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Pyrgidis N, Apfelbeck M, Stredele R, Rodler S, Kidess M, Volz Y, Weinhold P, Stief CG, Marcon J, Schulz GB, Chaloupka M. The impact of health care on outcomes of suspected testicular torsion: results from the GRAND study. World J Urol 2024; 42:309. [PMID: 38722366 PMCID: PMC11082016 DOI: 10.1007/s00345-024-05015-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/20/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Suspicion of testicular torsion represents a urological emergency, necessitating immediate surgery. Comprehensive data on the current trends and perioperative outcomes regarding surgical exploration are sparse. Therefore, we utilized nationwide data on the prevalence and results of this surgery, aiming to provide evidence on this matter. METHODS We assessed the GeRmAn Nationwide inpatient Data (GRAND) from 2005 to 2021, provided by the Research Data Center of the Federal Bureau of Statistics. We performed multiple regression analyses to evaluate the perioperative outcomes (length of hospital stay, transfusion, and surgical wound infection) after surgical exploration due to suspected testicular torsion based on both the outcome of surgery (orchiectomy, detorsion with preservation of the testicle, and no testicular torsion) and on the department of operation (urological versus non-urological). RESULTS A total of 81,899 males underwent surgical exploration due to suspected testicular torsion in Germany from 2005 to 2021. Of them, 11,725 (14%) underwent orchiectomy, 30,765 (38%) detorsion with preservation of the testicle and subsequent orchidopexy, and 39,409 (48%) presented no testicular torsion. Orchiectomy was significantly associated with longer length of hospital stay (day difference of 1.4 days, 95%CI: 1.3-1.4, p < 0.001), higher odds of transfusion (1.8, 95% CI: 1.2-2.6, p = 0.002) and surgical wound infections (1.8, 95%CI: 1.4-2.3, p < 0.001) compared to no testicular torsion. The proportion of patients undergoing orchiectomy was significantly lower in urological departments (14%) versus non-urological departments (16%) and the proportion of patients undergoing preservation of testicle after detorsion was significantly higher in urological departments (38%) versus non-urological departments (37%), p < 0.001. Patients undergoing treatment in a urological department were discharged earlier and presented lower odds of transfusion and surgical wound infection (p < 0.001) compared to patients undergoing treatment in a non-urological department. CONCLUSIONS Nearly half of patients who underwent surgery for suspected testicular torsion did not have intraoperatively the condition confirmed. Patients treated in urological departments had significantly better perioperative outcomes compared to those treated in non-urological departments. Therefore, we advise to refer patients to urological treatment as early as possible.
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Affiliation(s)
- Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany.
| | - Maria Apfelbeck
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Regina Stredele
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Severin Rodler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Marc Kidess
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Yannic Volz
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Gerald B Schulz
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Chaloupka
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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Takeshita H. Editorial Comment on A nomogram for predicting risk factors of testicular salvage after testicular torsion in children. Int J Urol 2024; 31:575. [PMID: 38627934 DOI: 10.1111/iju.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Hideki Takeshita
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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Chen P, Huang W, He Y, Sun M, Sun X, Huang Y, Li S. A nomogram for predicting risk factors of testicular salvage after testicular torsion in children. Int J Urol 2024; 31:568-574. [PMID: 38339874 DOI: 10.1111/iju.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES This study aimed to establish a nomogram for predicting the probability of testicular salvage after testicular torsion in children. METHODS We retrospectively collected data of children with testicular torsion who were treated at Shenzhen Children's Hospital between September 2005 and August 2022. Of the training cohort, 113 patients who underwent orchiectomy and five with testicular atrophy after orchiopexy were included in the failed testicular salvage group. Additionally, 37 patients who underwent orchiopexy without postoperative testicular atrophy were included in the successful testicular salvage group. The predictive factors affecting testicular salvage were determined using univariate and multivariate logistic regression analyses; a nomogram was constructed. The nomogram was verified using data from the validation group. RESULTS Using multivariate logistic regression analysis, the independent risk factors of testicular salvage after testicular torsion were symptom duration (p = 0.034), intratesticular blood flow (p = 0.003), spermatic cord torsion degree (p = 0.037), and monocyte count (odds ratio: 0.012, p = 0.036). A nomogram was established based on these four risk factors. In the training cohort, the area under the receiver operating characteristic curve was 0.969. The area under the receiver operating characteristic curve of the verification cohort was 0.965, indicating good discrimination ability of the nomogram. Increased symptom duration without intratesticular blood flow increased the monocyte count and spermatic cord torsion degree and decreased the success rate of testicular salvage. CONCLUSION This prediction model could obtain the corresponding probability of testicular salvage according to the clinical characteristics of different patients with testicular torsion, providing reference for clinicians and parents.
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Affiliation(s)
- Pengyu Chen
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Weipeng Huang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yingying He
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Mengkui Sun
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xuerui Sun
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yiyan Huang
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Shoulin Li
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
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Heckscher D, Jalfon M, Buck MB, Abello A, Nguyen JV, Casilla-Lennon M, Leapman MS, Hittelman AB, Teitelbaum J, Emerson BL, Kenney PA, Cavallo JA, Lambert S. Implementation of a health system intervention to reduce time from presentation to surgical intervention for pediatric testicular torsion. J Pediatr Urol 2024; 20:254.e1-254.e7. [PMID: 38030428 DOI: 10.1016/j.jpurol.2023.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Testicular salvage rates for torsion are time-dependent1. Door to detorsion time has been identified as an independent testicular survival factor2. We describe an initiative to reduce door to incision (DTI) time for pediatric testicular torsion. MATERIALS AND METHODS An institutional multidisciplinary quality improvement initiative with a primary outcome of reducing DTI time for pediatric testicular torsion was developed with multidisciplinary stakeholders. Several process and balancing measures were used as secondary outcomes to help interpret and verify the observed change in DTI time. Interventions were implemented in cycles. Initial interventions standardized assessment of suspected torsion by Emergency Medicine utilizing a validated scoring system. A threshold Testicular Workup for Ischemia and Suspected Torsion (TWIST) score led to parallel notification of essential services for rapid assessment and case prioritization3. Subsequently, bedside ultrasound in the Emergency Department was implemented. Progress was tracked in a live dashboard and analyzed with X-mR process control charts and Nelson rules. These tools are used in quality improvement and process control to demonstrate the significance of changes as they are being implemented, prior to when traditional hypothesis testing would be able to do so. We aimed to increase the proportion of cases with DTI times under 4 h from 64% to >90% within one year. RESULTS We observed 22 torsion cases prior to and 62 following initial implementation. The percentage of cases with DTI times under 4 h improved from 64% to 95%. At week 29, a shift identified a significant change on the X chart, with reduction in mean DTI time from 221 to 147 min. At the same time, a shift on the mR chart identified reduction in patient-to-patient variation. Mean time from arrival to Urology evaluation decreased from 140 to 56 min, mean time from arrival to scrotal ultrasound decreased from 70 to 36 min, and mean time from scrotal ultrasound to surgical incision decreased from 128 to 80 min. These improvements highlight the two key successes of our project: application of the TWIST score and bedside ultrasound for rapid assessment of suspected testicular torsions, and parallel processing of the evaluation and management. CONCLUSIONS Implementation of a protocol for pediatric testicular torsion increased the proportion of cases with DTI time <4 h to 95%, decreased mean DTI time, and decreased variation. Our protocol provides a model to improve timeliness of care in treating pediatric testicular torsion.
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Affiliation(s)
| | | | | | | | | | | | - Michael S Leapman
- Yale University School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, West Haven and Newington, CT, USA
| | | | | | | | | | - Jaime A Cavallo
- Yale University School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, West Haven and Newington, CT, USA.
| | - Sarah Lambert
- Yale University School of Medicine, New Haven, CT, USA
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Moran GW, Wang CN, Chung R, Movassaghi M, Carpenter CP, Finkelstein JB. Atypical Presentation Delays Treatment of Pediatric Testicular Torsion. Pediatr Emerg Care 2024; 40:255-260. [PMID: 37195643 DOI: 10.1097/pec.0000000000002969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE The aim of the study is to identify patient- and care-related factors associated with time to treatment for acute testicular torsion and the likelihood of testicular loss. METHODS Data were retrospectively collected for patients 18 years and younger who had surgery for acute testicular torsion between April 1, 2005, and September 1, 2021. Atypical symptoms and history were defined as having abdominal, leg, or flank pain, dysuria, urinary frequency, local trauma, or not having testicular pain. The primary outcome was testicular loss. The primary process measure was time from emergency department (ED) triage to surgery. RESULTS One hundred eleven patients were included in descriptive analysis. The rate of testicular loss was 35%. Forty-one percent of all patients reported atypical symptoms or history. Eighty-four patients had adequate data to calculate time from symptom onset to surgery and time from triage to surgery and were included in analyses of factors affecting risk of testicular loss. Sixty-eight patients had adequate data to evaluate all care-related time points and were included in analyses to determine factors affecting time from ED triage to surgery. On multivariable regression analyses, increased risk of testicular loss was associated with younger age and longer time from symptom onset to ED triage, while longer time from triage to surgery was associated with reporting atypical symptoms or history.The most frequently reported atypical symptom was abdominal pain, in 26% of patients. These patients were more likely to have nausea and/or vomiting and abdominal tenderness but equally likely to report testicular pain and swelling and have testicular findings on examination. CONCLUSIONS Patients presenting to the ED with acute testicular torsion reporting atypical symptoms or history experience slower transit from arrival in the ED to operative management and may be at greater risk of testicular loss. Increased awareness of atypical presentations of pediatric acute testicular torsion may improve time to treatment.
