• Contrastenhanced ultrasonography (CEUS)
• Ovarian torsion
• Pediatric surgery
• Testicular torsion
• Ultrasonography

• Humans
• Male
• Radiologist
• Spermatic cord torsion
• Testis

• Humans
• Spermatic Cord Torsion/diagnostic imaging
• Spermatic Cord Torsion/therapy
• Male
• Ultrasonography/methods
• Child

• Indocyanine green fluorescence
• Testicular atrophy
• Testicular torsion

• Humans
• Male
• Indocyanine Green
• Testis/pathology
• Testis/diagnostic imaging
• Testis/blood supply
• Pilot Projects
• Atrophy
• Spermatic Cord Torsion/surgery
• Spermatic Cord Torsion/diagnostic imaging
• Spermatic Cord Torsion/pathology
• Retrospective Studies
• Adult
• Optical Imaging/methods
• Time Factors
• Middle Aged
• Young Adult
• Postoperative Complications
• Regional Blood Flow
• Organ Size
• Adolescent

• case report
• cryptorchidism
• diagnose and treatment
• intraperitoneal mass
• perinatal testicular torsion

• Appendicitis
• Malpractice
• Meningitis
• Testicular torsion

• Humans
• Spermatic Cord Torsion/diagnosis
• Child
• Appendicitis/diagnosis
• Male
• Meningitis/diagnosis
• Meningitis/etiology
• Malpractice/legislation & jurisprudence
• Pediatric Emergency Medicine
• Child, Preschool
• Infant

• Humans
• Infant, Newborn
• Resuscitation/methods
• Intensive Care Units, Neonatal
• Infant, Premature
• Fluid Therapy/methods

• manual reduction
• orchiectomy
• testicular survival rate
• testicular torsion
• ultrasound

• Humans
• Male
• Spermatic Cord Torsion/diagnostic imaging
• Spermatic Cord Torsion/surgery
• Retrospective Studies
• Child
• Scrotum/diagnostic imaging
• Scrotum/blood supply
• Child, Preschool
• Ultrasonography, Doppler, Color/methods
• Testis/diagnostic imaging
• Testis/blood supply
• Adolescent
• Infant
• Ultrasonography/methods

• hematological parameters
• hydrocele
• multivariate logistic regression analysis
• orchidopexy
• pediatric testicular torsion

• color doppler ultrasonography
• cryptorchidism
• infarcted testicle
• inguino-scrotal swelling
• pediatrics
• poor assessment / misdiagnosis
• testicular torsion
• undescended testicle

• children
• emergency care
• point of care system
• testicular torsion
• ultrasound

• Male
• Child
• Humans
• Spermatic Cord Torsion/diagnostic imaging
• Point-of-Care Systems
• Retrospective Studies
• Ultrasonography
• Emergency Service, Hospital
• Pain

• scrotal pain
• testicular torsion
• testicular ultrasonic blood flow
• orchiectomy

• Male
• Child
• Humans
• Adolescent
• Spermatic Cord Torsion/complications
• Spermatic Cord Torsion/diagnosis
• Spermatic Cord Torsion/surgery
• Orchiectomy
• Retrospective Studies
• Testis/surgery
• Pain/etiology
• Pain/surgery

• Resource limited setting
• Salvageability
• Testicular torsion
• Uganda

• Male
• Humans
• Adult
• Testis/surgery
• Spermatic Cord Torsion/diagnosis
• Spermatic Cord Torsion/surgery
• Longitudinal Studies
• Orchiectomy
• Tertiary Care Centers

• bell clapper deformity
• children
• misdiagnosis
• orchiopexy
• testicular torsion

• Acute scrotum
• Testicular pain
• Testicular torsion
• Urology

• Ultrasonography
• pediatric emergency medicine

• acute scrotum
• antioxidants
• apoptosis
• astaxanthin
• carotenoids
• infertility
• ischemia-reperfusion injury
• rats
• testicular torsion

• KK.01.1.1.01.0008. European Regional Development Fund

• Extravaginal
• orchiectomy
• orchiopexy
• perinatal
• testicular torsion

• bell-clapper deformity
• pain-reduced testicular torsion
• painless testicular torsion
• testicular salvage
• testicular ultrasound

Common pediatric surgical entities often get a delayed referral to the pediatric surgeon in the average Indian scenario. This study was conducted to assess the awareness about management of select common pediatric surgical entities among practicing pediatricians.

