The Impact of Targeted Education of American Urological Association Cryptorchidism Guidelines in a Rural State: Improvement Still Needed
Tyler Trump, MD, Amr A. Elbakry, MD, Ahmad Haffar, BS, Daniel McClelland, MD, Chad Morley, MD, Osama Al-Omar, MD, MBA.
West Virginia University, Morgantown, WV, USA.
BACKGROUND: The American Urological Association published guidelines in 2014 regarding screening, diagnosis, referral, and treatment of undescended testicles (UDT). Despite these guidelines, prior studies have indicated discordance between the guidelines and actual practice especially in rural states. This study aims to identify if educating referring providers improves the management of UDT. METHODS: Patients with UDT referred to our institution were divided into two groups: those referred prior to targeted education (Group 1) and those referred following targeted education (Group 2). Retrospective review was performed to compare the two groups in terms of age at time of referral and surgery, laterality, specialty and practice setting of referring provider, and whether or not ultrasound (US) was performed prior to referral. RESULTS: A total of 100 patients were identified in Group 1 and 168 in Group 2. No significant differences were noted between the groups regarding age, variability of referring provider, or those receiving US prior to referral. Median age at referral was 20.7 months (range 0-194.) and 33 months (range 0-205.1) in Group 1 and 2, respectively (p=0.26). Total of 39 (39%) patients underwent surgical evaluation within 18 months of age or younger in Group 1 compared to 62 (37%) in Group 2 (p=0.73). Private practice pediatricians comprised the majority of referring providers in both cohorts. US was performed prior to referral in 41% of patients in Group 1 compared to 35.8% in Group 2 (p=0.51). Number of US ordered prior to referral significantly decreased from 10 (50%) to 6 (19%) following education among academic providers (p=0.02). No significant difference was found following education for private practice physicians (p=0.27). (Table A1) CONCLUSIONS: Targeted education did not improve age at referral in the short-term, which may reflect suboptimal healthcare access. Our results do suggest that targeted education may lead to less utilization of US prior to referral. Expanding targeted audience may improve adherence to UDT guidelines. 
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