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Namugosa M, Parham KJ, Matthew AN, Wilson B, Fogg R, Nelson ED. Surgical management of extravaginal testicular torsion in a 16-year-old male: a case report. Urology 2024:S0090-4295(24)00202-4. [PMID: 38555070 DOI: 10.1016/j.urology.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Extravaginal torsion (EVT) is a rare type of testicular torsion that usually occurs in neonates. The primary type of testicular torsion that occurs in adolescents is intravaginal torsion (IVT). In this case report, we describe the first case of EVT reported in a 16-year-old male with a contralateral bell clapper deformity and subsequent surgical management using a tunica vaginalis flap (TVF) and bilateral orchiopexy. In discussion of this case, we examine possible anatomical causes of EVT and suggestions for appropriate surgical management.
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Affiliation(s)
- Mary Namugosa
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
| | - Kevin J Parham
- Department of Urology, University of South Alabama, Mobile, AL, 36688, USA
| | - Ashley N Matthew
- Division of Urology, Virginia Commonwealth University, Richmond, Virginia 23223, United States
| | - Brandon Wilson
- Division of Urology, Virginia Commonwealth University, Richmond, Virginia 23223, United States
| | - Ryan Fogg
- Division of Urology, Virginia Commonwealth University, Richmond, Virginia 23223, United States
| | - Eric D Nelson
- Division of Urology, Virginia Commonwealth University, Richmond, Virginia 23223, United States.
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2
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Caniklioglu M, Oztekin Ü, Fırat F, Ataç F, Doğanyigit Z, Oflamaz AO. Is testicular tissue resection effective in testicular compartment syndrome? Niger J Clin Pract 2023; 26:1361-1367. [PMID: 37794551 DOI: 10.4103/njcp.njcp_170_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background There have been many testicular losses due to testicular compartment syndrome (TCS). Studies are ongoing to lower the pressure within tunica vaginalis during TCS. Aims To provide enough space for reperfusion of the testicular tissue and to reduce intratesticular pressure by resecting testicular tissue in the affected testis for treatment of TCS. Materials and Methods The study was designed as a prospective randomized animal study. A total of 24 Wistar albino adult rats were randomly divided into three groups. After torsion surgery group 1 underwent detorsion + testicular tissue resection (TTR), while only detorsion was performed in group 2. The control group did not undergo any procedures. At the postoperative 5th day all subjects were sacrificed, and their testes were evaluated in terms of histologic findings, apoptosis, and microangiogenesis. One-way ANOVA and Tukey's test were used for analysis. Results According to Johnsen scores, all the groups were statistically different from each other and the damage in group 1 was less than in group 2 (P < 0.05). Factor VIII expressions in surgical groups were significantly higher than in the control group (P < 0.05). However, the surgical groups did not show any significant difference between each other (P > 0.05). Apoptotic cell counts were higher in both surgical groups than in the control group. Also, there was significantly higher apoptotic cell count in group 2 than in group 1 (P < 0.05). Conclusions The injury secondary to TCS is lower when TTR is performed. In the cases in which tunica vaginalis graft could not be obtained or in the delayed cases, TTR may be useful.
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Affiliation(s)
- M Caniklioglu
- Departments of Urology, Yozgat Bozok University, Yozgat, Turkey
| | - Ü Oztekin
- Urology Clinic, Kayseri System Hospital, Kayseri, Turkey
| | - F Fırat
- Department of Urology, Tokat State Hospital, Tokat, Turkey
| | - F Ataç
- Department of Urology, Batman Zilan Private Hospital, Batman, Turkey
| | - Z Doğanyigit
- Histology and Embryology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - A Okan Oflamaz
- Histology and Embryology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
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Hidaka AK, Glina FPA, Hayashi RM, Smaidi K, Baccaglini W, Pazetto CL, Nascimento FJ, Glina S. Testicular decompression and tunica vaginalis flap in human acute testicular torsion: modified step-by-step technique description and preliminary outcomes. EINSTEIN-SAO PAULO 2023; 21:eAO0220. [PMID: 37585887 PMCID: PMC10421604 DOI: 10.31744/einstein_journal/2023ao0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/20/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To report the effects of a tunica vagina flap on testicular compartment syndrome. METHODS This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months. RESULTS Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed. CONCLUSION The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma. Testicular torsion causes orchiectomy in more than 80% of the cases after 24 hours of pain onset. Testicular detorsion only (P1-P2) showed a small difference in intratesticular pressure (median 4mmHg). Testicular incision (P2-P3) only demonstrated a major pressure decrease (median, 45mmHg). The final pressure after TVR was similar to the non-twisted testicle pressure (median, 1mmHg). Testicular salvage (88.9%) and atrophy (66.3%) rates were slightly higher than the previous literature reports, perhaps the initial learning curve of this novel technique.