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Affiliation(s)
- George W Moran
- From the Department of Urology, Columbia University Irving Medical Center
| | - Connie N Wang
- From the Department of Urology, Columbia University Irving Medical Center
| | - Rainjade Chung
- From the Department of Urology, Columbia University Irving Medical Center
| | - Miyad Movassaghi
- From the Department of Urology, Columbia University Irving Medical Center
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Dong X, Wang G, Xie T, Zhang S. A seminoma with the initial clinical manifestation of testicular torsion. Asian J Surg 2024; 47:1526-1527. [PMID: 38065738 DOI: 10.1016/j.asjsur.2023.11.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Xiaoyong Dong
- Department of Urology, The Ninth People's Hospital of Chongqing, Chongqing, China.
| | - Gang Wang
- Department of Urology, The Ninth People's Hospital of Chongqing, Chongqing, China
| | - Tiejun Xie
- Department of Urology, The Ninth People's Hospital of Chongqing, Chongqing, China
| | - Song Zhang
- Department of Pathology, The Ninth People's Hospital of Chongqing, Chongqing, China
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7
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Barbosa RG, Favorito LA, Sampaio FJB. Morphometric study applied to testicular and epididymis hydatids torsion. Sci Rep 2024; 14:3249. [PMID: 38332206 PMCID: PMC10853171 DOI: 10.1038/s41598-024-52734-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
Twisted testicular appendages had difficult differential diagnosis with testicular torsion. The objective of this paper is to evaluate the number, shape, size and determine the laterality pattern of the testicular and epididymal hydatids and evaluate the correlations between the length and width of the testicular and epididymal hydatids with testicular measurements. We analyzed 60 fixed cadavers and 16 patients with prostate cancer without previous hormonal treatment undergoing bilateral orchiectomy, totalizing 76 units and 152 testicles. In relation to the testicular appendices, we analyzed the following situations: absence of testicular and epididymis appendages, presence of a testicular appendix, presence of epididymis appendix, and presence of testicular and epididymis appendix. We measured the length, width and thickness of the testis and classified the appendages as sessile or pedicled. Chi-square test was used to verify associations between categorical variables. McNemar Test was used to verify differences between the percentages of right and left appendages. Correlations between quantitative measures were evaluated using the Pearson Correlation Coefficient (p < 0.05). In 50 cases (65.78%) we observed the presence of some type of appendices, in 34 cases (44.72%) we observed the presence of testicular appendices and in 19 cases (25%) the presence of epididymal appendices. We observed the presence of pedicled appendices in 39 cases (51.32%), with 25 of the cases (32.89%) of pedicled testicular appendices and 14 of the cases (18.42%) of pedicled epididymal appendages, with a significant association between the occurrence of appendices on the right and left sides (p < 0.001). Testicular hydatids were present in around two thirds of our sample being pedunculated in almost half of the cases with bilateral similarity. There is a significant chance in cases of twisted appendices that the same anatomical characteristics are present on the opposite side, which is a factor that tends to indicate the need for contralateral surgical exploration in cases of torsion, however studies with larger samples are needed to confirm these findings.
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Affiliation(s)
- Renato G Barbosa
- Urogenital Research Unit, Department of Anatomy, State University of Rio de Janeiro - UERJ, Rua Professor Gabizo, 104/201, Tijuca, Rio de Janeiro, RJ, CEP: 20271-320, Brazil
| | - Luciano Alves Favorito
- Urogenital Research Unit, Department of Anatomy, State University of Rio de Janeiro - UERJ, Rua Professor Gabizo, 104/201, Tijuca, Rio de Janeiro, RJ, CEP: 20271-320, Brazil.
| | - Francisco J B Sampaio
- Urogenital Research Unit, Department of Anatomy, State University of Rio de Janeiro - UERJ, Rua Professor Gabizo, 104/201, Tijuca, Rio de Janeiro, RJ, CEP: 20271-320, Brazil
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8
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Zhao K, Lu JY, Shkolnik B, Davis RB. Practice Patterns Affecting Delays in Care of Testicular Torsion. Urology 2024; 184:83-86. [PMID: 38043906 DOI: 10.1016/j.urology.2023.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES To compare impact of day or on-call team, pediatric or adult attending, and patient age on testicular torsion management and outcomes. METHODS A retrospective study of patients with testicular torsion between 2012 and 2022 at a single institution was conducted. Variables impacting management time were assessed using univariate analyses. RESULTS One hundred and thirty-four patients were included: 49 underwent orchiectomies and 84 underwent orchiopexies. There was no significant difference between efficiency of on-call vs day team regarding time to ultrasound or time to operating room (OR). There were no significant differences between pediatric vs adult attending surgeons for time to surgery, intraoperative length of surgery, or testicular salvage rates. However, when patients were stratified by age greater or younger than 18years, older patients had significantly longer symptom duration (91.9 vs 20.0 minutes, P = .005), time to receive an ultrasound from emergency room registration (152 vs 87 minutes, P < .001), time to OR from emergency room registration (268 vs 185 minutes, P < .001), and time to OR from ultrasound read (187 vs 123 minutes, P = .03). Older patients also had lower rates of testicular salvage approaching significance (orchiectomy rate 48.8% vs 31.5%, P = .057). CONCLUSION While no significant delays in testicular torsion management were detected between management by on-call vs day team nor pediatric vs adult attending, increased age of patient was associated with delays in definitive surgical management. Greater index of suspicion for testicular torsion diagnosis in adult patients may improve the rate of testicular salvage.
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Affiliation(s)
- Kelley Zhao
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Jennifer Y Lu
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.
| | - Brian Shkolnik
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Rachel Bennett Davis
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
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Méndez Serrano CS, Joshi P, Ngai M, Moskowitz EJ. Clinical Challenge in Urology: Management of Intermittent Testicular Torsion. Urology 2024; 183:e312-e313. [PMID: 37898322 DOI: 10.1016/j.urology.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/24/2023] [Accepted: 10/05/2023] [Indexed: 10/30/2023]
Affiliation(s)
| | - Parth Joshi
- Department of Urology, New York University Langone Hospital - Long Island, Mineola, NY
| | - Megan Ngai
- Department of Urology, New York University Langone Hospital - Long Island, Mineola, NY
| | - Eric J Moskowitz
- Department of Urology, New York University Langone Hospital - Long Island, Mineola, NY.
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Yi H, Wang D, Wu X, Gan X, Wang D, Zhao X, Cheng H. Analysis of factors associated with delayed diagnosis and treatment of testicular torsion in 1005 cases from Chongqing city, China: a cross-sectional study. Sci Rep 2023; 13:22765. [PMID: 38123616 PMCID: PMC10733420 DOI: 10.1038/s41598-023-49820-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
This study aimed to investigate the clinical and social factors of delayed treatment for testicular torsion (TT) and to explore the risk factors of testicular excision in China. The clinical data of 1005 patients with TT who were admitted to 48 medical institutions in Chongqing city (China) from January 2012 to December 2021 were retrospectively analyzed. It was revealed that the misdiagnosis rates of non-senior (junior and middle) grade doctors and senior doctors were 25.1% and 9.6%, respectively. The proportion of TT patients who received timely treatment (within 6 h after onset of symptoms) was 23.8%. The results of the multivariable logistic regression analysis indicated that absent cremasteric reflex was a protective factor for delayed surgery of more than 6 h from onset of symptoms to surgery. Misdiagnosis, consultation with a non-urologist as the first consultant doctor, absence blood flow in color Doppler ultrasound, negative high-riding testis findings, the presence of fever, and non-manual detorsion were identified as risk factors associated with delayed surgery (more than 6 h from the onset of symptoms) for TT. Furthermore, misdiagnosis, non-urologist first-consultant doctor, absent blood flow in DUS, non-manual detorsion, fever, degree of cord twisting > 180, and the initial diagnosis in tertiary hospitals were risk factors for orchidectomy. Having TT on the right side, and the presence of nausea and vomiting were identified as protective factors for orchidectomy. Technical training in the diagnosis and treatment of TT should be extended to primary hospitals and doctors to significantly improve their accuracy in managing this condition.
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Affiliation(s)
- Hongmei Yi
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Delin Wang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiaohou Wu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiangzhi Gan
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dan Wang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xin Zhao
- Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Honglin Cheng
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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11
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Oyedeji O, Alruwaii FI, Hassan O, Gupta N, Al-Obaidy KI. Chronic Testicular Vasculopathy Presenting as Acute Testicular Torsion and Mimicking Localized Vasculitis. Int J Surg Pathol 2023; 31:1505-1507. [PMID: 36823789 DOI: 10.1177/10668969231157773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Oluwayomi Oyedeji
- Department of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, MI, USA
| | - Fatimah I Alruwaii
- Department of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, MI, USA
| | - Oudai Hassan
- Department of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, MI, USA
| | - Nilesh Gupta
- Department of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, MI, USA
| | - Khaleel I Al-Obaidy
- Department of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, MI, USA
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Fachko TD, Hoang JH, Robey CL, Werner A, Williamson SH, Fox JA. Infarction of Paratesticular Inflammatory Myofibroblastic Tumor Mimicking Testicular Torsion. Urology 2023; 182:e249-e252. [PMID: 37696306 DOI: 10.1016/j.urology.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/20/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
This report describes a 14-year-old male with a rare paratesticular inflammatory myofibroblastic tumor that presented atypically with acute unilateral scrotal pain and swelling. This presentation, which raised suspicion for testicular torsion, contrasts with the typical presentation of a slow-growing scrotal mass. Scrotal exploration revealed an infarcted right testis, demonstrating this locally aggressive tumor can undergo vascular invasion and occlude testicular blood supply. Thus, inflammatory myofibroblastic tumor should be considered in the differential diagnosis when evaluating patients with acute scrotal pain suspicious for testicular infarction.
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Affiliation(s)
- Trevor D Fachko
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA.
| | - James H Hoang
- Department of Urology, Eastern Virginia Medical School, Norfolk, VA
| | | | - Alice Werner
- Department of Pediatric Pathology, Children's Hospital of The King's Daughters, Norfolk, VA
| | - Sarah H Williamson
- Department of Pediatric Urology, Children's Hospital of The King's Daughters, Norfolk, VA
| | - Janelle A Fox
- Department of Pediatric Urology, Children's Hospital of The King's Daughters, Norfolk, VA
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13
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Seizilles de Mazancourt E, Khene Z, Sbizerra M, Kaulanjan K, Plassais C, Bardet F, Pinar U, Duquesne I, Margue G, Ali Benali N, Berchiche W, Gaillard C, Wandoren W, Manuguerra A, Dang VT, Mauger de Varennes A, Hulin M, Gaillard V, Dominique I, Michiels C, Grevez T, Felber M, Vallee M, Gondran-Tellier B, Freton L, Lannes F, Pradère B, Matillon X. Cut-off time for surgery and prediction of orchiectomy in spermatic cord torsion: a retrospective multicentric study over 15 years. World J Urol 2023; 41:3789-3794. [PMID: 37897515 DOI: 10.1007/s00345-023-04671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/26/2023] [Indexed: 10/30/2023] Open
Abstract
PURPOSE Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic cord in a large cohort. METHODS We performed a retrospective multicenter study (TORSAFUF cohort) of patients with suspected spermatic cord torsion between 2005 and 2019. All patients aged > 12 years who were suspected of having a torsion of the spermatic cord in 14 University Hospitals in France were included (n = 2986). Patients for whom data on pain duration were not available (n = 923) or for whom the final diagnosis was not torsion of the spermatic cord (n = 807) were excluded. The primary outcome was orchiectomy. The secondary outcomes were testicular survival time and the prediction of orchiectomy with the duration of pain. RESULTS 1266 patients were included with an orchiectomy rate of 12% (150 patients). The mean age was 21.5 years old in the salvage group and 23.7 years old in the orchiectomy group (p = 0.01), respectively. The median time from the onset of pain to surgery was 5.5 (IQR = 5) hours in the salvage group and 51.1 (IQR = 70) hours in the orchiectomy group (p < 0.0001). The risk of orchiectomy increased after a time cut-off of 6 h 30. A delay of 15 h 30 in pain duration was found to predict orchiectomy (sensitivity: 0.81; specificity: 0.87). CONCLUSIONS Pain duration can predict the probability of salvaging the testicles and performing orchiectomy. Rapid intervention should be recommended, regardless of the time elapsed from the onset of pain.
