Orchidopexy Practice Patterns Among Canadian Pediatric Urologists: Barriers to Widespread Adoption of Pre-scrotal Orchidopexy for Palpable Undescended Testis (pUDT)
CUA Online Library. WEHBI E. 06/25/13; 31369; MP-09.12
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Abstract
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ORCHIDOPEXY PRACTICE PATTERNS AMONG CANADIAN PEDIATRIC UROLOGISTS: BARRIERS TO WIDESPREAD ADOPTION OF PRE-SCROTAL ORCHIDOPEXY FOR PALPABLE UNDESCENDED TESTIS (pUDT)
INTRODUCTION AND OBJECTIVES
Although attempts have been made to establish the role for single incision scrotal (SIS) surgery for pUDT, the classic inguinal orchidopexy remains the favored gold standard. We hypothesize that this may be due to its recognized success and widespread anatomic familiarity. There is paucity of data on the reasons behind reluctance to embrace the SIS technique. Herein we aim to provide insight into barriers to its use.
METHODS
A questionnaire was distributed via SurveyMonkey® to the Pediatric Urologists of Canada, exploring preferences for the surgical approach to pUDT, experience with different orchidopexy techniques and demographics. A multi-logic algorithm was employed to decrease redundancy, streamline questions and maximize completion rates. Anonymized responses were pooled, summarized and descriptively analyzed.
RESULTS
Response rate was 98% (41/42). Median number of years in practice for the group was 12 (IQR 7-22). Thirty-five (85.4%) of the respondents had performed SIS orchidopexies in the past and 26 (74.3%) currently offer it, selectively performing the procedure one-third of the time for pUDT.
Of those that perform SIS, the most common reasons to favor this approach included shorter operative time and perceived improved cosmesis. All those that perform the procedure rank location of the testis as the number one factor they consider when choosing between inguinal and SIS approaches, with body habitus ranked number two. When using SIS, 92% (24/26) feel that their outcomes are equivalent to the classic inguinal and 73% (19/26) of them report a <10% conversion rate to an inguinal approach. Of the 9 surgeons that stopped offering the procedure, 67% did so because their outcomes were thought to be substandard. Of those that have never (6/41) or no longer offer the procedure (9/41), the 2 most common reasons for this are potential difficulty with management of the hernia sac or perceived limitations with proximal cord release and lengthening maneuvers.
CONCLUSIONS
There is variation in the preference for SIS among Canadian pediatric urologists. Barriers to more widespread use include potential difficulty with proximal lengthening maneuvers and concomitant hernia sac dissection. With a high response rate, we confirmed that a large proportion of pediatric urologists continue to offer the procedure and achieve subjectively good outcomes with low conversion rates. These data may help address specific concerns ultimately establishing a more definitive role for SIS in select cases.
INTRODUCTION AND OBJECTIVES
Although attempts have been made to establish the role for single incision scrotal (SIS) surgery for pUDT, the classic inguinal orchidopexy remains the favored gold standard. We hypothesize that this may be due to its recognized success and widespread anatomic familiarity. There is paucity of data on the reasons behind reluctance to embrace the SIS technique. Herein we aim to provide insight into barriers to its use.
METHODS
A questionnaire was distributed via SurveyMonkey® to the Pediatric Urologists of Canada, exploring preferences for the surgical approach to pUDT, experience with different orchidopexy techniques and demographics. A multi-logic algorithm was employed to decrease redundancy, streamline questions and maximize completion rates. Anonymized responses were pooled, summarized and descriptively analyzed.
RESULTS
Response rate was 98% (41/42). Median number of years in practice for the group was 12 (IQR 7-22). Thirty-five (85.4%) of the respondents had performed SIS orchidopexies in the past and 26 (74.3%) currently offer it, selectively performing the procedure one-third of the time for pUDT.
Of those that perform SIS, the most common reasons to favor this approach included shorter operative time and perceived improved cosmesis. All those that perform the procedure rank location of the testis as the number one factor they consider when choosing between inguinal and SIS approaches, with body habitus ranked number two. When using SIS, 92% (24/26) feel that their outcomes are equivalent to the classic inguinal and 73% (19/26) of them report a <10% conversion rate to an inguinal approach. Of the 9 surgeons that stopped offering the procedure, 67% did so because their outcomes were thought to be substandard. Of those that have never (6/41) or no longer offer the procedure (9/41), the 2 most common reasons for this are potential difficulty with management of the hernia sac or perceived limitations with proximal cord release and lengthening maneuvers.
CONCLUSIONS
There is variation in the preference for SIS among Canadian pediatric urologists. Barriers to more widespread use include potential difficulty with proximal lengthening maneuvers and concomitant hernia sac dissection. With a high response rate, we confirmed that a large proportion of pediatric urologists continue to offer the procedure and achieve subjectively good outcomes with low conversion rates. These data may help address specific concerns ultimately establishing a more definitive role for SIS in select cases.
