title: Obesity does not decrease the accuracy of testicular examination in anesthetized boys with cryptorchidism.
abstract: OBJECTIVE
  Given that the prevalence of childhood obesity is increasing in the United States, we tested the timely hypothesis that obesity hinders physical examination based localization of the cryptorchid testis.
  
  
  METHODS
  Body mass index and percentiles of weight for height and body mass index for age were calculated for boys undergoing surgery for cryptorchidism at the University of California San Francisco Children's Hospital and Children's Hospital of Oakland. Two definitions of obesity were examined, ie greater than 85% or greater than 95% for either percentile. Patients were examined in the office and under general anesthesia before the skin incision. Intraoperative testicular location was recorded for each patient. The numbers of correct and incorrect preoperative determinations of testicular location were stratified by weight classification. Results were analyzed using contingency tables and Fisher's exact test.
  
  
  RESULTS
  A total of 161 boys were recruited, accounting for 171 testes. The predictive value of palpating a suspected testis preoperatively with patients under anesthesia was greater than 95% for all weight classifications (p <0.0001). The predictive value of not palpating a testis preoperatively under anesthesia was greater than 56% for obese boys and greater than 42% for nonobese boys (p <0.0001). The concordance rates between examinations in the office and those performed under anesthesia were 90.9% and 82.7% for obese and nonobese boys, respectively (p = 0.51). The predictive value of not palpating a suspected cryptorchid testis in the office was higher in nonobese boys than in obese boys (81% vs 22%, p <0.0001).
  
  
  CONCLUSIONS
  In our series childhood obesity did not make preoperative testicular examinations under anesthesia less accurate. However, office examinations may be more accurate in nonobese boys.
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.forename: Michael
authors.initials: M
authors.lastname: DiSandro
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Baskin
authors.forename: Michael H
authors.initials: MH
authors.lastname: Hsieh
mesh_terms: D015992:Body Mass Index; D002675:Child, Preschool; D015331:Cohort Studies; D003456:Cryptorchidism / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications / Q000175:diagnosis*; D009919:Orchiectomy / Q000379:methods; D010173:Palpation / Q000379:methods*; D010808:Physical Examination / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity