title: Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study.
abstract: BACKGROUND
  Although previous evidence has shown that ultrasound is unreliable to diagnose undescended testis, many primary care providers (PCP) continue to misuse it. We assessed the performance of ultrasound as a diagnostic tool for palpable undescended testis, as well as the diagnostic agreement between PCP and pediatric urologists.
  
  
  METHODS
  We performed a prospective observational cohort study between 2011 and 2013 for consecutive boys referred with a diagnosis of undescended testis to our tertiary pediatric hospital. Patients referred without an ultrasound and those with non-palpable testes were excluded. Data on referring diagnosis, pediatric urology examination and ultrasound reports were analyzed.
  
  
  RESULTS
  Our study consisted of 339 boys. Of these, patients without an ultrasound (n = 132) and those with non-palpable testes (n = 38) were excluded. In the end, there were 169 pateints in this study. Ultrasound was performed in 50% of referred boys showing 256 undescended testis. The mean age at time of referral was 45 months. When ultrasound was compared to physical examination by the pediatric urologist, agreement was only 34%. The performance of ultrasound for palpable undescended testis was: sensitivity = 100%; specificity = 16%; positive predictive value = 34%; negative predictive value = 100%; positive likelihood ratio = 1.2; and negative likelihood ratio = 0. Diagnosis of undescended testis by PCP was confirmed by physical examination in 30% of cases, with 70% re-diagnosed with normal or retractile testes.
  
  
  CONCLUSIONS
  Ultrasound performed poorly to assess for palpable undescended testis in boys and should not be used. Although the study has important limitations, there is an increasing need for education and evidence-based guidelines for PCP in the management of undescended testis.
authors.affiliation: Department of Surgery (Urology), McMaster Children's Hospital, McMaster University, Hamilton, ON;
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Wong
authors.affiliation: Department of Surgery (Urology), McMaster Children's Hospital, McMaster University, Hamilton, ON;
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Bansal
authors.affiliation: Department of Surgery (Urology), Hospital for Sick Children, University of Toronto, ON.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Lorenzo
authors.affiliation: Department of Surgery (Urology), Hospital for Sick Children, University of Toronto, ON.
authors.forename: Jorge
authors.initials: J
authors.lastname: DeMaria
authors.affiliation: Department of Surgery (Urology), McMaster Children's Hospital, McMaster University, Hamilton, ON;
authors.forename: Luis H
authors.initials: LH
authors.lastname: Braga