American Academy of Pediatrics Referral Guidelines

American Academy of Pediatrics Referral Guidelines

The Surgical Advisory Panel of the American Academy of Pediatrics (AAP), in response to a recommendation from the AAP Subspecialty Work Group and with the collaboration of the Surgical Sections of the AAP, has created referral guidelines intended to serve as voluntary practice parameters to assist general pediatricians in determining when and where to refer their patients to pediatric surgical specialists. It is recognized that the guidelines here may be difficult to achieve.

A pediatric urologist has completed a residency in urology and is certified by the American Board of Urologic Surgery and has completed additional training in a pediatric urology fellowship. In select situations, a urologist may have gained a lifetime of pediatric experience but started practice before such fellowships were available. For purposes of developing these guidelines, the following group definitions are used: infant (0–1 year), child (2–12 years), and adolescent (13–18 years).

  • Undescended testicles and elective congenital hydrocele/hernia are optimally corrected in infancy or early childhood; the operation should be performed by a pediatric urologist or surgical specialist.
  • Hypospadias is usually repaired in infancy or early childhood; the operation should be performed by a pediatric urologist.
  • Complex congenital urologic problems (eg, duplex systems, ureterocele, bladder exstrophy, moderate or severe vesicoureteral reflux, posterior urethral valves) should preferably be managed by a pediatric urologist.
  • Solid malignancies of the kidney, bladder, and testicle should be treated from the outset by a pediatric urologist or surgical specialist in conjunction with a pediatric medical cancer specialist.
  • Intersex (ambiguous genitalia) conditions should be comanaged from the outset by the primary care pediatrician and a pediatric urologist or surgical specialist. The management team should include a pediatric endocrinologist and a psychologist in consultation with the primary care pediatrician and pediatric urologist or surgical specialist.
  • Cystoscopic procedures in infants and children preferably should be performed by a pediatric urologist.
  • A pediatric urology consultation should be considered when a child has prolonged, severe daytime voiding difficulty.
  • A pediatric urologist should be involved in the care of children with spinal cord disorders (eg, myelomeningocele, spinal cord injuries).
  • Infants or children with major urologic injuries should be stabilized at the nearest medical center and then transported to a pediatric trauma center.

Infants or children with testicular torsion should be evaluated at the nearest medical center and operated on promptly.

When a urinary tract abnormality has been identified prenatally, a pediatric urologist or surgeon should be consulted as a member of the fetal treatment team.

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