MP26-02 SPONTANEOUS DESCENT RATE OF CRYPTORCHID TESTES: A PLEA FOR EARLY REFERRAL

Abstract

INTRODUCTION AND OBJECTIVES: Despite a growing body of opposing evidence, ultrasound (US) examinations are still overused by referring physicians for the diagnosis of undescended testes (UDT). To address this preventable misuse of healthcare resources, guideline revisions are underway. However, additional focused educational efforts may be a more effective way of initiating a change in practice. Herein we identify referring physician characteristics as predictor of likelihood of ordering an US for UDT. METHODS: Consecutive referrals for UDT to a tertiary care center between 2007-2011 were evaluated. The Canadian Medical Directory was used to capture information on referring physician specialty (general practitioner/pediatrician/urologist/other specialist), practice type (academic/community), practice location (urban/rural), medical school of graduation (Canadian/International), and years in practice. Physicians were then stratified into groups based on whether US was ordered prior to referral. Logistic regression analyses were used to evaluate correlations between referring physician characteristics, and the likelihood of ordering an US for UDT. RESULTS: 1193 new patients were referred for evaluation, and complete referring physician information was available for 1009 cases. US was ordered in 497 (49.3%) of cases. Logistic regression analysis demonstrated that pediatricians were most likely to order US (p1⁄40.017), compared to pediatric subspecialists and general urologists. Physicians in rural centers were more likely to order US compared to urban (p1⁄40.001, see figure). There was an inverse relationship between the odds of ordering an US and years in practice (p<0.001). There was no significant difference in US patterns based on practice type and medical school of graduation. CONCLUSIONS: These data demonstrate differences in US use for UDT based primarily on practice location and years in practice, indicating that efforts should be focused toward younger physicians practicing in rural areas. In the era of cost containment and emphasis on improving efficiency, focused educational efforts can increase the likelihood of initiating a rapid and lasting change in practice patterns. Source of Funding: None