[Diagnosis and treatment of 109 cases of testicular torsion in children and adolescents]

OBJECTIVE

To investigate the diagnosis and treatment of testicular torsion in children and adolescents and to analyze the postoperative outcomes.

METHODS

We retrospectively analyzed 109 cases of unilateral testicular torsion treated in our hospital between 2015 and 2017, including 62 cases of left (56.9%) and 47 cases of right torsion (43.1%), and 98 cases of intravaginal (89.9%) and 11 cases of extravaginal torsion (10.1%), clinically 96 cases with scrotal pain (88.1%), 70 with scrotal redness and swelling (64.2%), 25 with abdominal pain (22.9%), and 33 with nausea and vomiting (30.3%). The patients ranged in age from 4 days to 15 years, averaging 9.7 ± 3.3 years, and fell into 3 groups according to the time of onset: <12 h, 12－24 h and >24 h. We analyzed the results of scrotal ultrasonography, clinical manifestations, and intraoperative and follow-up data of the patients.

RESULTS

Scrotal ultrasonography showed no or decreased testicular blood flow in 96 cases (88.1%) and unconspicuously reduced testicular blood flow with scrotal wall thickening and vaginal sac effusion in 13 cases (11.9%). Eighty-three (76.1%) of the patients were treated by orchiectomy and the other 26 by testis-sparing surgery. Of the latter 26 cases, 2 were lost to follow-up, 16 (66.6%) achieved testis survival, and 8 (33.3%) developed testicular atrophy at 6 months after surgery. The rates of orchiectomy were 9.1%, 47.4% and 92.4%, and the incidences of postoperative testicular atrophy were 10.0%, 25.0% and 83.3% in the <12 h, 12－24 h and >24 h groups, respectively, both with statistically significant differences among the three groups (P < 0.01).

CONCLUSIONS

Testicular torsion is common in children and adolescents, with clinical symptoms of scrotal pain, scrotal redness, abdominal pain, and nausea and vomiting. Scrotal ultrasonography can effectively display the status of testicular blood flow, and surgery is the most accurate treatment. Testis-sparing surgery is most valuable for the cases with the onset time of <12 hours, while orchiectomy is preferable for those with the onset time of >24 hours.

[Clinical characterization of incomplete testicular torsion in children]

OBJECTIVE

To analyze the clinical characteristics of incomplete testicular torsion (ITT) in children in order to gain a deeper insight into the disease.

METHODS

This retrospective study included 37 children with ITT treated in our hospital from April 2007 to April 2017. We analyzed the clinical characteristics and results of physical examination, laboratory examination, ultrasonography and treatment.

RESULTS

The patients were aged 1－14 (mean 5.7) years, with a high incidence of ITT at 2－4 and 12－14 years and a disease course of 12－96 (48 ± 8) hours. Preoperative color Doppler ultrasonography showed reduced blood flow signals in the affected testis in 31 cases (83.8%) and transverse testis with normal blood flow signals in the other 6 (16.2%). Anticlockwise torsion was found in 27 cases (72.9%), clockwise torsion in 10 (27.1%), 90-degree torsion in 7 (18.9%), 180-degree torsion in 20 (54.0%), 270-degree torsion in 10 (27.1%), intravaginal torsion in 31 (83.8%) and extravaginal torsion in 6 (16.2%). According to Arda's three grades of testicular tissue bleeding, 16 cases (43.3%) were categorized as grade Ⅰ and 21 (56.7%) as grade Ⅱ, and so the affected testes were preserved in all the cases during the operation. The patients were followed up for 12 months postoperatively, which revealed testicular atrophy in 6 cases (16.2%).

CONCLUSIONS

ITT occurs in children at a young age, of less than 360 degrees in all cases, mostly 180 degrees, and the survival rate of the affected testis is high after surgery. Reduction in testicular blood flow signals at preoperative color Doppler examination is an important indication in the diagnosis of the disease.

[Testicular torsion of <360 degrees in children: A 10-year single-center retrospective study]

OBJECTIVE

To further understand the clinical features of <360-degree testicular torsion (TT) in children and better predict its prognosis.

METHODS

This retrospective study included 73 cases of TT surgically confirmed in our hospital from January 2007 to January 2017, which, according to the inclusion and exclusion criteria, were divided into groups A (TT of <360 degrees, n = 26) and B (TT of ≥360 degrees, n = 47). We sorted out the clinical data through the hospital medical information management system and analyzed the clinical characteristics and treatment of the cases.

RESULTS

Compared with the children of group B, those of group A had a significantly younger median age of TT onset (11.2 vs 2.4 yr, P < 0.01), a longer course of disease (［12 ± 6］ vs ［80 ± 12］ h, P < 0.01), and a lower rate of testis loss (91.1% vs 12%, P < 0.01).

CONCLUSIONS

Testicular torsion of <360 degrees mainly develops in children aged 2－3 years, with a long course of disease but a high rate of testicular survival after surgical treatment. Color Doppler ultrasonography has an important value in the diagnosis of the disease by revealing decreased blood flow signals.