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PEDIATRIC
UROLOGY
Ultrasonography
is unnecessary in evaluating boys with a nonpalpable testis
Elder JS
Division of Pediatric Urology, Rainbow Babies and Children’s Hospital,
Department of Urology, Case Western Reserve University School of Medicine,
Cleveland, Ohio, USA
Pediatrics 2002; 110:748-51
- Objective:
An
inguinal sonogram often is obtained in boys with a nonpalpable testis
to “localize” the testis, i.e., determine whether the testis
is present. The results of ultrasonography in boys with a nonpalpable
testis were analyzed.
- Methods:
The
records of boys who were referred to a pediatric urology center with
a diagnosis of nonpalpable testis and who had undergone inguinal sonography
were reviewed. The results of sonography were compared with findings
in the office as well as surgical findings.
- Results:
A total of 62 boys who were referred with a diagnosis of a nonpalpable
testis and who had undergone a sonogram were reviewed. The sonogram
was ordered by the primary care physician in 51 boys (82%) and by a
general urologist in 11 cases (18%). The testis was identified by sonography
in 12 (18%) of 66 cases, and all were localized to the inguinal canal.
Physical examination by a pediatric urologist showed that 6 were in
the scrotum and 6 were in the inguinal canal or perineum. Of the 54
testes that were not localized by the sonogram, 33 (61%) were palpable
and 21 (39%) were nonpalpable. Of the truly nonpalpable testes, laparoscopy
and abdominal/inguinal exploration identified the testis as abdominal
in 10 cases and atrophic secondary to spermatic cord torsion in 11 cases.
- Conclusion:
Sonography
is unnecessary in boys with a nonpalpable testis, because it rarely
if ever localizes a true nonpalpable testis, and it does not alter the
surgical approach in these patients.
- Editorial
Comment
This is a long-awaited confirmation of the information that most pediatric
urologists already know. Ultrasound is a non-invasive technology and
is often used to find testes that are difficult to palpate. On the other
hand, the information it provides is unreliable. Indeed, it is less
accurate than a physical examination by an experienced examiner. Furthermore,
the physical examination is much better at determining whether a testis
is “retractile.” In an era were health care costs are rising,
ultrasound to determine testicular position is almost never warranted.
Interestingly, many insurance companies discourage referrals to specialists
using the justification that they are expensive and unnecessary, but
this paper shows that for this condition, a referral to a specialist
results in not only better care, but also in cost savings.
Dr.
Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA
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