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Affiliation(s)
- Alexandre Kyoshi Hidaka
- Centro Universitário FMABCSanto AndréSPBrazil Centro Universitário FMABC, Santo André, SP, Brazil.
| | | | - Renan Murata Hayashi
- Centro Universitário FMABCSanto AndréSPBrazil Centro Universitário FMABC, Santo André, SP, Brazil.
| | - Khalil Smaidi
- Centro Universitário FMABCSanto AndréSPBrazil Centro Universitário FMABC, Santo André, SP, Brazil.
| | - Willy Baccaglini
- Centro Universitário FMABCSanto AndréSPBrazil Centro Universitário FMABC, Santo André, SP, Brazil.
| | - Cristiano Linck Pazetto
- Centro Universitário FMABCSanto AndréSPBrazil Centro Universitário FMABC, Santo André, SP, Brazil.
| | - Fabio José Nascimento
- Centro Universitário FMABCSanto AndréSPBrazil Centro Universitário FMABC, Santo André, SP, Brazil.
| | - Sidney Glina
- Centro Universitário FMABCSanto AndréSPBrazil Centro Universitário FMABC, Santo André, SP, Brazil.
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Kameoka Y, Yoshimura S, Matsufuji H, Umeyama T, Machigashira S, Yada K. Criteria for Preserving Grossly Ischemic Torsed Testicles Using Indocyanine Green Fluorescence Imaging: A Single-Center Case Series. Urology 2023; 178:133-137. [PMID: 37030579 DOI: 10.1016/j.urology.2022.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 04/10/2023]
Abstract
Testicular torsion (TT) is a surgical emergency requiring early diagnosis and surgical intervention to avoid testicular loss. We report 3 pediatric TT cases with testicular salvage to visualize the blood flow by indocyanine green fluorescence imaging (ICG-FI) on the tunica albuginea of the testis. ICG-FI could not confirm blood flow in the testicular parenchyma; however, it could be detected in postoperative ultrasonography. Blood visualization of the tunica albuginea by ICG-FI may have potential criteria for testicular salvage. Long-term follow-up investigations after testicular salvage are needed to conclude the ICG-FI efficacy for TT.
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Affiliation(s)
- Yasuyuki Kameoka
- Department of Pediatric Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Shohei Yoshimura
- Department of Pediatric Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroshi Matsufuji
- Department of Pediatric Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoshige Umeyama
- Department of Pediatric Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Seiro Machigashira
- Department of Pediatric Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Keigo Yada
- Department of Pediatric Surgery, St. Luke's International Hospital, Tokyo, Japan.
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5
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Kim KM, Kim JH. Collagen fleece (Tachosil ®) for treating testis torsion: A case report. World J Clin Cases 2023; 11:4306-4312. [PMID: 37449221 PMCID: PMC10337006 DOI: 10.12998/wjcc.v11.i18.4306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/13/2023] [Accepted: 04/14/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Testicular torsion is an emergent disease in urology, and there has been discussion of the treatment of testicular torsion. Testicular decompression has been established as a critical treatment for testicular compartment syndrome (TCS), which occurs after detorsion in a patient who is diagnosed with testis torsion. Until now, testicular fasciotomy and incision of tunica albuginea with tunica vaginalis flap (TVF) graft have been suggested for decompression, and some studies about the efficacy of TVF were reported. However, this method is time consuming and needs meticulous technique, so other methods such as orchio-septopexy are suggested. The objective of this clinical case report was to propose new surgical method using collagen fleece (Tachosil®) instead of tunica vagina flap.
CASE SUMMARY A 5-year-old boy with scrotal pain visited our hospital 24 h after symptom onset. After history taking, physical examination, and scrotum ultrasonography, he was diagnosed with testis torsion. Emergency surgery was performed after diagnosis. Following the incision of scrotum and fasciotomy, we covered his tunica albuginea with collagen fleece called Tachosil® instead of covering with TVF.