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Affiliation(s)
- Emilien Seizilles de Mazancourt
- Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.
- Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France.
| | - Zinnedine Khene
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Marc Sbizerra
- Department of Urology, Lyon Sud Hospital, Lyon, France
| | - Kevin Kaulanjan
- Department of Urology, Pointe A Pitre University Hospital, Guadeloupe, France
| | - Caroline Plassais
- Department of Urology, APHP, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, Sorbonne Université, Paris, France
| | - Florian Bardet
- Department of Urology, Dijon University Hospital, Dijon, France
| | - Ugo Pinar
- Department of Urology, APHP, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, Sorbonne Université, Paris, France
| | - Igor Duquesne
- Department of Urology, APHP, Hôpital Cochin, Université de Paris, Paris, France
| | - Gaelle Margue
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Nadia Ali Benali
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - William Berchiche
- Department of Urology, La Conception University Hospital, Marseille, France
| | | | - William Wandoren
- Department of Urology, Pointe A Pitre University Hospital, Guadeloupe, France
| | | | - Van Thi Dang
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | | | - Maud Hulin
- Department of Urology, Reims University Hospital, Reims, France
| | - Victor Gaillard
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | | | - Clement Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Tristan Grevez
- Department of Urology, Tours University Hospital, Tours, France
| | - Margaux Felber
- Department of Urology, APHP, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, Sorbonne Université, Paris, France
| | - Maxime Vallee
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | | | - Lucas Freton
- Department of Urology, Rennes University Hospital, Rennes, France
| | - François Lannes
- Department of Urology, La Conception University Hospital, Marseille, France
| | - Benjamin Pradère
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | - Xavier Matillon
- Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France
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Cigsar Kuzu EB, Tiryaki S, Guney N, Polatdemir K, Cakir Y, Karagozlu Akgul A, Toper MH, Karaguzel G, Ucar M, Bassorgun CI, Ozel SK, Ozkanli S, Salci G, Aydin Mungan S, Yilmaz MU, Aytac Vuruskan B, Yagmur I, Tarini EZ, Kaba M, Tanik C, Canbaz FA, Hurdogan O, User IR, Orhan D, Atici A, Gursoy D, Yagmurlu EA, Enneli D, Kilic SS, Erdogan S. Low-Grade Injury following Testicular Torsion: A Multicenter Study Confirming a Disturbing Possibility. Urol Int 2023; 107:971-976. [PMID: 37913756 DOI: 10.1159/000534454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion (TT) in cases where the testis seems non-viable. The main problem is lack of objective criteria defining testicular viability. The aim of this study was to investigate the grade of injury in orchiectomy specimens obtained from cases of TT and its association with clinical findings. METHODS This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings. RESULTS A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p < 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172). CONCLUSION Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury.
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Affiliation(s)
| | - Sibel Tiryaki
- Div. Pediatric Urology, Department Pediatric Surgery, Ege University, İzmir, Turkey
| | - Neslihan Guney
- Department Pathology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Kamer Polatdemir
- Department Pediatric Surgery, Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Yasemin Cakir
- Department Pathology, Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Ahsen Karagozlu Akgul
- Div. Pediatric Urology, Department Pediatic Surgery, Marmara University Medical Faculty, İstanbul, Turkey
| | | | - Gungor Karaguzel
- Department Pediatric Surgery, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Murat Ucar
- Department Urology, Akdeniz University Medical Faculty, Antalya, Turkey
| | | | - Seyhmus Kerem Ozel
- Div. Pediatric Urology, Department Pediatric Surgery, İstanbul Medeniyet University, İstanbul, Turkey
| | - Seyma Ozkanli
- Department Pathology, İstanbul Medeniyet University, İstanbul, Turkey
| | - Gul Salci
- Department Pediatric Surgery, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Sevdegul Aydin Mungan
- Department Pathology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Mehmet Ugur Yilmaz
- Div. Pediatric Urology, Department Pediatric Surgery, Bursa Uludağ University Medical Faculty, Bursa, Turkey
| | | | - Ismail Yagmur
- Div. Pediatric Urology, Department Urology, Harran University Medical Faculty, Şanlıurfa, Turkey
| | - Emine Zeynep Tarini
- Department Pathology, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Meltem Kaba
- Department Pediatric Surgery, Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Canan Tanik
- Department Pathology, Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Furkan Adem Canbaz
- Div. Pediatric Urology, Department Pediatric Surgery, İstanbul Medical Faculty, İstanbul, Turkey
| | - Ozge Hurdogan
- Department Pathology, İstanbul Medical Faculty, İstanbul, Turkey
| | - Idil Rana User
- Department Pediatric Surgery, Hacettepe Univesity Medical Faculty, Ankara, Turkey
| | - Diclehan Orhan
- Department Pathology, Hacettepe Univesity Medical Faculty, Ankara, Turkey
| | - Ahmet Atici
- Department Pediatric Surgery, Mustafa Kemal University Medical Faculty, Hatay, Turkey
| | - Didar Gursoy
- Department Pathology, Mustafa Kemal University Medical Faculty, Hatay, Turkey
| | - Emin Aydin Yagmurlu
- Department Pediatric Surgery, Ankara Univesity Medical Faculty, Ankara, Turkey
| | - Duygu Enneli
- Department Pathology, Ankara Univesity Medical Faculty, Ankara, Turkey
| | - Seref Selcuk Kilic
- Department Pediatric Surgery, Çukurova University Medical Faculty, Adana, Turkey
| | - Seyda Erdogan
- Department Pathology, Çukurova University Medical Faculty, Adana, Turkey
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15
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Scheier E, Levy ES. Testicular Traction Technique in an Adolescent With Torsion. Pediatr Emerg Care 2023; 39:e75-e76. [PMID: 37506673 DOI: 10.1097/pec.0000000000003024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
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Demirdogen SO, Cinislioglu AE, Aksakalli T, Al S, Kozubaev B, Akkas F, Adanur S, Yapanoglu T, Aksoy Y, Ozbey I, Polat O. When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study. Actas Urol Esp 2023; 47:527-534. [PMID: 37453494 DOI: 10.1016/j.acuroe.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE In this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. METHODS Postpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into 2 groups according to the "patient-based approach" criteria we adopted in our clinic. Group 1 in whom the contralateral teste was fixed in the same surgical act and group 2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. RESULTS A total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% Group 1 vs. 5.3% Group 2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. CONCLUSION There is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results.
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Affiliation(s)
- S O Demirdogen
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey.
| | - A E Cinislioglu
- Servicio de Urología, Hospital de Formación e Investigación de Erzurum, Universidad de Ciencias de la Salud, Erzurum, Turkey
| | - T Aksakalli
- Servicio de Urología, Hospital de Formación e Investigación de Erzurum, Universidad de Ciencias de la Salud, Erzurum, Turkey
| | - S Al
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey
| | - B Kozubaev
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey
| | - F Akkas
- Servicio de Urología, Hospital de Formación e Investigación de Erzurum, Universidad de Ciencias de la Salud, Erzurum, Turkey
| | - S Adanur
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey
| | - T Yapanoglu
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey
| | - Y Aksoy
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey
| | - I Ozbey
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey
| | - O Polat
- Servicio de Urología, Facultad de Medicina, Universidad de Atatürk, Erzurum, Turkey
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17
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Yen CW, Chang YJ, Ming YC, Gau CC, Wu CT, Lee J. Factors Determining Testicular Torsion and Consequent Orchiectomy in Pediatric Patients Presenting With Scrotal Pain. Pediatr Emerg Care 2023; 39:744-750. [PMID: 37624776 PMCID: PMC10547102 DOI: 10.1097/pec.0000000000003037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Factors associated with testicular torsion (TT) and consequent orchiectomy in patients presenting to pediatric emergency departments (PEDs) with scrotal pain (SP) are not well described. We report the factors predicting TT and consequent orchiectomy in children with SP. METHODS The data on patients (aged ≤18 years) who presented with SP to PEDs at 4 branches of the Chang Gung Hospital through 10 years were analyzed. RESULTS In all, 256 pediatric patients presented with SP. Their mean age was 11.60 ± 4.61 years and 72.7% (n = 186) were aged 10 to 18 years. The pain was left-sided in 54.7% (n = 140) and the interval between SP onset and PED arrival was 22.45 ± 31.27 hours. Overall, 84 (32.8%) patients needed surgery and 72 (28.1%) had TT. Of the patients with TT, 28 (38.9%) patients needed an orchiectomy. After analysis, TT and consequent orchiectomy were associated with a longer interval between SP onset and PED arrival, absent of testicular ultrasonic blood flow, interval between SP onset and surgery of more than 24 hours, and a high degree of TT. None of them experienced recurrent SP symptoms or TT again. CONCLUSIONS The rate of TT in patients presenting to PEDs with an SP was 28.1%, and 38.9% of the patients with TT needed an orchiectomy. Early diagnosis and intervention helped to prevent subsequent orchiectomy in pediatric patients with TT.
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Affiliation(s)
- Chen-Wei Yen
- From the Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Ching Ming
- Division of Pediatric Surgery, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Chun Gau
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chang-Teng Wu
- From the Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung Lee
- From the Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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18
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Mohamed MA, Abraha D, Olasinde AA, Kiswezi A, Molen SF, Muhumuza J, Lule H. Testicular salvageability and its predictors among patients with testicular torsion in a resource limited setting: a multicentre longitudinal study. BMC Surg 2023; 23:248. [PMID: 37605257 PMCID: PMC10441739 DOI: 10.1186/s12893-023-02118-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/22/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Testicular torsion refers to ischemia of the testicle due to twisting or rotation of the vessels supplying the testes. It is a urologic emergency requiring a high index of clinical suspicion and prompt surgical intervention with management aimed at avoiding testicular loss and resulting infertility. This paper gives an update on the current situation regarding this topic in low-income settings. The aim of this study was to determine testicular salvageability and its predictors amongst patients with testicular torsion at two tertiary African hospitals. METHODS This was a hospital-based multicentre longitudinal study at two tertiary hospitals in western Uganda. Patients with acute scrotum were enrolled and evaluated for testicular torsion. Those with confirmed testicular torsion underwent surgery and salvageability was reported as the primary outcome. Predictors for testicular salvageability were determined using backward binary logistic regression in SPSS version 22. RESULTS During the study period, 232 patients with acute scrotum were enrolled. The mean age was 35.3 (SD = 20.4) years. Forty-one (17.7%) patients had testicular torsion. Only 16 (39.0%) of patients with torsion had viable testes that were salvageable. Orchiectomy was performed on 25 patients (61.0%). At multivariate analysis, a patient who presented after 48 h from the onset of symptoms was 34.833 times more likely to have orchiectomy compared to one who presented within 12 h [AOR = 34.833, (95% CI = 5.020-60.711), P < 0.001]. CONCLUSION In this study, the testicular salvage rate was low. The only predictor of salvageability was the time from the onset of symptoms to presentation. All males should be sensitized about the clinical features of testicular torsion to ensure early presentation to increase salvage rates.
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Affiliation(s)
- Mohamed Abdullahi Mohamed
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Demoz Abraha
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Anthoney Ayotunde Olasinde
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Ahmed Kiswezi
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Selamo Fabrice Molen
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Joshua Muhumuza
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Herman Lule
- Injury Epidemiology and Prevention Research Group, Division of Clinical Neurosciences, University of Turku, Turku, Finland
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19
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Guo BC, Wu HP. Atypical symptoms of testicular torsion in a 7-year-old child: A case report. Medicine (Baltimore) 2023; 102:e33709. [PMID: 37144991 PMCID: PMC10158923 DOI: 10.1097/md.0000000000033709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
RATIONALE Testicular torsion accounting for 25% of acute scrotal disease, is an acute surgical condition. Atypical presentations of testicular torsion may lead delay diagnosis. PATIENT CONCERNS A 7-year-old boy was admitted to the pediatric emergency department with continuous and progressive left scrotal pain for 2 days, associated symptoms and signs included left scrotal swelling and erythema. The pain started 4 days ago as left lower abdominal pain which then migrated to the left scrotum. DIAGNOSES Physical examination showed left scrotum skin redness, swelling, local heat, tenderness, high-riding testis, absence of the left side cremasteric reflex and a negative Prehn's sign. Subsequent point of care ultrasound of scrotum revealed increased volume of the left testicle, inhomogeneous hypo-echoic left testis, and no detectable flow in the left testis. Left testicular torsion was diagnosed. INTERVENTIONS Surgical examination confirmed testicular torsion showing 720° counterclockwise rotation of the spermatic cord with ischemic changes in the left testis and epididymis. OUTCOMES The patient was stabilized and discharged after left orchiectomy, right orchiopexy and antibiotic therapy. LESSONS Symptoms of testicular torsion may be atypical, especially in prepubertal age. Detailed history, physical examination, point of care ultrasound usage and timely urologist consultation and intervention are important for prompt rescue to prevent testicular loss, testicular atrophy, and eventual impairment of fertility.
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Affiliation(s)
- Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
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20
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van Doeveren T, Somani BK, T Hoen LA, Haensel SM. Real-world management of testicular torsion: Level of adherence to the EAU Pediatric Urology guidelines. J Pediatr Urol 2023; 19:117-124. [PMID: 36266168 DOI: 10.1016/j.jpurol.2022.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/05/2022] [Accepted: 09/20/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Testicular torsion is the most frequent cause of irreversible ischemia to the testis. Despite guidelines being available, challenges remain in both diagnosis and management of the disease. OBJECTIVE This study aims to determine the adherence of urologists and residents in urology to the European Association of Urology (EAU) Pediatric Guideline on Testicular torsion. STUDY DESIGN Both Dutch and European urologists, and residents in urology filled in a survey on testicular torsion. Information on demographics, diagnostics, and treatment modalities was retrieved from the questionnaire based on the EAU Guideline on Paediatric Urology. RESULTS A total of 303 responders participated, of which 214 (71%) were from The Netherlands. Most (61%) responders treated three or more cases of testicular torsion in 2020. Ultrasound was used by 64%, followed by an attempt of manual detorsion by 38% (Summary Fig.). Importantly, 23% preferred not to perform emergency surgery after successful manual detorsion. A Winkelmann procedure was performed by 23%, without fixation of the test is using suture material. A large group of responders (30%) only fixed the contralateral testis by a proven testicular torsion. DISCUSSION A feasible adherence to the EAU Guideline on Paediatric Urology in treating testicular torsion was reported using this survey, although not all recommendations are implemented as proposed. The fact that outcomes of the different diagnostic and treatment modalities are lacking might be a limitation in interpreting the results of this survey. CONCLUSION Majority of the responders followed the EAU Guideline on Paediatric Urology in the diagnosis and treatment of testicular torsion. Ultrasound might contribute to diagnosing testicular torsion as long as this does not cause any delay for surgical exploration. Surprisingly, many urologists do not perform a surgical fixation of the testis after detorsion. Since a wide range of techniques and materials is used in case of surgical fixation, the guideline may provide in preferences for a unified policy among urologists.
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Affiliation(s)
- Thomas van Doeveren
- Department of Urology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Bhaskar K Somani
- Department of Urology, University of Southampton, Southampton, United Kingdom
| | - Lisette A T Hoen
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Stefan M Haensel
- Department of Urology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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21
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Zvizdic Z, Aganovic A, Milisic E, Jonuzi A, Zvizdic D, Vranic S. The Role of Demographic and Clinical Characteristics in Distinguishing Testicular Torsion from Torsion of the Appendix Testis: A Single-center Retrospective Study. Prague Med Rep 2023; 124:255-264. [PMID: 37736949 DOI: 10.14712/23362936.2023.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
The acute scrotum (AS) in the pediatric population is a medical emergency. AS is usually caused by testicular torsion (TT) and torsion of the appendix testis (TAT). The current study explored which demographic and clinical characteristics can help distinguish between TT and TAT. We analyzed all children ≤16 years who underwent surgical exploration for AS. The patients were divided into Group 1/TT and Group 2/TAT. Ninety patients were included in the study (24 with TT and 66 with TAT). The peak incidence of TT was significantly higher than in the TAT group (p<0.001). Scrotal pain was more prevalent in the TAT group (p=0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p=0.003 and p<0.001, respectively). The duration of symptoms was significantly longer in the TAT group (p<0.001). The duration of symptoms in the TT cohort significantly impacted the testicular salvage (p=0.008). Color Doppler ultrasound (CDUS) findings of absent/decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p<0.001). The older age, shorter duration of symptoms, systemic signs, and CDUS findings can help distinguish between the two most common acute scrotum causes.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Emir Milisic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Denisa Zvizdic
- Eye Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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22
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Ebell MH. Clinical Diagnosis of Testicular Torsion. Am Fam Physician 2022; 106:712-713. [PMID: 36521475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Mark H Ebell
- College of Public Health, University of Georgia, Athens, Georgia
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23
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Berg EK, Stief CG, Marcon J. [Testicular torsion - etiology, diagnostic pathway and treatment]. MMW Fortschr Med 2022; 164:39-40. [PMID: 36064921 DOI: 10.1007/s15006-022-1816-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Elena K Berg
- Urologische Klinik und Poliklinik, Campus Großhadern der LMU München - Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - Christian G Stief
- Urologische Klinik und Poliklinik, Klinik der Universität München, Campus Großhadern, München, Deutschland
| | - Julian Marcon
- Urologische Klinik und Poliklinik, Klinikum Großhadern d. LMU München, München, Deutschland
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24
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Shields LBE, Daniels MW, Peppas DS, White JT, Mohamed AZ, Canalichio K, Rosenberg S, Rosenberg E. Surge in testicular torsion in pediatric patients during the COVID-19 pandemic. J Pediatr Surg 2022; 57:1660-1663. [PMID: 34392971 PMCID: PMC9282895 DOI: 10.1016/j.jpedsurg.2021.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/23/2021] [Accepted: 07/11/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Testicular torsion is a pediatric surgical emergency, and prompt diagnosis and treatment is imperative. During the COVID-19 pandemic, pediatric patients with symptoms of testicular torsion may be reluctant to seek medical care which increases the likelihood of delayed presentation and the need for an orchiectomy. This observational study sought to determine whether there was a higher number of testicular torsion cases during COVID-19. METHODS As the first patient with COVID-19 was admitted to our facility on March 6, 2020, we identified male children ages 1-18 years with testicular torsion between March 1-December 31, 2020 (during COVID-19) compared to the same time period between 2015 and 2019 (prior to COVID-19). All patients were evaluated at our Institution's Emergency Department by a pediatric urologist. RESULTS There were 38 cases of testicular torsion between March 1-December 31, 2020 compared to 15.8 cases on average during the same 10-month period between 2015 and 2019 (a total of 79 cases). There was a statistically significant increase in testicular torsion cases during the COVID-19 pandemic compared to equivalent time periods in 2015-2019 (38 vs. 15.8, p = 0.05). Patients with testicular torsion during the COVID-19 pandemic were younger, had a longer duration of symptoms, and had a higher number of orchiectomies (although not statistically significant). CONCLUSION During the COVID-19 pandemic, an escalation in testicular torsion cases was observed. Timely assessment, diagnosis, and surgery are crucial to prevent testicular loss and potential infertility in the future. Further evaluation is needed to elucidate the surge in testicular torsion and possible mechanisms.
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Affiliation(s)
- Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY 40202, USA
| | - Michael W Daniels
- Department of Bioinformatics & Biostatistics, University of Louisville, Louisville KY 40292 USA
| | - Dennis S Peppas
- Norton Children's Urology, Norton Healthcare, Louisville, KY 40207, USA
| | - Jeffrey T White
- Norton Children's Urology, Norton Healthcare, Louisville, KY 40207, USA
| | - Ahmad Z Mohamed
- Department of Urology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Katie Canalichio
- Norton Children's Urology, Norton Healthcare, Louisville, KY 40207, USA
| | - Shilo Rosenberg
- Department of Urology, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Eran Rosenberg
- Norton Children's Urology, Norton Healthcare, Louisville, KY 40207, USA.
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Winters DA, Mehmi AK, Menzies-Wilson R, Folkard SS, Ryan K, Sevdalis N, Green JSA. Supporting a Learning System in Pediatric Emergency Pathways: Using Organizational Comparisons, Serious Incidents, and Near-Miss Events to Improve the Diagnosis and Treatment of Testicular Torsion. Pediatr Emerg Care 2022; 38:e1402-e1407. [PMID: 35639373 DOI: 10.1097/pec.0000000000002766] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Scrotal pain is a common presentation to the emergency department requiring prompt investigation and management to identify testicular torsion and increase the opportunity for testicular salvage. Using national data obtained from the NHS Improvement, we aim to identify key suboptimal areas in the acute diagnosis and management of testicular torsion with a view to learning from these and improving outcomes. METHODS A freedom of information request was made to all 134 hospital groups in England and Wales that manage testicular torsion. Serious incidents experienced by these hospitals were analyzed to see whether those with pediatric emergency departments fared better than those without. In addition, a qualitative thematic analysis of the NHS Improvement National Reporting and Learning System database over a 12-year period (2007-2019) was undertaken, to identify common themes associated with orchidectomies and "near-miss" events in the pediatric population. RESULTS Three hundred four patient safety incidents were returned and divided into 62 orchidectomies and 242 near-miss events. The most common factor in the orchidectomy group was individual factors (83.9%). Misdiagnosis of symptomatic testicle was not significant when comparing ED to specialist surgeons (odds ratio = 1.46, P = 0.3842). Atypical presentation resulting in orchidectomy was significant when comparing ED with specialists (odds ratio = 6, P = 0.0355). Near-miss events, not leading to orchidectomy, are often due to a wider variety of factors. A Mann-Whitney U test showed that there was no statistical significance in incidents when comparing general ED units caring for all ages with pediatric EDs in terms of incidents ( U = 807.5, z = -1.124, P = 0.261). CONCLUSIONS There is a need for education in ED about atypical presentation of testicular torsion and examination of scrotum in cases of lower abdominal pain. It is also vital that specialist teams are cognizant of the standard operating procedures relevant to scrotal pain and testicular within the organization and the wider clinical network. Finally, there should be a drive for annual collation of data in urology and ED units with regards to testicular torsion as patient safety incidents may be underreported.
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Affiliation(s)
- David Adam Winters
- From the Department of Urology, Barts Health NHS Trust, Whipps Cross University Hospital, London
| | - Ashley K Mehmi
- From the Department of Urology, Barts Health NHS Trust, Whipps Cross University Hospital, London
| | | | | | - Kate Ryan
- Department of Pediatrics, Royal London Hospital, Barts Health NHS Trust, London
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, United Kingdom
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LONG-DEPAQUIT T, CHIRON P, BOURGOUIN S, HARDY J, DELEDALLE FX, LAROCHE J, MOLIMARD B, SAVOIE PH. [Management of testicular torsion by a general surgeon isolated in Africa]. Med Trop Sante Int 2022; 2:mtsi.v2i2.2022.230. [PMID: 35685303 PMCID: PMC9128443 DOI: 10.48327/mtsi.v2i2.2022.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/02/2022] [Indexed: 06/15/2023]
Abstract
The onset of sudden and intense scrotal pain exposes to several problems when it occurs in a young man in Africa. Among the possible etiologies, testicular torsion is the surgical emergency to rule out, because beyond 6 hours of evolution the functional prognosis of the testicle is concerned. The septic evolution towards a purulent melting, in case of exceeded torsion, is also possible. Of slightly lower incidence than in Western countries, lack of awareness of this pathology by local health actors, the precariousness or health isolation of certain populations in certain under-medicalized regions, contribute to diagnostic and therapeutic delays. This often leads to a pejorative development, loss of the testicle being directly correlated with the delay in treatment. Testicular torsion has thus been identified as one of the main causes of male infertility in Africa. However, clinical diagnosis and surgical treatment require few resources and remain accessible in an environment with low resources or in precarious conditions. Indeed, despite the contribution of ultrasound in certain situations, the clinical picture is at the center of the diagnosis and therapeutic decision making. At the slightest doubt, surgical exploration is necessary. The multi-tunic anatomy of the testicle facilitates its surgical fixation in the event of conservation, ideally by triangulation of single-strand non-absorbable thread. Simultaneous fixation of the contralateral testicle is currently the subject of debate in the literature. In Africa, the benefit/risk balance, taking into account in particular the difficulty of subsequent access to care, justifies, from our point of view, performing contralateral orchidopexy at the same time. Depending on the appearance of the testicle and, to a lesser extent, the duration of the evolution of the symptoms, orchidectomy may be necessary. This article describes the clinical picture of spermatic cord torsion and the orchidopexy technique.
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Affiliation(s)
- Thibaut LONG-DEPAQUIT
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - Paul CHIRON
- Service d’urologie, Hôpital d’instruction des armées Bégin, 69 avenue de Paris, 94160 Saint-Mandé, France
| | - Stéphane BOURGOUIN
- Service de chirurgie viscérale, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - Julie HARDY
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - François-Xavier DELEDALLE
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - Julien LAROCHE
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - Benoit MOLIMARD
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
| | - Pierre-Henri SAVOIE
- Service d’urologie, Hôpital d’instruction des armées Sainte-Anne, 2 boulevard Sainte Anne, BP 600, 83000 Toulon, France
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Lee AS, Pohl HG, Rushton HG, Rana MS, Davis TD. Do healthcare disparities play a role in pediatric testicular torsion? - Analysis of a single large pediatric center. J Pediatr Urol 2022; 18:210.e1-210.e7. [PMID: 35181222 DOI: 10.1016/j.jpurol.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Healthcare disparities have been shown to impact outcomes of various acute pediatric conditions. We sought to examine the impact of race, ethnicity and insurance status on the presentation, management and outcome of testicular torsion. MATERIALS AND METHODS A retrospective review of a prospectively maintained testicular torsion database was performed. Patients ≤18 years of age evaluated in our pediatric institution's emergency room between April 2016-April 2020 with US diagnosed and OR confirmed testicular torsion were included. Basic demographics, timing of presentation, referral rate, time to OR and orchiectomy rate were extracted and compared. P < 0.05 was considered statistically significant. RESULTS A total of 206 patients were included. 114 (56.2%) were Black or African American (Black/AA), 43 were (21.2%) Hispanic/Latino, 22 (10.8%) were Caucasian, and 24 (11.8%) were designated as Other races. Ninety-eight (48.3%) patients had Medicaid, 90 (44.3%) had private insurance, and 15 (7.4%) patients were uninsured. Sixty-eight (33.0%) presented in a delayed fashion (>24 h). Compared to the Caucasian patients, Black/AA patients were 2.1 years (95% CI: 0.5, 3.8; P = 0.010) older at the time of presentation. When compared to those with Medicaid insurance, uninsured patients had 6.26 times (95% CI: 1.58, 41.88; P = 0.021) higher odds to be referred from an outside hospital for management. In those patients presenting acutely (<24 h, N = 138), there were no significant differences in the odds of orchiectomy for Black/AA or Hispanic/Latino patients when compared to Caucasian patients, however, the odds of orchiectomy in Other races (non-Caucasian, non-Black/AA, non-Hispanic/Latino) was significantly higher (OR: 10.38; 95% CI: 1.13, 246.96; P = 0.049). While the mean time in minutes from ED to OR was longer in those with Medicaid insurance (141 vs 125.4 private vs 115 uninsured, p = 0.042), this did not impact orchiectomy rate (39.8% vs 40.9% vs 46.7%, p = 0.88). CONCLUSIONS We found no differences in the orchiectomy rates by race with the exception of a higher rate in the diverse and heterogeneous Other race (non-Caucasian, non-Black/AA, non-Hispanic/Latino) group. Those uninsured had a higher referral rate highlighting the potential existence of disparities for those uninsured and the need for further investigation.
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Affiliation(s)
- Albert S Lee
- Division of Pediatric Urology, Children's National Hospital, Washington, DC 20010, USA
| | - Hans G Pohl
- Division of Pediatric Urology, Children's National Hospital, Washington, DC 20010, USA
| | - H G Rushton
- Division of Pediatric Urology, Children's National Hospital, Washington, DC 20010, USA
| | - Md Sohel Rana
- Joseph E. Robert, Jr., Center for Surgical Care, Children's National Hospital, Washington, DC 20010, USA
| | - Tanya D Davis
- Division of Pediatric Urology, Children's National Hospital, Washington, DC 20010, USA.
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Coles V, Elagami H, Bhandarker K, Awolaran G, Murphy F, Yardley I, Hallows R, Davenport M. The acute scrotum in infancy: A retrospective regional study. J Pediatr Urol 2022; 18:226-231. [PMID: 34456148 DOI: 10.1016/j.jpurol.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 08/01/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Testicular torsion during infancy (<1 year) is known to be a rare event with relatively few studies on the subject in the published scientific literature. We reviewed the experience of infant scrotal exploration within a paediatric surgical network of four centres serving an approximate paediatric population of 1.8 million. AIM To review current practice of scrotal explorations in infancy and explore areas for improvement. METHOD Retrospective review of emergency operations for acute scrotum between January 2016 and December 2018. Data are presented as median (range) and compared using non-parametric tests. P < 0.05 was regarded as significant. RESULTS A total of 560 paediatric scrotal explorations were performed. Of these, 25 (4%) were under one year at the time of surgery, median 4 months (1 day-5 months) (Fig. 1). The most common diagnosis was "epididymitis" (11/25, 44%). Testicular torsion was found in 28% (7/25), increasing to 66% (4/6) in those under one month. Of those with confirmed testicular torsion, three (43%) underwent a primary orchiectomy with contralateral fixation and three (43%) detorsion and bilateral fixation, with all three cases found to have testicular atrophy at follow-up. The final case was of metachronous torsion, with the initial presentation not operated on and the subsequent presentation undergoing detorsion and fixation. This was the only case of testicular salvage in our series. There were no underlying urological issues in any patient and no reported complications or ongoing urological issues post-surgery. The rate of follow-up was 17/25 (68%). CONCLUSION We present one of the only clinical series to focus on acute scrotum in the under one year old and not just the neonatal period. Testicular torsion remains a rare event in this age group but invariably leads to testicular loss.
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Affiliation(s)
- Vanessa Coles
- Departments of Paediatric Surgery: King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Hesham Elagami
- St George's University Hospital, Tooting, London, SW17 0QT, UK.
| | - Kailas Bhandarker
- The Evelina London Children's Hospital, Lambeth, London, SE1 7EH, UK.
| | | | - Feilim Murphy
- St George's University Hospital, Tooting, London, SW17 0QT, UK.
| | - Iain Yardley
- The Evelina London Children's Hospital, Lambeth, London, SE1 7EH, UK.
| | - Ruth Hallows
- Brighton Children's Hospital, Brighton, BN2 5BE, UK.
| | - Mark Davenport
- Departments of Paediatric Surgery: King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
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Pogorelić Z, Anand S, Artuković L, Krishnan N. Comparison of the outcomes of testicular torsion among children presenting during the Coronavirus Disease 2019 (COVID-19) pandemic versus the pre-pandemic period: A systematic review and meta-analysis. J Pediatr Urol 2022; 18:202-209. [PMID: 35093284 PMCID: PMC8757646 DOI: 10.1016/j.jpurol.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/08/2021] [Accepted: 01/11/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate whether the Coronavirus Disease 2019 (COVID-19) pandemic resulted in a prolonged duration of symptoms, a delayed presentation to the medical facility, and consequently more orchiectomy procedures among children with testicular torsion compared to the pre-COVID-19 period. METHODS Systematic search of four scientific databases was performed. The search terms used were (coronavirus OR novel coronavirus OR SARS-CoV-2 OR COVID-19) AND (testicular torsion OR orchidectomy OR orchiectomy OR orchidopexy OR orchiopexy). The inclusion criteria were all boys presenting with testicular torsion during the COVID-19 and pre-COVID-19 periods. A comparison of the average duration of symptoms, the proportion of children with delayed presentation (>24 h), and the proportion of children requiring orchiectomy was made among the two groups. The Downs and Black scale was used for methodological quality assessment. RESULTS The present meta-analysis included six comparative studies (five retrospective studies). A total of 711 patients (473 during the COVID-19 period) were included. No significant differences in the average duration of symptoms (WMD: 2.6, 95% CI -6.78 to 11.99, P = 0.59), the proportion of children with delayed presentation (RR = 1.03, 95% CI 0.52-2.02, p = 0.94), and orchiectomy rate (RR = 1.23, 95% CI 0.82-1.84, p = 0.31) were observed among the two patient groups. All studies had a moderate risk of bias. CONCLUSION The duration of symptoms, the proportion of children with delayed presentation, and orchiectomy rate did not significantly differ among the children with testicular torsion presenting during the COVID-19 and pre-COVID-19 periods. However, due to the moderate risk of bias, the level of evidence of the available comparative studies is limited.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split 21000, Croatia; Department of Surgery, University of Split, School of Medicine, Split 21000, Croatia
| | - Sachit Anand
- Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India.
| | - Leon Artuković
- Department of Surgery, University of Split, School of Medicine, Split 21000, Croatia
| | - Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
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Frisenda M, Signore S, Delicato G, Martinelli AG, Cantiani A, Colafelice M, Tufano A, Del Giudice F, Eisenberg ML, Sciarra A, Canale V. Influence of COVID-19 pandemic on timing and outcomes of treatment for acute testicular torsion in adults: a single institution experience. Can J Urol 2022; 29:11095-11100. [PMID: 35429428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The worldwide spread of SARS-COV2 had led to a delay in treatment of numerous urological pathologies, even in emergency conditions. We therefore sought to determine whether the timing of diagnosis and treatment and the postoperative outcome of patients with testicular torsion had been changed during the COVID pandemic. MATERIALS AND METHODS We considered all patients evaluated in the emergency department (ED) for testicular torsion from February 2018 to August 2019 (pre-COVID period) and from February 2020 to August 2021 (during COVID pandemic). All patients underwent clinical and ultrasound evaluation and subsequently scrotal exploration. Primary outcomes were the time differences from pain onset to ED presentation and from ED presentation to surgical treatment. We also investigated whether the number or orchiectomies required changed during the pandemic. RESULTS A total of 54 patients were divided in two groups: 40 patients in pre-COVID-19 group and 14 in the COVID-19 cohort. Mean time from symptoms onset to ED access was longer during the pandemic (4.2 ± 5.7 versus 39.6 ± 37.3 hours, p = 0.009). Mean time from ED access to surgery was similar (2.9 ± 1.1 versus 4.2 ± 2.3, p = 0.355). In addition, the number of orchiectomies was higher in COVID-19 group (2.5% versus 28.6%, p < 0.01), compared to a lower number of detorsions (97.5% versus 71.4%, p < 0.01). Elapsed time from pain onset to surgery was directly correlated with the increased white blood cell (WBC) count after surgery (r = 0.399, p = 0.002). DISCUSSION AND CONCLUSIONS The current study identifies a significant delay in presentation of testicular torsion which resulted in a significant increase in orchiectomies with the expected decreased in detorsion/orchiopexy. In addition, there was an increase in the WBC at presentation associated with delayed presentation.
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Affiliation(s)
- Marco Frisenda
- Department of Urology, Sant'Eugenio Hospital, Rome, Italy
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | | | | | | | | | | | - Antonio Tufano
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Vittorio Canale
- Department of Urology, Sant'Eugenio Hospital, Rome, Italy
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
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Cabral Dias Filho A, Rincon Cintra da Cruz P, Zanettini Riccetto CL. Testicular Torsion Patients Should Be Manually Detorsed at Diagnosis: A Propensity Score Matched Analysis of the Influence of Interhospital Transfer and Surgical Wait Times on Surgical Organ Salvage. Pediatr Emerg Care 2022; 38:e936-e942. [PMID: 34225327 DOI: 10.1097/pec.0000000000002492] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess organ salvage in testicular torsion patients submitted to manual detorsion according to interhospital transfer and surgical wait times. METHODS Retrospective analysis of consecutive surgically treated testicular torsion patients between 2012 and 2018. We compared testicular surgical salvage in testicular torsion patients submitted to manual detorsion either at clinical diagnosis (immediate detorsion) or after interhospital transfer from lower level-of-care facilities (delayed detorsion) and estimated the influence of interhospital transfer and surgical wait times on outcomes. Analysis included Bayesian logistic regression after propensity score matching. We excluded patients first examined at off-state and private facilities, with prediagnostic time of more than 24 hours, not initially diagnosed with testicular torsion or not submitted to manual detorsion at any time. RESULTS One hundred sixty-two patients (median age, 15.8 years) fulfilled inclusion criteria. The median prediagnostic, transfer, and surgical wait times were respectively 4.9, 2.4, and 4.3 hours, with 58 patients undergoing immediate and 104 delayed detorsion. Propensity score matching for prediagnostic and surgical wait times paired 58 immediate with 40 delayed detorsion patients, with corresponding surgical salvage rates of 54/58 (93%) and 33/40 (82%). Forty-seven patients (29%) still had torsion at surgery. Transfer time was inversely associated with testicular salvage, with median 13% greater probability of an unfavorable outcome for each hour of transfer time. Similarly, each hour of surgical wait time decreased surgical salvage by 6%. CONCLUSIONS Immediate detorsion led to improved surgical outcomes in testicular torsion patients. Because of residual torsion, surgery for detorsed patients should not be postponed.
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Thomas T, Roberts-Woodbury J. Massive Scrotal Swelling. Am Fam Physician 2022; 105:77-78. [PMID: 35029938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Taryn Thomas
- St. Luke's Warren Hospital Family Medicine Residency, Phillipsburg, NJ, USA
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Vasconcelos-Castro S, Soares-Oliveira M, Campos JM, Estevão-Costa J. Simultaneous Testicular and Appendix Testis Torsion: A Novel Clinically Relevant Association. Pediatr Emerg Care 2021; 37:e868-e869. [PMID: 30839439 DOI: 10.1097/pec.0000000000001784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Torsion of the appendix testis (TAT) and testicular torsion (TT) are the most common causes of acute scrotum in the pediatric population. They usually present as separate conditions and have distinct managements. We report a unique case of a 16-year-old boy with concomitant TAT and TT. The role of TAT as a trigger factor to TT is addressed, and its clinical repercussion on the management of acute scrotum is discussed.
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Affiliation(s)
- Sofia Vasconcelos-Castro
- From the Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Faculty of Medicine, Porto, Portugal
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Abstract
OBJECTIVES Acute scrotal pain in children is a common presenting complaint in hospital, and it is imperative that cases of testicular torsion are identified and managed promptly. We aim to identify the most influential points in the pathway in determining whether patients are managed in the appropriate time frame, so these areas can be targeted to improve salvage rates. METHODS Using quality improvement principles, the pediatric scrotal pain pathway was mapped out, commencing with initial symptom onset and ending with definitive surgical management. We retrospectively reviewed data on all patients between 0 and 18 years of age attending the emergency department at Whipps Cross University Hospital with acute scrotal pain between October 2010 and October 2013. RESULTS Over the 3-year period, 238 patients 18 years or younger presented to casualty with scrotal pain. Of the patients assessed initially by an emergency department physician, 52.8% (n = 67) were discharged without referral. To our knowledge, none of these patients presented later with a missed torsion. Torsion was diagnosed in 23.2% of the patients operated on (n = 22), of which 5 required orchidectomy, comprising 2.1% of all patients presenting with scrotal pain. In this group, 4 were due to late presentation by the patient. CONCLUSIONS We demonstrate the value of different stages of the pathway, as more than half of patients seen in A&E were correctly discharged without referral. In the context of our study, late presentation to hospital appears to be the most significant factor leading to orchidectomy. To target this issue, awareness among both children and parents must be improved.
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Affiliation(s)
| | - Kate Ryan
- From the Whipps Cross University Hospital, Barts Health NHS Trust, London
| | - Sami Hamid
- Ninewells Hospital, Dundee, United Kingdom
| | - Chi-Ying Li
- From the Whipps Cross University Hospital, Barts Health NHS Trust, London
| | - James S A Green
- From the Whipps Cross University Hospital, Barts Health NHS Trust, London
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Abstract
Abdominal pain is the most common chief complaint in the Emergency Department. Abdominal pain is caused by a variety of gastrointestinal and nongastrointestinal disorders. Some frequently missed conditions include biliary pathology, appendicitis, diverticulitis, and urogenital pathology. The Emergency Medicine clinician must consider all aspects of the patient's presentation including history, physical examination, laboratory testing, and imaging. If no diagnosis is identified, close reassessment of pain, vital signs, and physical examination are necessary to ensure safe discharge. Strict verbal and written return precautions should be provided to the patient.
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Affiliation(s)
- Maglin Halsey-Nichols
- University of North Carolina at Chapel Hill, Houpt Building (Physician Office Building) Suite 1116, 170 Manning Drive- CB-7594, Chapel Hill, NC 27599-7594, USA.
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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Abstract
QUESTION As a family physician caring for a large pediatric population, I evaluate numerous adolescents with testicular pain. Given the gravity of prognosis for late treatment of children with testicular torsion, what are best practices for its assessment and management? ANSWER The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score has been developed and validated to identify children at risk of testicular torsion. If the TWIST score is 0 and clinical suspicion is low in the office setting, a referral to urology for urgent consultation is not needed. If the TWIST score is 1 or higher or if the clinical presentation suggests torsion, manual detorsion should be attempted and the patient should be urgently sent to the nearest emergency department.
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Rosenberg H, Long B, Keays M. Just the facts: assessment and management of testicular torsion in the emergency department. CAN J EMERG MED 2021; 23:740-743. [PMID: 34406643 DOI: 10.1007/s43678-021-00189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Hans Rosenberg
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Brit Long
- Brooke Army Medical Center, San Antonio, TX, USA
| | - Melise Keays
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
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Holzman SA, Ahn JJ, Baker Z, Chuang KW, Copp HL, Davidson J, Davis-Dao CA, Ewing E, Ko J, Lee V, Macaraeg A, Nicassio L, Sadighian M, Stephany HA, Sturm R, Swords K, Wang P, Wehbi EJ, Khoury AE. A multicenter study of acute testicular torsion in the time of COVID-19. J Pediatr Urol 2021; 17:478.e1-478.e6. [PMID: 33832873 PMCID: PMC7977032 DOI: 10.1016/j.jpurol.2021.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Testicular torsion is a surgical emergency, and time to detorsion is imperative for testicular salvage. During the COVID-19 pandemic, patients may delay emergency care due to stay-at-home orders and concern of COVID-19 exposure. OBJECTIVE To assess whether emergency presentation for testicular torsion was delayed during the COVID-19 pandemic, and whether the rate of orchiectomy increased compared to a retrospective period. STUDY DESIGN Patients were prospectively enrolled in a multicenter study from seven institutions in the United States and Canada. Inclusion criteria were patients two months to 18 years of age with acute testicular torsion from March through July 2020. The retrospective group included patients from January 2019 through February 2020. Statistical analysis was performed using Kruskal-Wallis tests, Chi-square tests, and logistic regression. RESULTS A total of 221 patients were included: 84 patients in the COVID-19 cohort and 137 in the retrospective cohort. Median times from symptom onset to emergency department presentation during COVID-19 compared to the retrospective period were 17.9 h (IQR 5.5-48.0) and 7.5 h (IQR 4.0-28.0) respectively (p = 0.04). In the COVID-19 cohort, 42% of patients underwent orchiectomy compared to 29% of pre-pandemic controls (p = 0.06). During COVID-19, 46% of patients endorsed delay in presentation compared to 33% in the retrospective group (p = 0.04). DISCUSSION We found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a higher proportion of patients reported delaying care. Strengths of the study include the number of included patients and the multicenter prospective design during the pandemic. Limitations include a retrospective pre-pandemic comparison group. CONCLUSIONS In a large multicenter study we found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a significantly higher proportion of patients reported delaying care. Based on the findings of this study, more patient education is needed on the management of testicular torsion during a pandemic.
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Affiliation(s)
- Sarah A Holzman
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.
| | - Jennifer J Ahn
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Zoe Baker
- Children's Hospital Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Kai-Wen Chuang
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Hillary L Copp
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
| | - Jacob Davidson
- Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada
| | - Carol A Davis-Dao
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Emily Ewing
- Western University, Department of Urology, London, Ontario, Canada
| | - Joan Ko
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Victoria Lee
- University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Amanda Macaraeg
- University of California, Irvine, Department of Urology, Irvine, CA, USA
| | - Lauren Nicassio
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Michael Sadighian
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
| | - Heidi A Stephany
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Renea Sturm
- University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Kelly Swords
- University of California, San Diego, Department of Urology, La Jolla, CA, USA; Rady Children's Hospital, Division of Pediatric Urology, San Diego, CA, USA
| | - Peter Wang
- Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada
| | - Elias J Wehbi
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Antoine E Khoury
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
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Yeniocak S, Sarac F, Erbin A, Yazicioglu M, Olgac V, Koldas M, Uzun O, Akkoc I. The diagnostic role of testicular fatty acid-binding protein in testicular ischemia: A randomized controlled experimental study. ARCH ESP UROL 2021; 74:328-334. [PMID: 33818429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the diagnostic value of testicular fatty acid-binding protein (T-FABP) in acute testicular ischemia and prolonged ischemia. METHODS: The study included a total of 28 prepubertal male Wistar-Hannover rats. The animals were randomly divided into 4 groups as torsion groups (group I; min 30; 7 rats, group II; min 120; 7 rats, group III; min 240; 7 rats) and control group (group IV; 7 rats). In each group, the left testis was separated from the gubernaculum by blunt dissection together with the tunica vaginalis and spermatic cord, and then exposed. In the control group, the blood samples and left testicular tissues were collected at min 240 after extraction. In torsion groups, the left testis was rotated together with its cord elements,720° in a clockwise direction for the induction of an extravaginal TT model. The blood samples were obtained at min 30, 120, and 240 in the torsion groups. Bilateral testicular tissues were collected via orchiectomy for histopathological examination in all groups. RESULTS: The mean plasma T-FABP level in group III (torsion, min 240) was significantly higher than those of other groups. The T-FABP level at min 240 had a sensitivity and specificity of 100% and 85%, respectively, at a cut-off value of 1.059. A significant difference was found between the torsion groups and the control group with regard to histopathological scores. CONCLUSIONS: The increased T-FABP levels in testicular ischemia seem to be correlated with testicular necrosis rather than acute ischemia.
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Affiliation(s)
- Selman Yeniocak
- Department of Emergency Medicine. Haseki Training and Research Hospital. Istanbul
| | - Fatma Sarac
- Department of Pediatric Surgery. Haseki Traning and Research Hospital. Istanbul
| | - Akif Erbin
- Department of Urology. Haseki Traning and Research Hospital. Istanbul
| | - Mustafa Yazicioglu
- Department of Emergency Medicine. Yeditepe University Faculty of Medicine. Istanbul
| | - Vakur Olgac
- Department of Pathology. Istanbul University Faculty of Medicine. Istanbul
| | - Macit Koldas
- Department of Biochemistry. Haseki Training and Research Hospital. Istanbul
| | - Ozlem Uzun
- Department of Emergency Medicine. Bagcilar Training and Research Hospital. Istanbul
| | - Ibrahim Akkoc
- Department of Anesthesia and Reanimation. Haseki Training and Research Hospital. Istanbul
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Rew KT, Langan RC, Hadj-Moussa M, Heidelbaugh JJ. Men's Health: Scrotal and Testicular Conditions. FP Essent 2021; 503:23-27. [PMID: 33856180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Scrotal and testicular conditions include benign masses, infections, testicular torsion, and testicular cancer. Common palpable benign scrotal masses include spermatocele, varicocele, and hydrocele. Most patients with these masses require no treatment. Some varicoceles are associated with impaired fertility, probably due to an increase in scrotal temperature that leads to testicular hyperthermia, oxidative stress, and reduced spermatogenesis. Patients with documented infertility or scrotal pain should be referred to a urology subspecialist for consideration of surgical management. Epididymitis and epididymo-orchitis are caused by infection with Neisseria gonorrhoeae, Chlamydia trachomatis, or enteric bacteria. Antibiotics and supportive measures (eg, scrotal elevation, bed rest) are recommended for management of acute epididymitis. Testicular torsion is a urologic emergency that requires rapid surgical exploration and orchidopexy to reduce the risk of testicular loss due to ischemia. Salvage rates exceed 90% when surgical exploration is performed within 6 hours of symptom onset. Testicular cancer commonly manifests as a painless, incidentally discovered mass in a single testis. Ultrasonography is recommended to confirm the diagnosis. The recommended primary intervention for a suspected malignant testicular tumor is radical inguinal orchiectomy.
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Affiliation(s)
- Karl T Rew
- University of Michigan Medical School Department of Family Medicine, 300 North Ingalls St NI4C06, Ann Arbor, Michigan 48109-5435
| | - Robert C Langan
- St. Luke's Family Medicine Residency Program at St. Luke's Hospital - Sacred Heart Campus, 421 West Chew St, Allentown, PA, 18102
| | - Miriam Hadj-Moussa
- University of Michigan Medical School Department of Urology, 1500 E. Medical Center Dr, Ann Arbor, Michigan 48109-5330
| | - Joel J Heidelbaugh
- University of Michigan Medical School Department of Family Medicine, 300 North Ingalls St NI4C06, Ann Arbor, Michigan 48109-5435
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Abstract
OBJECTIVES To determine if boys with acute testicular torsion, a surgical emergency requiring prompt diagnosis and treatment to optimize salvage of the testicle, delayed presentation to a medical facility and experienced an extended duration of symptoms (DoS), and secondarily, a higher rate of orchiectomy, during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Single-center, descriptive retrospective chart review of boys presenting with acute testicular torsion from March 15, to May 4, 2020 ("during COVID-19" or group 2), as well as for the same time window in the 5-year period from 2015 to 2019 ("pre-COVID-19" or group 1). RESULTS A total of 78 boys met inclusion criteria, group 1 (n = 57) and group 2 (n = 21). The mean age was 12.86 ± 2.63 (group 1) and 12.86 ± 2.13 (group 2). Mean DoS before presentation at a medical facility was 23.2 ± 35.0 hours in group 1 compared with 21.3 ± 29.7 hours in group 2 (P < 0.37). When DoS was broken down into acute (<24 hours) versus delayed (≥24 hours), 41 (71.9%) of 57 boys in group 1 and 16 (76.2%) of 21 boys in group 2 presented within less than 24 hours of symptom onset (P < 0.78). There was no difference in rate of orchiectomy between group 1 and group 2 (44.7% vs 25%, P < 0.17), respectively. CONCLUSIONS Boys with acute testicular torsion in our catchment area did not delay presentation to a medical facility from March 15, to May 4, 2020, and did not subsequently undergo a higher rate of orchiectomy.
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Affiliation(s)
- Annalise R. Littman
- From the Department of Urology, Emory University and Children's Healthcare of Atlanta
| | - Karmon M. Janssen
- From the Department of Urology, Emory University and Children's Healthcare of Atlanta
| | - Li Tong
- Department of Biomedical Engineering
| | - Hang Wu
- Department of Biomedical Engineering
| | - May D. Wang
- Department of Biomedical Engineering, School of Electric and Computer Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Emily Blum
- From the Department of Urology, Emory University and Children's Healthcare of Atlanta
| | - Andrew J. Kirsch
- From the Department of Urology, Emory University and Children's Healthcare of Atlanta
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Martin HA, Noble M. Consideration of Testicular Torsion in Young Males With Abdominal Pain Is Essential: A Case Review. J Emerg Nurs 2020; 47:186-191. [PMID: 33187720 DOI: 10.1016/j.jen.2020.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022]
Abstract
Testicular torsion is a surgical emergency and requires prompt recognition and treatment. Health care personnel often forget this differential diagnosis in males who present with abdominal pain as their only complaint. There is a 4- to 6-hour window from the onset of symptoms to the surgical intervention to salvage the testes. It is imperative for health care personnel to consider testicular torsion in any male presenting with abdominal pain and to complete a genitourinary examination. The purpose of this case review is to highlight the importance of a genitourinary examination in recognizing testicular torsion.
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Pan P. Validation of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score in the Diagnosis of Testicular Torsion in Children With Acute Scrotum. Indian Pediatr 2020; 57:926-928. [PMID: 33089809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To validate the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score for the evaluation of children presenting with acute scrotum. METHODS This prospective study calculated TWIST score in patients of acute scrotum admitted to a pediatric surgery unit. The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1) and high-riding testis (1). All the patients were examined by a pediatric surgeon. RESULTS Among 96 children with acute scrotum, 68 (70.8%) patients had testicular torsion. In the testicular torsion group, the mean (SD) TWIST score was 5.7 (1.2) and in no torsion group, it was 1.46 (0.67). In the testicular torsion group, the number of patients with low, intermediate, and high risk was 0, 13, and 55, respectively and in without testicular torsion these were 21, 7, and 0, respectively. CONCLUSIONS TWIST score has high predictive value for testicular torsion, and can be used for clinical diagnosis of testicular torsion.
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Affiliation(s)
- Pradyumna Pan
- Pediatric Surgery Unit, Ashish Hospital and Research Centre, Jabalpur, Madhya Pradesh, India
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44
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Tabakin AL, Farber NJ, Barone J. Testicular torsion in brothers. Can J Urol 2020; 27:10135-10137. [PMID: 32065872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Testicular torsion is a common pediatric emergency. Predisposing factors and other risk factors for testicular torsion have not been fully elucidated. This case report highlights teenage brothers who each experienced right-sided testicular torsion at nearly the same age, just 1 year apart. Because of their parents' urgency in seeking medical attention, the affected testicles in both patients were salvaged. We also review the current literature in regards to etiology, inheritance, and patient and parental education.
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Affiliation(s)
- Alexandra L Tabakin
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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45
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Wang X, Zhang Z, Fang LK, Chen D, Peng N, Thakker PU, Schwartz MZ, Zhang Y. Challenges in the diagnosis of testicular infarction in the presence of prolonged epididymitis: Three cases report and literature review. J Xray Sci Technol 2020; 28:809-819. [PMID: 32474478 DOI: 10.3233/xst-200671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Testicular infarction is a rare complication of prolonged epididymitis and may be misdiagnosed as testicular torsion. In this study, we present three cases of testicular infarction and discuss their clinical characteristics, imaging features and clinical management. PATIENTS AND METHODS Three adult males with prolonged epididymitis presented with chronic unilateral testicular pain, tenderness, and palpable swelling, including left varicocele in one case and hydrocele in the other two cases. Patient's symptoms were not relieved after antibiotic therapy. We analyzed the diagnosis, management, and outcome of these three cases of testicular infarction resulting from prolonged epididymitis. This includes the clinical characteristics, features of color doppler ultrasound imaging for diagnosis, and treatment strategy for testicular infarction from prolonged epididymitis. RESULTS Complete blood count (CBC) indicated a small leukocytosis (10.6±0.4×109/L; normal arrange 3.5-9.5 WBC×109/L). Color doppler images demonstrated appropriate blood flow to areas of interest at patient's initial visit. At follow up visit several months later, the increased blood flow was detected at the edges of the involved testes with no blood flow to the center. The sizes of the involved testis (27±4 ml) was significantly larger compared to the non affected side (17±2 ml) (p < 0.05). Unilateral simple orchiectomy was performed on the involved testis in all three cases. Grossly, abscess cavities with caseous necrosis were found at the center of the testicle and epididymis in two patients. Histopathologic examination showed chronic inflammation with lymphocytic and macrophage infiltration of the involved testicle in two cases. The third case stained positive for acid fast bacteria. Left varicocele disappeared postoperatively in one patient. No pain, wound infection or other discomfort were noted 12 months after surgery. COMMENTS This series revealed that testicular infarction may result from inappropriately treated prolonged epididymitis. Epididymal tuberculosis should be considered in cases with epididymitis not responding to broad spectrum antibiotics. Testicular infarction induced by prolonged epididymitis is easily missed due to a lack of symptom changes. Color doppler images are helpful in the diagnosis. This usually presents as a decrease in blood flow at the center of the testis with the increased flow at the periphery differentiating this from testicular torsion.
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Affiliation(s)
- Xisheng Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Zejian Zhang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Lie Kui Fang
- Urinary Surgery Department of the Second Affiliated Hospital of Southern University Of Science And Technology, Shenzhen Third People's Hospital, Shenzhen, Guangdong Province, China
| | - Dong Chen
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Naixiong Peng
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Parth Udayan Thakker
- Department of Urology and Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Marshall Zane Schwartz
- Department of Urology and Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Yuanyuan Zhang
- Department of Urology and Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Pogorelic Z, Neumann C, Jukic M. An unusual presentation of testicular torsion in children: a single - centre retrospective study. Can J Urol 2019; 26:10026-10032. [PMID: 31860419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The aim of this study was to investigate demographic and clinical characteristics and outcomes of the treatments of the patients with an unusual presentation of the testicular torsion (TT) and to clarify their peculiarities. MATERIAL AND METHODS From January 1999 until December 2017, the case records of 149 patients who underwent surgery for TT were retrospectively reviewed. Out of that number, 25 patients were identified with unusual presentation of an acute scrotum (14 patients who presented with an abdominal pain only, and 11 who presented with testicular torsion in inguinal canal). RESULTS The median age of all children with TT at the time of surgery was 14 years. The duration of the symptoms varied substantially and ranged from 1 hour to 120 hours with a median of 6 hours, with only 63 (42.3%) out of the 149 patients staying below the golden 6 hours. Only 2/11 (18.2%) children of the inguinal group and 5/14 (35.71%) children of the abdominal group presented within 6 hours. In the group with inguinal TT the median age was 13 years with the median duration of symptoms of 24 hours. The symptoms were mostly abdominal pain (90.9%), followed by groin pain (45.5%) and nausea (45.5%). In 6 out of 11 children, the first physical examination did not include a genital examination. In the group with abdominal pain, the a median age was 13 years, with median duration of symptoms of 17 hours. The symptoms were limited, besides the abdominal pain, to groin pain (42.8%) and nausea (50%). In 9 out of 14 children, the first physical examination did not include a genital examination. The rate of orchidectomy in the inguinal TT group was 54.5%, while in the abdominal group 57.1%. CONCLUSION Testicular torsion, particulary in regard to torsion in the inguinal canal or presenting dominantly with abdominal pain can be easily misdiagnosed, but needs to be recognized on time, to salvage the affected testicle. The complete physical examination, including the genital examination, needs to be performed in each male patient presenting with lower abdominal or groin pain.
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Affiliation(s)
- Zenon Pogorelic
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
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47
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Goyal A, Salman B. Case 2: Chronic Testicular Torsion in a Healthy Neonate. Neoreviews 2019; 20:e667-e669. [PMID: 31676742 DOI: 10.1542/neo.20-11-e667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Ashima Goyal
- Department of Pediatrics at Beaumont Children's Hospital, Royal Oak, MI
| | - Bassel Salman
- Department of Pediatrics at Beaumont Children's Hospital, Royal Oak, MI
- Oakland University William Beaumont School of Medicine, Rochester, MI
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48
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de Vries LJ, Vos H, Speel TGW, van den Elskamp I, Datema J, Lameijer H. [A young man with a painful scrotum]. Ned Tijdschr Geneeskd 2019; 163:D3529. [PMID: 31580035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 16-year-old male patient with no known medical history presented at the Emergency Department (ED) with a 2-day history of pain and swelling in his right hemiscrotum. He was diagnosed with non-bacterial epididymitis and discharged home with medical advice. Six days after being diagnosed, the pain and swelling worsened and he was seen by a general practitioner who concluded that the symptoms were attributable to the previously diagnosed epididymitis. No further investigations were performed. Two days later he again presented at the ED, at which time colour Doppler echography revealed a testicular torsion of probably two days old. As after operative detorsion the testis was found to be non-vital, an orchidectomy was performed. This case illustrates that the diagnosis of epididymitis should always be reviewed in patients in whom the scrotum once again becomes painful. Early recognition and treatment of torsio testis gives a better chance of keeping the testis and therefore fertility.
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Affiliation(s)
| | - H Vos
- Medisch Centrum Leeuwarden, afd. Spoedeisende Hulp, Leeuwarden
| | | | | | - Joris Datema
- Medisch Centrum Leeuwarden, afd. Spoedeisende Hulp, Leeuwarden
| | - Heleen Lameijer
- Medisch Centrum Leeuwarden, afd. Spoedeisende Hulp, Leeuwarden
- Contact: H. Lameijer
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Lin SS, Han CY, Chen CY, Su YJ. A Man with Right Lower Quadrant Abdominal Pain. Am J Med 2019; 132:830-832. [PMID: 30853477 DOI: 10.1016/j.amjmed.2019.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Shum-Shin Lin
- Department of Emergency Medicine, Tao-Yuan General Hospital, Ministry of Health and Welfare, Tao-Yuan, Taiwan
| | - Ching-Yu Han
- Department of Emergency Medicine, Tao-Yuan General Hospital, Ministry of Health and Welfare, Tao-Yuan, Taiwan; Department of Emergency Medicine, Hsinchu Mackay Memorial Hospital Hospital, Hsinchu City, Taiwan
| | - Chun-Yu Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
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50
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Guo X, Li S, Guo H, Lei W. [Testicular torsion of <360 degrees in children: A 10-year single-center retrospective study]. Zhonghua Nan Ke Xue 2019; 25:539-543. [PMID: 32223090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Xiang Guo
- Department of Urology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
| | - Shuang Li
- Department of Urology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
| | - Hui Guo
- Department of Urology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
| | - Wei Lei
- Department of Urology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
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