Pd49-06 the Proof Is in the Pudding: Utility of Ultrasound in Evaluation of Cryptorchidism in Obese Appalachian Patients

You have accessJournal of UrologyPediatrics V (PD49)1 May 2024PD49-06 THE PROOF IS IN THE PUDDING: UTILITY OF ULTRASOUND IN EVALUATION OF CRYPTORCHIDISM IN OBESE APPALACHIAN PATIENTS David Zekan, Zachary Edgerton, Luke O'Connor, Tyler Trump, Ahmed Abdelhalim, and Osama Al-Omar David ZekanDavid Zekan , Zachary EdgertonZachary Edgerton , Luke O'ConnorLuke O'Connor , Tyler TrumpTyler Trump , Ahmed AbdelhalimAhmed Abdelhalim , and Osama Al-OmarOsama Al-Omar View All Author Informationhttps://doi.org/10.1097/01.JU.0001008752.72292.d7.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: AUA guidelines discourage the use of any imaging including scrotal/inguinal ultrasound (US) in the evaluation of cryptorchidism, as clinical exam (CE) dictates management. Patients with non-palpable testes on exam under anesthesia (EUA) should undergo laparoscopic exploration. However, abnormal body habitus, like obesity, makes CE difficult and limits accuracy. We propose that US could improve evaluation of cryptorchidism in obese patients when physical examination is limited for both counseling and operative planning. It can help avoid surgical morbidity from unnecessary laparoscopic exploration. Herein, we seek to characterize the utility of US in evaluating patients with cryptorchidism in a population with a high prevalence of obesity among children. METHODS: Following IRB approval, 267 patients with cryptorchidism treated at the study institution between 2017-2021 were studied retrospectively. Variables collected included the age, BMI, CE, ultrasound and operative findings. Patients were stratified into non-obese (BMI 85th percentile for age). The diagnostic performance of US and CE were compared to findings on EUA, as the gold standard. Appropriate statistical tests were performed using Microsoft Excel. RESULTS: 82 patients (94 undescended testicles, 12 bilateral) had US performed prior to referral, of whom 24 patients (30 testicles) were obese group and 58 patients (64 testicles) were non-obese. In the obese group, 83.3% of testicles were palpable on CE, 93.3% visible in the inguinal canal on US, and 93.3% palpable on EUA. The performance of CE and US against EUA is shown in Table 1. Overall, in the obese group, US had 100% sensitivity, 100% specificity and 100% overall accuracy, whereas CE had 89.3% sensitivity, 60% specificity and 83.3% overall accuracy. In the non-obese group, US had 91.8% sensitivity, 53.5% specificity and 82.8% overall accuracy, whereas CE had 93.9% sensitivity, 100% specificity, and 95.3% overall accuracy. CONCLUSIONS: US outperformed CE in locating cryptorchid testicles in obese patients. Conversely, CE outperformed US in non-obese patients. Thus, US can help in locating cryptorchid testicles in obese patients whose habitus limits CE for the purposes of both counseling and operative planning. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1052 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information David Zekan More articles by this author Zachary Edgerton More articles by this author Luke O'Connor More articles by this author Tyler Trump More articles by this author Ahmed Abdelhalim More articles by this author Osama Al-Omar More articles by this author Expand All Advertisement PDF downloadLoading ...