CONCLUSION Short-term follow-up showed normal blood flow in testis without a TCS. This is the first case report of using Tachosil® in testicular torsion surgery, and its advantages were already reported in other surgeries like Peyronie’s disease. Our case suggests this new technique is an appropriate method because of its advantages including its cost-effective and time-saving characteristics. The main limitation is the short follow-up, so more studies are needed to provide a high level of evidence about its efficacy and safety.
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Affiliation(s)
- Ki Min Kim
- Department of Urology, Soonchunhayng University Seoul Hospital, Seoul 04410, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhayng University Seoul Hospital, Seoul 04410, South Korea
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Phan D, Saxton A, Rabinowitz R, Quarrier SO. Testicular Compartment Syndrome After Trauma Managed With a Tunica Vaginalis Flap. Urology 2023; 176:175-177. [PMID: 36822244 DOI: 10.1016/j.urology.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 02/23/2023]
Abstract
Testicular compartment syndrome requires timely diagnosis and intervention but may be challenging. We present a case discussing the presentation and management of testicular compartment syndrome following testicular trauma in an 11-year-old male. The patient presented 24 hours after testicular trauma from a kick with testicular enlargement and sharp pain. Ultrasound showed markedly decreased blood flow and a reactive hydrocele. Testis-sparing intervention included emergent tunica albuginea incision, debridement, and tunica vaginalis flap.
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Affiliation(s)
- Dennis Phan
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Aaron Saxton
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Ronald Rabinowitz
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Scott O Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, NY.
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7
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Suzuki I, Kijima T, Shimoda H, Imasato N, Kokubun H, Kamai T. A case of testicular torsion successfully treated with tunica albuginea incision and tunica vaginalis patch. Urol Case Rep 2023; 47:102373. [PMID: 36941870 PMCID: PMC10023861 DOI: 10.1016/j.eucr.2023.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Previous studies indicated the occurrence of compartment syndrome after testicular detorsion. In such cases, testicular blood flow may improve with tunica albuginea incision. A 14-year-old man presented with right-sided testicular torsion. No improvement in testicular appearance after detorsion led to a tunica albuginea incision for immediate recovery of testicular blood flow. The affected testis, covered with a tunica vaginalis patch, exhibited no atrophy at the 6-month follow-up. Magnetic resonance imaging revealed that the affected testis had blood flow comparable to that on the unaffected side. This technique is useful for avoiding orchiectomy in testes with poor blood flow after detorsion.
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8
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Abidoğlu S, Karagözlü Akgül A. Close Range Gun Shot Injury Bilateral Ruptured Testis Repair Using Tunica Vaginalis Flap. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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Elifranji M, Abbas T, Leslie B, Vallasciani S, El Kadhi A, Pippi-Salle JL. Orchio-Septopexy: A new technique to cover and fix detorsed testis undergoing fasciotomy of tunica albuginea. Int Braz J Urol 2022; 48:706-711. [PMID: 35373956 PMCID: PMC9306361 DOI: 10.1590/s1677-5538.ibju.2022.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose Compartment Syndrome (CS) has been recognized as a potential factor that worsens testicular viability after detorsion, especially in borderline cases of prolonged ischemia. Fasciotomy of the testicular tunica albuginea to relieve the pressure associated with CS has been proposed to accommodate edema after detorsion, embracing the raw fasciotomy area with tunica vaginalis flap (TVF) or graft. Fashioning the TVF can be tedious in cases of severe scrotal edema. Herein we present a technique that facilitates and expedites the procedure, maintaining the fasciotomy area decompressed. Materials and Methods In testicular torsion, where the testis remains with dark coloration and questionable viability after detorsion a longitudinal releasing incision is made in the tunica albuginea (fasciotomy) to decrease compartmental pressure. If signs of parenchymal recovery (bleeding points, better color) are seen an orchio-septopexy is performed, suturing the incised albuginea’s edges to the septum with a running suture, avoiding CS as well as re-torsion. Results Orchio-septopexy was performed in 11 cases with a mean age of 11.9 years (3-17). All cases had clinic follow-up and testicular Doppler US with a mean of 9.5 months (6-24). 6/11 cases (54%) were salvaged, with good vascularity in the Doppler US and maintained more than 50% testicular volume compared to the contralateral side. Conclusion Orchio-septopexy after testicular fasciotomy is a simple and fast technique that can be utilized in cases of prolonged testicular ischemia and questionable viability. More than half of the testes recovered, encouraging us to propose its utilization as well as its validation by other surgeons.
