Reliance of preoperative scrotal examination versus final operative findings in the evaluation of non-palpable testes.

OBJECTIVE: The current study evaluates whether the preoperative scrotal examination in children with non-palpable testes is sufficient in all cases or if laparoscopy is necessary to confirm the examination findings. Are the findings different amongst physicians depending on their level of experience? MATERIALS AND METHODS: This retrospective study was done between October 2009 and May 2013. Children with non-palpable testes underwent an examination under anesthesia prior to surgery to feel for a testis or nubbin, followed by a diagnostic laparoscopy to validate the scrotal examination. The test was considered correct if the laparoscopic findings supported the scrotal examination. It was considered incorrect if laparoscopy revealed a different finding. RESULTS: A total of 74 testes were evaluated. All patients underwent examination under anesthesia by the surgeon and senior resident. The findings were recorded separately. Despite careful examination by experienced surgeons under anesthesia, the scrotal examination was incorrect in 14 patients. Four viable testes would have been missed if laparoscopy had not been performed. CONCLUSION: Laparoscopy should be considered in case of palpable scrotal nubbins to ensure no testis is left within the abdominal cavity.

Marketing issues for the hospital industry.

The controls on payments by insurance companies and governmental agencies (Medicare, Medicaid, Title 19) to hospitals have led to restricted hospital services for patients. This situation has caused over-capacity in hospitals. Also, there is a surplus of both hospital capacity and doctors. However, there are frequent shortages of nurses and many other trained technical personnel. This situation has behavioral implications which are discussed in this paper.