18 The Use of Community Health Pathways (CHP) to Improve the Timeliness of Referral of Undescended Testis (UDT)
Erika Stark, Alison Campbell, Spencer W Beasley
Christchurch Hospital, Christchurch, New Zealand


Aim of the Study

Our previous data showed most boys with UDT are referred later than best practice guidelines consider optimal, mainly from delay in referral, resulting in orchidopexy being later than ideal. It was hoped that improvements in primary care education and easily-used referral processes could decrease the age of referral.

An online resource for GPs and allied professionals was initiated in 2008 (CHP). The UDT guideline advises referral to paediatric surgery if testes do not sit spontaneously in the scrotum at 3 months corrected age. We aimed to seek evidence of any reduction in age of referral, and orchidopexy.



Data were collected prospectively for boys referred with UDT over a 5-year period during which time agreed GP guidelines for referral were introduced. Trends in the age at referral, age at surgery and outcomes were analysed.


Main Results

Complete data were obtained for 164 boys.  Referral before age 6 months increased from 12% in 2012 to 38% in 2016; and before 12 months from 38% in 2012 to 67% in 2016. Orchidopexy by 12 months was achieved in 10% in 2012 and 33% in 2016; and by 18 months in 44% in 2012 up to 68% in 2016. Median age at orchidopexy for this 2012-2016 cohort was 16.6 months compared with 31.1 months from 1997-2007.



These data demonstrate earlier referral of boys with UDT and earlier orchidopexy is occurring. This corresponds to the introduction of the GP website “Community health pathways”. A similar resource available in other regions or countries might be expected to reduce the age of referral from primary care providers.