Technique of orchidopexy following testicular torsion

Suspected Testicular Torsion: A Survey of Clinical Practice in North West England

Several aspects of the management of suspected testicular torsion are controversial. A questionnaire was mailed to all 33 consultant urologists in the North West region of England to elicit their policies for routine clinical management. 29 of 33 questionnaires were returned (2 incomplete).

As regards radiological investigation, 4 consultants always request ultrasound examination; the others do not favour routine imaging. When the diagnosis of testicular torsion is confirmed at operation, all consultants would perform bilateral testicular fixation, although with considerable variations in technique; most use Vicryl sutures (66%) and three-point fixation (57%). One-third would do an ipsilateral orchidopexy if there was no clear evidence of testicular torsion at operation.

The variation revealed by this survey prompted an attempt to formulate a protocol for management. A review of the published work indicates that, in cases of proven testicular torsion, treatment should include bilateral fixation with delayed-absorption or nonabsorbable sutures; fixation should be at three points. When torsion is not found at operation, there is no evidence of benefit from orchidopexy.

[Eversion orchidopexy as prophylaxis for recurrence of testicular torsion]

BACKGROUND

In patients with torsion of the testis, in addition to the urgency of early recognition and immediate operation, it is questionable which method should be used to prevent renewed torsion of the affected and/or contralateral testis with the least damage and most enduring results. Direct suturing or indirect adhesion fixation are recommended as alternative methods. A review of the literature has shown, however, that recurrence of testicular torsion can occur in many cases and that in some cases this leads to complete anatomical or functional loss of the testis.

PATIENTS AND METHODS

As a logical continuation of a successful pilot study, it was retrospectively investigated by means of a structured questionnaire whether the known eversion operations according to Jaboulay or Kocher for the treatment of idiopathic hydrocele of the testis were also suitable as organ-sparing and enduring procedures for the prophylaxis of recurrent testicular torsion.

RESULTS

In 53 out of 76 patients who were treated exclusively for testicular torsion by means of eversion orchidopexy between 1988 and 2008, no evidence of any subsequent recurrent testicular torsion or any other testicular disease was found by means of a structured questionnaire 1-21 years later. Occasional cicatricial symptoms that were of no clinical significance were found in only 5 cases (9.4%).

CONCLUSIONS

On the basis of these results it may be concluded that eversion orchidopexy can be considered to be a safe and effective method for the prophylaxis of recurrent testicular torsion in comparison to alternative methods.

Suspected testicular torsion: a survey of clinical practice in North West England

Several aspects of the management of suspected testicular torsion are controversial. A questionnaire was mailed to all 33 consultant urologists in the North West region of England to elicit their policies for routine clinical management. 29 of 33 questionnaires were returned (2 incomplete). As regards radiological investigation, 4 consultants always request ultrasound examination; the others do not favour routine imaging. When the diagnosis of testicular torsion is confirmed at operation, all consultants would perform bilateral testicular fixation, although with considerable variations in technique; most use Vicryl sutures (66%) and three-point fixation (57%). One-third would do an ipsilateral orchidopexy if there was no clear evidence of testicular torsion at operation. The variation revealed by this survey prompted an attempt to formulate a protocol for management. A review of the published work indicates that, in cases of proven testicular torsion, treatment should include bilateral fixation with delayed-absorption or non-absorbable sutures; fixation should be at three points. When torsion is not found at operation, there is no evidence of benefit from orchidopexy.