to 2018, related to undescended testes, and their management. 32 articles were reviewed from 2000 to 2018 and showed with a high level of evidence that failure of testicular descent by 6 months of age (gestational) should prompt referral to an appropriate specialist. Physical exam is crucial. The main concerns for patients with cryptorchidism are the increased risk of testicular cancer and sub fertility. Routine use of scrotal ultrasound is not recommended in the evaluation of cryptorchidism. Diagnostic laparoscopy serves to confirm the presence of an intra-abdominal testicle. Surgical intervention within 18 months of age is imperative. Cryptorchidism should be corrected surgically between 6 months and 18 months of age. Early detection with diagnostic laparoscopy is the standard of care for treatment of palpable, undescended testis.

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“…Tracking of the age of orchidopexy revealed a statistically significant downward trend after this intervention was instituted 11 . Similarly, a 2016 study carried out in England implemented an educational survey to 144 general practitioners, which provided them with current recommendations for the optimal time of referral and treatment for boys with UDT 14 . The authors observed that the average age of referral improved significantly after educational intervention, decreasing from 2.8 years in 2010 to 1.25 years in 2013.…”

mentioning

confidence: 99%

Barriers to implementation of guidelines for the diagnosis and management of undescended testis

Smith

Nguyen

2019

F1000Res

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Cryptorchidism or undescended testis (UDT) is one of the most common genital disorders identified at birth. The gold standard for treatment in the US is to surgically bring the UDT into the scrotal sac. In 2014, the American Urologic Association (AUA) presented a guideline for evaluation and treatment of cryptorchidism. We reviewed some of the most recent domestic and international studies examining the results of implementing the AUA and similar guidelines for the diagnosis and management of UDT. In addition, we reviewed some of the more common barriers to the implementation of the AUA guidelines and offered recommendations on how to increase the rate of early detection of UDT, thereby increasing the rate of surgical correction at the appropriate age.

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Educational survey of regional general practitioner's management of paediatric patients with undescended testis

Cited by 11 publications

References 16 publications

<p>Chronological Changes In Uroflowmetry After Hypospadias Repair: An Observational Study</p>

<p>Chronological Changes In Uroflowmetry After Hypospadias Repair: An Observational Study</p>

A practical guide to cryptorchidism for the primary care physician

Barriers to implementation of guidelines for the diagnosis and management of undescended testis

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