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Affiliation(s)
- Mohammed Elifranji
- Department of Surgery, Division of Pediatric Urology, Sidra Medicine, Doha, Qatar
| | - Tariq Abbas
- Department of Surgery, Division of Pediatric Urology, Sidra Medicine, Doha, Qatar
| | - Bruno Leslie
- Department of Surgery, Division of Pediatric Urology, Sidra Medicine, Doha, Qatar
| | - Santiago Vallasciani
- Department of Surgery, Division of Pediatric Urology, Sidra Medicine, Doha, Qatar
| | - Abderrahman El Kadhi
- Department of Surgery, Division of Pediatric Urology, Sidra Medicine, Doha, Qatar
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10
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Testicular volume loss in the long-term follow-up after surgical detorsion of the testis. Pediatr Surg Int 2022; 38:907-911. [PMID: 35366086 DOI: 10.1007/s00383-022-05118-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
AIM The aim of this study is to evaluate sonographic testicular volume of patients who underwent surgical detorsion due to testicular torsion and to reveal the frequency of long-term testicular volume loss and the factors affecting it. METHOD The files of patients who underwent surgical detorsion due to unilateral testicular torsion in our hospital between 2011 and 2019 were reviewed retrospectively. Age at the time of detorsion surgery, time from the onset of pain to surgery, degree of torsion, and ultrasonographic testicular volumes before detorsion were noted. Afterward, patients with at least 6 months of follow-up were contacted by phone and testicular volumes were measured by scrotal ultrasonography (US). The sonographic formula Length × Width × Height × 0.72 was used to determine testicular volumes. RESULTS There were 97 patients who underwent surgical detorsion within the given time frame. However, 43 of these patients accepted to be involved in the study and a follow-up scrotal US was performed. The mean age at the time of detorsion was 13.6 ± 5.6 years, whereas it was 16.7 ± 6.2 years at the time of the follow-up visit. The median time from the onset of pain to surgery was 4 h (range 1-36 h). In the preoperative US, the mean volume of the affected testis was 10.8 ± 5.6 mm3, while the mean contralateral testis volume was 10.2 ± 5.4 mm3 (p = 0.134). The median follow-up time in our study was 24 months (range 6-96 months). In the control US, the mean volume of the affected testis was 9.5 ± 7.1 mm3, while the mean volume of the contralateral testis was 14.4 ± 9 mm3 (p = 0.001). The affected testicular volumes decreased in 23 patients (range 1.1-100%), there was no change in testicular volumes in two patients, and there was an increase in testicular volumes in 18 patients (range 3.8-100%). In the ROC analysis, risk of testicular volume loss can be predicted with 87.5% sensitivity and 83.9% specificity when the time from the onset of pain to surgery exceeds 5.5 h (AUC = 0.904). CONCLUSION Our results indicated that if the time from the onset of pain to surgery exceeds 5.5 h, the testicular volume loss may be expected in the long term. Thus, patients and parents should be informed accordingly.
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Soltani M, Rahmati M, Nikravesh MR, Nejat SS, Jalali M. Autophagy comparative after decompression of tunica albuginea in testicular torsion in mature and immature rat. Surgery 2022; 172:427-435. [DOI: 10.1016/j.surg.2022.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
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12
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Kylat RI, Ahmed MN. Neonatal testicular torsion. Afr J Paediatr Surg 2022; 19:1-4. [PMID: 34916342 PMCID: PMC8759414 DOI: 10.4103/ajps.ajps_153_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rotation of the testis around the axis of the spermatic cord results in tissue ischaemia and testicular torsion (TT). TT in the newborn infant in the 1st month of life is referred to as neonatal TT (NTT) or perinatal TT and occurs in 6.1/100, 000 live births. The true incidence could be higher as some of these occur prenatally and can be asymptomatic. TT can be extravaginal, intravaginal and mesorchial and NTT is usually extravaginal. Physical examination can be adequate for the diagnosis, and utility of ultrasound (US) is mainly to exclude other conditions. If the timing of the torsion is prenatal, the testicle may not be salvageable. But, in certain situations, these could be asymptomatic bilateral TT. When the timing of torsion is not simultaneous (asynchronous torsion) early contralateral orchiopexy done at the time of exploration would prevent the occurence of asynchronous torsion. Non.operative maneuvres to detorse in NTT are not successful and not recommended. This review focuses on the diagnostic approach and management.