An online multiple-choice questionnaire consisting of twenty questions related to the diagnosis and management of common pediatric surgical entities encountered by pediatricians in their routine office practice was prepared, and the electronic link was circulated among the practicing pediatricians of India. Each question had one correct response.

One hundred and seventy-five responses were obtained, collated, grouped, and analyzed. Overall, 35% of all responses were correct. Individually, 56% of respondents marked 51%–75% of answers correctly; only 7% scored above 75%. Some clinical observations were disparate: 65% were unfamiliar with preputial adhesions and 51% would discharge a preterm neonate with inguinal hernia without a surgical consult. There is a tendency toward unnecessary imaging (60% – localization of undescended testis, 91% – wet umbilicus, and 51% – postanal dimple) and overzealous medical management (propranolol for the involuting hemangioma). However, 82%–88% concurred on the standard conservative or surgical management in index conditions such as hypospadias and umbilical problems.

There was a concurrence in the principles of management of common pediatric surgical entities between pediatricians and pediatric surgeons in 35%. Misdiagnosis, unwarranted investigations, overzealous medical management, and delayed surgical consults figured in 65%. A systematic professional interaction between the physicians and surgeons would facilitate a coordinated management. A larger study would yield more meaningful data.

• Awareness
• Indian pediatrician
• children
• common
• pediatric surgery

• Extravaginal
• Orchiectomy
• Orchiopexy
• Perinatal
• Testicular torsion

• Intravaginal
• Newborn
• Testis
• Torsion

This study aimed to summarize clinical manifestations, and physical examination, laboratory examination, and ultrasound results of children with testicular torsion <360°.

We performed a retrospective study of children who were diagnosed with testicular torsion <360° between October 2007 and October 2017.

There were 11 (19.2%) patients with testicular torsion of 90°, 33 (58.0%) with 180°, and 13 (22.8%) with 270°. The median age of onset was 5.7 years (range, 1–14 years) and the median duration of symptoms was 4.2 days (range, 0.5–5 days). Ultrasound showed low blood flow in 46 (80.8%) patients. The testis was retained in 41 (72.0%) patients and resected in 16 (28.0%). The testes appeared necrotic at 2 to 3 days after onset for patients with 270° torsion, appeared necrotic at 3 to 4 days after onset for those with 180° torsion, and were not necrotic at 4 to 5 days after onset for those with 90° torsion. The duration of symptoms in children decreased as the torsion angle increased.

Children with testicular torsion <360° are relatively young, while the duration of symptoms is relatively long. A high postoperative testicular survival rate is one of the clinical features in this study.

• Doppler ultrasound
• Testicular torsion
• atrophy
• children
• cremasteric reflex
• necrosis

Testicular torsion (TT) is a urologic emergency that requires prompt surgical intervention. In rural Appalachia, patients are often transferred from surrounding communities due to lack of urologic care. We hypothesized that those transferred would have delayed intervention and higher rates of orchiectomy when compared to those who presented directly to our hospital.

We performed a retrospective review of patient charts with an ICD-9 diagnosis of TT from 2008 to 2016. Patients met inclusion criteria if diagnosis was confirmed by operative exploration. We compared rate of testicular loss and time until surgical intervention between groups.

Twenty-three patients met inclusion criteria (12 transferred, 11 direct). Patient demographics did not significantly differ between groups. Transferred patients had a higher orchiectomy rate (33% v 22%,p = 0.41) although this was not statistically significant. Time to surgery from symptom onset was significantly longer in those transferred (12.9 h) compared to those not transferred (6.9 h, p = 0.02). Distance of transfer was not correlated with time of delay (r² = 0.063).

