Endocrine Abstracts

Background: Measuring testicular volume (TV) by orchidometer is a standard method of pubertal staging in boys. A paucity of evidence exists as to its inter and intra-user reliability and the impact of clinicians’ gender, training and experience on the accuracy of measurements. Specifically engineered prosthetic models of different size testes were developed to investigate the reliability of TV estimation.

Method: The study was conducted over the three-day BSPED meeting in November 2015. Three child-sized mannequins displayed latex scrotum containing prosthetic testicles of 3 ml, 4 ml, 5 ml, 10 ml and 20 ml. Demographic data, paediatric endocrinology experience, TV examination training, information on examination technique were collected anonymously and TV estimations performed. Delegates were asked to repeat their measurements later during the meeting. Scrotum order was changed daily to minimise recall bias.

Results: In total of 208 delegates participated (158F, 50M): 50% consultants, 30% trainees, –-9% clinical nurse specialists, 11% other. The majority of participants (60%) had less than 5 years experience in clinical endocrinology, 19% had practiced for over 10 years. Only 25.5% had received formal training in TV estimation. There was variability in examination technique, with the majority preferring the patient recumbent (54%) and using both look and feel for estimation (59%).

Participants measured TV accurately on 30% of occasions. Underestimations were made on 40% of measurements and overestimation on 30%. Males and females were similarly inaccurate, males estimating correctly on 31.4% of occasions and females on 29.7%. Experience improved accuracy with consultants scoring accurately 31.7%, paediatric trainees 28.4%, nurse specialists 27.2% and newly qualified doctors 11.1% of the time. Inaccuracies were highest at the smallest volumes: 57% overestimating 3 ml testis (largest coefficient of variation, 57.8%), compared with 17% for the 20 ml testis (smallest coefficient of variation, 31.9%).

Conclusion: Overall TV estimation accuracy was poor. There was considerable variation between subjects and at lower volumes. This is clinically pertinent considering the different management decisions made at smaller volumes. Seniority improves measurement estimation. Delegate feedback supported more training and developing these models for teaching simulation.