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Affiliation(s)
- Ranjit I Kylat
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, w, Tucson
| | - Mohamed N Ahmed
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, w, Tucson
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13
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Osemlak P, Jędrzejewski G, Woźniak M, Nachulewicz P. Ultrasound evaluation of long-term outcome in boys operated on due to testicular torsion. Medicine (Baltimore) 2021; 100:e26057. [PMID: 34032733 PMCID: PMC8154497 DOI: 10.1097/md.0000000000026057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
We aimed at verifying the usefulness of spectral Doppler ultrasonography in determining development of the testis after torsion in boys.The study involved 28 patients and 30 control cases divided into 3 developmental groups: pre-pubertal, early pubertal, and pubertal. It presented surgical management in testicular torsion (TT), volume, and echogenicity of testes, as well as peak-systolic velocity (PSV), end-diastolic velocity (EDV), and vascular resistance index (RI) in the capsular and intra-testicular arteries, regarding developmental groups, detorsed testes, uninvolved ones, and testes in the control group.Orchiectomy was performed in 13 boys with complete TT, in 11 lasting for over 24 hours, and in 2 lasting for 9 and 10 hours, respectively. Orchiectomy mainly involved patients aged up to 6 years, who at the time of the follow-up ultrasound belonged to the pre-pubertal group.There is no clear correlation between the type of testicular torsion, its duration, and the echogenicity of the testis. Testicular torsion has a negative effect on the volume of detorsed testis with compensatory hypertrophy of the uninvolved testis. The study represents a new approach to the issue of long-term gonadal blood supply abnormalities after treatment of testicular torsion in childhood.
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Affiliation(s)
- Paweł Osemlak
- The Department of Pediatric Surgery and Traumatology
| | - Grzegorz Jędrzejewski
- The Department of Pediatric Radiology, University Children's Hospital of Lublin, Medical University of Lublin, Lublin, Poland
| | - Magdalena Woźniak
- The Department of Pediatric Radiology, University Children's Hospital of Lublin, Medical University of Lublin, Lublin, Poland
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Thaker H, Nelson CP. Adjuvant pharmacological and surgical therapy for testicular torsion: Current state of the art. J Pediatr Urol 2020; 16:807-814. [PMID: 32861587 PMCID: PMC8048197 DOI: 10.1016/j.jpurol.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although the consequences of testicular torsion (TT) have been recognized for centuries, little progress has been made to improve outcomes beyond those seen with timely scrotal exploration. Even with testicular salvage, ischemia/reperfusion injury cause significant atrophy and functional impairment. Recent efforts have sought to identify adjuvant pharmacological or surgical interventions that may attenuate these consequences. In this review, we assess the evidence supporting clinical use of these nascent interventions. METHODS We conducted a review of the literature published from 2000 to 2020, using the search terms "torsion", "testicular", "reperfusion", "ischemia", and "injury". Clinical and laboratory research focused on adjuvant pharmacological and surgical techniques mitigating torsion-associated injury in animal models and humans were identified. We recorded intervention timing/dose/route, and outcome timing/category through biomarkers of reperfusion injury, histology, and hormonal/reproductive function. RESULTS Fifty-four FDA-approved agents, plus 52 herbal/investigational drugs, were reported in animal TT models. In every study, the investigated agents showed beneficial effects on measured endpoints compared to controls. Despite these universally promising animal findings, no pharmacological trials in humans were reported. Surgical techniques studied in animal models included decompression (tunica albuginea incision, TAI), "ischemic conditioning", and hypothermia. Only three human studies on surgical adjuvant maneuvers have been reported, all involving TAI; these showed potential benefit, but the level of evidence is low. CONCLUSION There is preliminary evidence that adjuvant treatments may mitigate the effects of ischemia/reperfusion injury. However, the pool of investigated pharmacological agents is wide, yet remarkably shallow; most compounds have been reported in a single animal study. To advance this field, a mechanism-based approach should be used to select promising agents that can be tested systematically. This will determine treatment parameters that maximize safety, efficacy, and tolerability. Only then is it possible to move toward human trials. Adjuvant surgical methods such as TAI show promise in humans but require more robust clinical evaluation.
