Presentation Authors: Jonathan A. Gerber*, Adithya Balasubramanian, Mihir A. Shukla, Jake S. Jacob, Huirong Zhu, Kunj R. Sheth, Carolina J. Jorgez, Angela G. Mittal, Duong D. Tu, Chester J. Koh, Nicolette K. Janzen, Ming-Hsien Wang, Paul F. Austin, Edmond T. Gonzales, David R. Roth, Abhishek Seth, Houston, TX
Introduction: Pediatric urology, like all pediatric subspecialties, relies heavily upon the referral patterns of general pediatricians. The GU exam is often omitted by primary care providers due to its uncomfortable nature. Based on previously reported rates, we hypothesize that 20-25% of male well child visits did not record a genital exam.
Methods: 998 consecutive male well child visits at our institution were reviewed. Visits took place across the institutions's main tertiary center and community-based practice locations. These visits were evaluated for documentation within EPIC EMR of a detailed GU exam, as well as all abnormal findings from these exams. Additionally, past medical and surgical histories of each child were reviewed to determine if a diagnosis of undescended testicles (UDT) was noted.
Results: Pediatricians at our institution document GU exams an astonishing 99.1% of the time during well child visits. Interestingly, and significantly different from the previously reported rates, only 1.1% of our cohort had a documentation of UDT. Of the 11 patients with UDT, 6 (54.5%) had spontaneous descent with no referral to urology while 5 (45.5%) required orchidopexy. An additional 6 patients had concern for UDT, however urology referral deemed these to have retractile testicles.
Conclusions: Pediatricians do, in fact, document GU examinations on a routine basis. This finding allows surgical subspecialists like pediatric urologists to rest assured that, at the very least, the genitalia are being examined indicating that the most egregious pathology will be identified and referred appropriately. While our data demonstrated a lower than expected rate of UDT, this could indicate that although examinations are being performed, the accuracy of the examinations may be diminished due to lack of specialized training in the performance of genitourinary examination. Follow up studies are required to verify these potentially changing rates.