ORCHIDOPEXY PRACTICE PATTERNS AMONG CANADIAN PEDIATRIC UROLOGISTS: BARRIERS TO WIDESPREAD ADOPTION OF PRE-SCROTAL ORCHIDOPEXY FOR PALPABLE UNDESCENDED TESTIS (pUDT)
INTRODUCTION AND OBJECTIVES
Although attempts have been made to establish the role for single incision scrotal (SIS) surgery for pUDT, the classic inguinal orchidopexy remains the favored gold standard. We hypothesize that this may be due to its recognized success and widespread anatomic familiarity. There is paucity of data on the reasons behind reluctance to embrace the SIS technique. Herein we aim to provide insight into barriers to its use.
METHODS
A questionnaire was distributed via SurveyMonkey® to the Pediatric Urologists of Canada, exploring preferences for the surgical approach to pUDT, experience with different orchidopexy techniques and demographics. A multi-logic algorithm was employed to decrease redundancy, streamline questions and maximize completion rates. Anonymized responses were pooled, summarized and descriptively analyzed.
RESULTS
Response rate was 98% (41/42). Median number of years in practice for the group was 12 (IQR 7-22). Thirty-five (85.4%) of the respondents had performed SIS orchidopexies in the past and 26 (74.3%) currently offer it, selectively performing the procedure one-third of the time for pUDT.
Of those that perform SIS, the most common reasons to favor this approach included shorter operative time and perceived improved cosmesis. All those that perform the procedure rank location of the testis as the number one factor they consider when choosing between inguinal and SIS approaches, with body habitus ranked number two. When using SIS, 92% (24/26) feel that their outcomes are equivalent to the classic inguinal and 73% (19/26) of them report a <10% conversion rate to an inguinal approach. Of the 9 surgeons that stopped offering the procedure, 67% did so because their outcomes were thought to be substandard. Of those that have never (6/41) or no longer offer the procedure (9/41), the 2 most common reasons for this are potential difficulty with management of the hernia sac or perceived limitations with proximal cord release and lengthening maneuvers.
CONCLUSIONS
There is variation in the preference for SIS among Canadian pediatric urologists. Barriers to more widespread use include potential difficulty with proximal lengthening maneuvers and concomitant hernia sac dissection. With a high response rate, we confirmed that a large proportion of pediatric urologists continue to offer the procedure and achieve subjectively good outcomes with low conversion rates. These data may help address specific concerns ultimately establishing a more definitive role for SIS in select cases.
INTRODUCTION AND OBJECTIVES
Although attempts have been made to establish the role for single incision scrotal (SIS) surgery for pUDT, the classic inguinal orchidopexy remains the favored gold standard. We hypothesize that this may be due to its recognized success and widespread anatomic familiarity. There is paucity of data on the reasons behind reluctance to embrace the SIS technique. Herein we aim to provide insight into barriers to its use.
METHODS
A questionnaire was distributed via SurveyMonkey® to the Pediatric Urologists of Canada, exploring preferences for the surgical approach to pUDT, experience with different orchidopexy techniques and demographics. A multi-logic algorithm was employed to decrease redundancy, streamline questions and maximize completion rates. Anonymized responses were pooled, summarized and descriptively analyzed.
RESULTS
Response rate was 98% (41/42). Median number of years in practice for the group was 12 (IQR 7-22). Thirty-five (85.4%) of the respondents had performed SIS orchidopexies in the past and 26 (74.3%) currently offer it, selectively performing the procedure one-third of the time for pUDT.
Of those that perform SIS, the most common reasons to favor this approach included shorter operative time and perceived improved cosmesis. All those that perform the procedure rank location of the testis as the number one factor they consider when choosing between inguinal and SIS approaches, with body habitus ranked number two. When using SIS, 92% (24/26) feel that their outcomes are equivalent to the classic inguinal and 73% (19/26) of them report a <10% conversion rate to an inguinal approach. Of the 9 surgeons that stopped offering the procedure, 67% did so because their outcomes were thought to be substandard. Of those that have never (6/41) or no longer offer the procedure (9/41), the 2 most common reasons for this are potential difficulty with management of the hernia sac or perceived limitations with proximal cord release and lengthening maneuvers.
CONCLUSIONS
There is variation in the preference for SIS among Canadian pediatric urologists. Barriers to more widespread use include potential difficulty with proximal lengthening maneuvers and concomitant hernia sac dissection. With a high response rate, we confirmed that a large proportion of pediatric urologists continue to offer the procedure and achieve subjectively good outcomes with low conversion rates. These data may help address specific concerns ultimately establishing a more definitive role for SIS in select cases.
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