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Affiliation(s)
- Hatim Thaker
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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15
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Kylat RI. Perinatal testicular torsion. Arch Pediatr 2020; 28:75-79. [PMID: 33277134 DOI: 10.1016/j.arcped.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/27/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022]
Abstract
Testicular torsion (TT) occurs when the testis rotates around the axis of the spermatic cord attachments and prevents blood flow to the testis, resulting in tissue ischemia. If this occurs in the first month of life it is referred to as "perinatal TT" (PTT) or "neonatal TT" (NTT). PTT has an incidence of 6.1 per 100,000 live births. Some of these cases occur prenatally. It can be missed on the initial newborn examination, as it can be asymptomatic. Hence, the true incidence is much higher since it is underdiagnosed. The types of TT include extravaginal, intravaginal, and mesorchial. Most cases of PTT are extravaginal. The diagnosis can generally be made on physical examination. Ultrasonography (US) can help exclude other rare diagnoses as long as surgical intervention is not delayed. There has been some debate regarding the timing of surgery. Although the torsed testicle may not be salvageable, the likelihood of asymptomatic bilateral TT has to be borne in mind and contralateral orchiopexy done at the time of exploration would prevent an asynchronous torsion. Nonoperative maneuvers to detorse in PTT are not recommended. The evaluation, diagnostic approach, and management of this relatively rare condition are described.
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Affiliation(s)
- R I Kylat
- Department of Pediatrics, University of Arizona, College of Medicine, PO BOX 245073, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
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Tian XM, Tan XH, Shi QL, Wen S, Lu P, Liu X, Li XL, He DW, Lin T, Wei GH. Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy. Front Pediatr 2020; 8:584796. [PMID: 33262963 PMCID: PMC7686235 DOI: 10.3389/fped.2020.584796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/29/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: To analyze the risk factors for testicular atrophy (TA) in children with testicular torsion (TT) following emergent orchiopexy. Methods: Clinical data of patients with TT undergoing orchiopexy were retrospectively reviewed, including age at surgery, affected side, delayed surgery (12-24 h and more than 24 h), echogenicity of testicular parenchyma on ultrasonography (ETPU), testicular blood flow on Color Doppler ultrasonography (CDUS), surgical findings (intraoperative blood supply, the degree of torsion, and surgical approaches), and follow-up. The primary outcome was the rate of TA after orchiopexy. The secondary outcome was the testicular volume loss (TVL) between the affected testis and the contralateral. Results: A total of 113 patients were enrolled in this study with a median age of 11 years. The median follow-up was 21 months. Patients had a median TVL of 51.02% and 44 (38.94%) of them developed severe TA during follow-up. TA was significantly associated with age at surgery (P < 0.0001), delayed surgery (P = 0.0003), ETPU (P = 0.0001), and intraoperative blood supply (P = 0.0005). Multivariate logistic regression analysis showed that school-age children (OR = 0.069, P < 0.001) and puberty (OR = 0.177, P = 0.007) had a decreased risk of TA compared with preschool children, and that heterogeneous ETPU (OR = 14.489, P = 0.0279) and delayed surgery >24 h (OR = 3.921, P = 0.040) increased the risk of TA. Multivariate analysis demonstrated that ETPU (F = 16.349, P < 0.001) and delayed surgery (F = 6.016, P = 0.003) were independent risk factors for TVL. Conclusions: Age at surgery, delayed surgery, and ETPU may play a crucial role in predicting the TA in children with TT following emergent orchiopexy. Moreover, blood flow measured by CDUS could not predict the outcome properly.
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Affiliation(s)
- Xiao-Mao Tian
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Medical University, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Xiao-Hui Tan
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qin-Lin Shi
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Medical University, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Sheng Wen
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Lu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Medical University, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Xu-Liang Li
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Da-Wei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Medical University, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Medical University, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Medical University, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
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Affiliation(s)
- Grace S Hyun
- Department of Pediatric Urology, NYU Langone Hospital-Brooklyn Brooklyn, NY
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18
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Osumah TS, Jimbo M, Granberg CF, Gargollo PC. Frontiers in pediatric testicular torsion: An integrated review of prevailing trends and management outcomes. J Pediatr Urol 2018; 14:394-401. [PMID: 30087037 DOI: 10.1016/j.jpurol.2018.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
Testicular torsion remains the most frequent cause of testicular ischemia, especially in adolescents and young adults. Timely diagnosis and intervention are keys to saving the affected testicle. This review presents current trends in the diagnosis and treatment of torsion, potential pitfalls and consequent outcomes. Additionally, other salient issues surrounding testicular torsion are also discussed, including: pathogenesis of injury, legal ramifications, fertility outcomes, novel management techniques, and recent advances in diagnostic technology.
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Affiliation(s)
- T S Osumah
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - M Jimbo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - C F Granberg
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - P C Gargollo
- Department of Urology, Mayo Clinic, Rochester, MN, USA.
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