title: Practice variation and clinical confusion regarding undescended testes and retractile testes among primary care respondents: a multi-regional survey study in the United States.
abstract: OBJECTIVE
  Although previous studies have looked at referral patterns and indications for orchiopexy, this is the first attempt at quantifying the primary care provider knowledge base of cryptorchidism and its implications in a large multi-state setting in the United States.
  
  
  METHODS
  Primary care providers (PCPs) (n = 3,000) were invited to complete a web-based survey regarding cryptorchidism. We evaluated: practice setting; training; knowledge of cryptorchidism; relationship to pediatric urologists and surgeons; understanding of the relationship between cryptorchidism, infertility and testis cancer.
  
  
  RESULTS
  Seventeen percent (n = 453) of PCPs responded to the survey. Fifty-three percent indicated that they had minimal to no exposure to pediatric urology during training. Two-thirds refer patients with retractile testes to surgical specialists. Practice setting was associated with the type of information families received about the impact of UDT on fertility and malignancy with rural practices being more likely to counsel that unilateral UDT imparted a high risk of malignancy (RR 1.5; 95 % CI 1.2, 1.9) and bilateral UDT resulted in likely infertility (RR 2.1; 95 % CI 1.5, 2.8).
  
  
  CONCLUSIONS
  This study underscores the need for increased evidence-based recommendations, as well as improved training and education of PCPs in the US who deal with disorders of testicular descent.
authors.affiliation: Division of Pediatric Urology, Department of Urology, University of Washington, Seattle Children's Hospital, Seattle, WA 98103, USA. margarett.shnorhavorian@seattlechildrens.org
authors.forename: Margarett
authors.initials: M
authors.lastname: Shnorhavorian
authors.forename: Micah A
authors.initials: MA
authors.lastname: Jacobs
authors.forename: Gillian
authors.initials: G
authors.lastname: Stearns
authors.forename: Gerald
authors.initials: G
authors.lastname: Mingin
authors.forename: Martin A
authors.initials: MA
authors.lastname: Koyle
mesh_terms: D003456:Cryptorchidism / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014481:United States