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The role of ultrasonography in the management of undescended testes. A 6 year review.

Rakan Al Darrab*, Rayan Almaini, Hmoud Alqarni, Omar B Alfraidi, Irfan Ullah, Badar Melaibary, Fayez Almodhen, Yasser Jamalalail, Ahmed Al Shammari, Tariq Burki

Background: Undescended Testis (UDT) is a common condition that has a potential to cause infertility and may become malignant if not treated surgically in time. Ultrasound is requested by different specialties for diagnosis of UDT before referring to a pediatric urology clinic. Objectives: To evaluate the trends for Ultrasound Scan (USS) requests by particular specialties before referral to a surgical team and to assess the sensitivity and specificity of ultrasound in accurately localizing UDT compared to per operative findings and its impact on the management plan. Methods: We reviewed all the patient between 1st of January 2014 to 1st of January 2019, who were referred to our paediatric urology department for UDT and had an USS testes before referral. Patients with ambiguous genital, hydrocele and redo orchidopexy were excluded. We recorded age at referral, referring specialty, their findings on clinical examination, the USS findings, and per operative findings. The results were expressed as mean/median, percentages, sensitivity, specificity and positive and negative predictive value. Results: We received 670 referrals for UDT to our clinic during this period. Among these 207 patients (31.04%) had an USS done before referral to us. There were nearly equal number of referrals made by the main specialties, which included neonatology, general paediatrics and family medicine. All the decisions as regards to surgery were based on the clinical examination in outpatient and the surgical approach of either open or laparoscopy was based on examination under anaesthesia irrespective of USS findings. The sensitivity and specificity of ultrasonography for correctly diagnosing a testis in the groin was 87.79% and 72.13%, in the abdomen 70.73% and 96.08% and for vanished testes 87% and 94.8% respectively when compared to per operative findings. USS missed diagnosed 43 out of 101 normal testes as either in the groin n=41(16.87%) or abdomen n=2(2.81%). This practice cost our hospital US$ 10350 (US$ 50 per scan). Conclusion: The use of ultrasound does not aid significantly in the accurate diagnosis or management of undescended testes and incur unnecessary additional cost to the health system. Physicians should refrain from requesting ultrasound for localization of testes before referral to surgical team.