Educational survey of regional general practitioner's management of paediatric patients with undescended testis
Introduction
The undescended testis (UDT) is one of the commonest congenital abnormalities in male infants. Approximately 4–5% of males at birth have undescended testes at birth but this incidence reduces to 1–2% by 3 months of age [1].
Despite its common occurrence, there is debate currently regarding the timing of orchidopexy for these patients. In 1975, an action committee of the American Academy of Pediatrics (AAP) recommended “the ideal age for orchidopexy is after age 4 and before age 6 unless a symptomatic hernia is present” [2]. In 1996, they revised their recommendations so that “orchidopexy should be performed at or near 1 year of age” [3]. More recently, the British Association of Paediatric Urology (BAPU) has released a consensus statement stating that “timing – 3–6 months now ideal. 6–12 months acceptable” [4]. This is based on evidence that germ cell loss begins at 3–6 months in a UDT and no spontaneous descent occurs after 3 months of age [5].
Despite these recommendations, there are several publications that have shown that the age at time of surgery is well above the suggested age recommended back in 1996 [6], [7], [8], [9], [10], [11], [12]. A retrospective audit at our institution in 2010 found that the average age of referral of patients under the age of 5 years with UDT was 2.8 years of age (unpublished data).
As the average age at surgery has already been shown to be higher than recommended, how can we expect this to improve without actively updating the referring practitioner with the most recent recommendations?
We sought to survey the regional GPs regarding their management of paediatric patients that they encounter with undescended testis. Unlike previous published literature, we aimed also to combine the survey with an educational aspect so that the same GPs would be aware of the current local paediatric surgical department's guidelines regarding patients with UDT and thereby align actual age of referral with current recommendations.
Section snippets
Methods
A departmental consensus was developed and agreed by the Paediatric Surgical Consultants based on the current recommendations and evidence at that time. A web-based questionnaire was then devised using SurveyMonkey. Questions were devised to ascertain the GP's knowledge, attitudes, and management of paediatric patients with UDT, including preoperative and postoperative management and long-term complications (Fig. 1). Where appropriate, an educational slide was shown after the question to
Results
A total of 401 GPs were identified from electronic databases. One hundred and forty-four (36%) started the survey and 118 GPs (30%) completed the entire survey. Of the respondents, there was a wide range of experience as a GP: 41.7% had less than 10 years, 23.9% had 10–20 years, and 34.7% had more than 20 years. Ninety-one per cent thought that they would see children with undescended testis UDT in their clinic.
Discussion
E-learning refers to “electronically-mediated learning in a digital format to enhance or facilitate teaching and learning” [12]. Its current use for medical teaching is commonplace with much published literature on how to maximise its effectiveness [13], [14]. For this study, we have combined two aspects of e-learning: e-teaching and e-assessment [15]. By doing this, we could ascertain the current knowledge of the regional GPs and their management of patients presenting with UDT while also
Conclusion
This project demonstrates that there is still varying practice of the GP's management of paediatric patients presenting with UDT, and in part explains the reason for delay in age at time of orchidopexy. We have also demonstrated the feasibility of surveying and educating the target population, and we suggest that it is an effective method of active communication to improve outcomes with the GPs with specific regard to referral times and perhaps other targets.
Conflict of interest
None.
Funding
None.
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