Transferred patients with TT have numerically higher rates of orchiectomy which may reach significance in an appropriately powered study, and relative delays in surgical intervention. This study highlights the need for improved access to urologic care in rural areas.

• Orchiectomy
• Patient transfer
• Rural
• Testicular torsion

Though prompt diagnosis to minimize symptom duration (SD) is highly associated with organ salvage in cases of testicular torsion (TT), SD is subjective and hard to determine. We thus investigated the clinical implications of systemic inflammatory responses (SIRs) as potential surrogates of SD to improve testis survival.

Sixty men with TT that underwent immediate operation among orchiectomy and orchiopexy following a visit to a single emergency department were retrospectively enrolled. Mandatory laboratory tests conducted included neutrophil, lymphocyte, and platelet counts.

Mean age and SD was 15.7±3.7 years and 8.27±4.98 hours, respectively. Thirty-eight (63.3%) underwent orchiectomy and the remaining 22 underwent orchiopexy. Leukocytosis (p=0.001) and neutrophil-lymphocyte ratio (NLR, p<0.001) were significantly lower in the orchiopexy group as was SD (3.27±1.88 vs. 11.16±3.80, p<0.001). Although multivariate model showed that the only single variable associated with receipt of orchiopexy was SD (odds ratio [OR]=0.259, p<0.001), it also revealed NLR as a sole SIR associated with SD (B=0.894, p<0.001). While 93.3% with a SD of within 3 hours underwent orchiopexy, only 26.6% of affected testes were preserved between 3 to 12 hours (n=30). When multivariable analysis was applied to those with window period, NLR alone predicted orchiopexy rather than orchiectomy (p=0.034, OR=0.635, p=0.013). The area under curve between SD (0.882) and NLR (0.756) was similar (p=0.14).

This study showed NLR independently predicted testis survival by proper surgical correction particularly for patients with marginally delayed diagnosis, which suggest the clinical usefulness for identifying candidates for orchiopexy in emergency setting.

• Inflammation
• Orchiectomy
• Orchiopexy
• Spermatic cord torsion
• Symptom assessment

• Orchiectomy
• Orchiopexy
• Spermatic cord torsion
• Testicular salvage
• Testicular torsion

• Child
• Detorsion
• Oophorectomy
• Oophoropexy
• Ovarian torsion
• Retorsion

• Adolescent
• Genetic analysis
• Insulin-like 3 gene
• Pediatric
• Testicular torsion

• Magnetic resonance imaging
• Male urogenital diseases
• Scrotum
• Testis
• Ultrasonography

• Local
• Paediatric
• Testicular torsion
• Transfer

Testicular torsion (TT) is a medical emergency that primary affects newborns and young adolescents. It causes testicular injury due to the torsion of the spermatic cord and its components, initially in the venous blood flow and finally in the arterial blood flow. Prompt diagnosis and early surgical management are necessary in managing this urgent situation. The process of the pathophysiological events in ischemia-reperfusion is multifactorial and deals with the perception of the oxidative stress responsible for the consequences of ischemia/reperfusion (I/R) stress following TT. Duration and severity of torsion also play a significant role in the oxidative stress. A detrimental result of the defense system of the testes takes place resulting finally in testicular atrophy and impaired function. Antioxidant factors have been experimentally studied in an effort to front this state. They have been classified as endogenous or exogenous antioxidants. Endogenous antioxidants comprise a structure of enzymic enzymatic and non-enzymic enzymatic particles presented within cytoplasm and numerous other subunits in the cells. Exogenous antioxidants include a variety of natural and pharmaceutical agents that may prevent or ameliorate the harmful effects of I/R injury. In this study we review those factors and their ability to enhance the oxidative status of the testis. A feature insight into where we are heading is attempted.

• Testis
• Torsion
• Experimental
• Ischemia-reperfusion injury
• Antioxidants