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Souid A, Gopalakrishnan M, Basin M, Cannon G, Tracey A, Mason M, Osten A, Villanueva J. Inequities and Progress in Testicular Torsion Care Following a US News & World Report Metric: A Retrospective Cohort Study. J Pediatr Surg 2025; 60:162273. [PMID: 40086160 DOI: 10.1016/j.jpedsurg.2025.162273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 02/19/2025] [Accepted: 03/02/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND AND OBJECTIVES Pediatric testicular torsion is a surgical emergency with known health disparities. The US News and World Report is an American media company that ranks colleges and hospitals based on annually published criteria. Hospitals that complied with the US News and World Report's (USNWR) Speed in Treating Testicular Torsion (SiTTT) metric saw improved surgical testicular salvage rates, but the metric's impact in mitigating inequities in testicular torsion is unstudied. METHODS A retrospective cohort study of patients 1-18 years of age presenting with testicular torsion was performed using the Pediatric Health Information System database. Hospitals were classified based on their SiTTT score at the metric's onset in 2015: they were labeled complete-scoring if they achieved the maximum score and partial-scoring otherwise. Surgical testicular salvage was defined as orchiopexy without concomitant orchiectomy. Testicular salvage rates were compared based on various socioeconomic variables including race between the pre-metric (2010-2015) and post-metric (2015-2019) periods with both univariate and adjusted, multivariate analyses. RESULTS We identified 3950 cases of testicular torsion: 2335 in complete-scoring hospitals and 1615 in partial-scoring hospitals. Only partial-scoring hospitals improved significantly in salvage rate (pre-metric 61.0 % vs post-metric 67.5 %, p < 0.01). Subgroup analysis revealed the largest benefit in patients with economic or communicative barriers such as those with complex chronic conditions (pre-metric 35.3 % vs post-metric 61.1 %, p < 0.05). No minority races had statistically significant improvement after the metric, and salvage rate gap between White and all other races increased (pre-metric 4.3 % vs post-metric 10.0 %, p < 0.05). CONCLUSIONS Patients with communicative or economic barriers showed improved equity after efforts to comply with a third-party metric, but disparities persisted for minority races. Future studies may better classify the mediators of this association. TYPE OF STUDY Retrospective Cohort Study. LEVEL OF EVIDENCE Level IV: Evidence from well-designed case-control or cohort studies.
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Affiliation(s)
- Ahmed Souid
- Department of Pediatrics, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, USA.
| | | | - Michael Basin
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, USA
| | - Glenn Cannon
- Urology Department, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anthony Tracey
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, USA
| | - Matthew Mason
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, USA
| | - Andrew Osten
- Department of Pediatrics, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, USA
| | - Jeffrey Villanueva
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, USA
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Zhang J, Wang Z, Zhang H, Shao Z, Wang W, Qiu Y, Shen H, Song H, Xie X. Nomogram predicts risk score and likehood of orchiectomy in patients with testicular torsion: a multicenter retrospective study. World J Urol 2025; 43:163. [PMID: 40072630 DOI: 10.1007/s00345-025-05539-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 02/28/2025] [Indexed: 03/14/2025] Open
Abstract
PURPOSE Testicular torsion is a prevalent scrotal emergency associated with a significant risk of testicular loss, and there is no reliable scoring system available to assess the likelihood of orchiectomy following testicular torsion. METHODS Clinical characteristics and surgical data of patients with testicular torsion from January 2015 to May 2024 were gathered from National Center for Children's Health (NCCH) and the Children's Hospital of Capital Institute of Pediatrics (CIPCH). Independent risk variables for testicular resection were evaluated by logistic regression analyses, leading to the establishment of a nomogram. The performance of the nomogram was assessed and validated using AUC, C-index, calibration curves, and DCA. Patients were classified based on their risk score obtained from the nomogram for clinical application. RESULTS A total of 387 patients were included. Risk factors were identified by multifactorial analysis: symptoms duration, testicular blood flow, degree of torsion, and cryptorchidism. A nomogram exhibits an area under the ROC curve of 0.9305 and a C-index of 0.9310. A scoring system was developed accordingly, categorising patients into four groups; 88.7% of patients in the super-low and low-risk categories preserved their testes, while 78.6% in the super-high and high-risk categories underwent testicular resection. CONCLUSION The strong concordance between predicted and actual outcomes suggests the model's utility in clinical decision-making. The nomogram demonstrates robust calibration and differentiation capabilities.
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Affiliation(s)
- Jingmin Zhang
- Department of Urology, Children's Hospital, Capital Institute of Pediatric, No. 2, Yabao Road, Chaoyang District, Beijing, 100020, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, No. 9, Dongdansantiao Road, Dongcheng District, Beijing, 100010, China
| | - Zihong Wang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Haoyuan Zhang
- Department of Pediatric Surgery, Children's Hospital, Capital Institute of Pediatrics, No. 2, Yabao Road, Chaoyang District, Beijing, 100020, China
| | - Zikun Shao
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Wenjie Wang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Ying Qiu
- Department of Urology, Children's Hospital, Capital Institute of Pediatric, No. 2, Yabao Road, Chaoyang District, Beijing, 100020, China
| | - Haosen Shen
- Department of Urology, Children's Hospital, Capital Institute of Pediatric, No. 2, Yabao Road, Chaoyang District, Beijing, 100020, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, No. 9, Dongdansantiao Road, Dongcheng District, Beijing, 100010, China
| | - Hongcheng Song
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China.
| | - Xianghui Xie
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China.
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Zvizdic Z, Jonuzi A, Glamoclija U, Zvizdic D, Vranic S. Impact of on-hours versus off-hours admission on outcome in pediatric patients with testicular torsion. Am J Emerg Med 2025; 88:1-6. [PMID: 39561426 DOI: 10.1016/j.ajem.2024.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/23/2024] [Accepted: 11/10/2024] [Indexed: 11/21/2024] Open
Abstract
OBJECTIVES Testicular torsion (TT) is an emergency requiring timely surgery to prevent testicular loss. There is a lack of reports on the clinical significance of the time of admission (on-hours vs. off-hours) on the long-term surgical outcome of TT. METHODS We retrospectively reviewed all consecutive patients <18 years who were admitted to the hospital and treated for TT during the ten years. Patients were classified according to their admission time: weekday (on-hours), outside working hours, and weekends (off-hours). They were also classified based on their testicular outcome: salvaged and non-salvaged testis. RESULTS Seventy-two patients were included. Their median age was 14.2 years. Thirty-three patients (46 %) were admitted during on-hours, whereas 39 patients (54 %) were admitted during off-hours. Forty-three patients (59.7 %) required orchidopexy and, out of those, during the long-term follow-up, only 27 (37.5 %) had definitive testicular salvage. Forty-five patients (62.5 %) were with no testicular salvage. On-hours vs. off-hours admission had no impact on the clinical outcome (p = 0.25). However, significant differences in the duration of symptoms (DoS) between the orchidopexy and orchidectomy groups were observed (p < 0.001). CONCLUSION Testicular torsion is a time-dependent diagnosis, and any delay in treatment could cause testicular loss. Our data suggest that the DoS before admission, rather than the admission time, influences the testicular outcome. The efficient management of emergencies regardless of the time of day is a key factor for the reduced probability that admission timing affects outcomes.
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Affiliation(s)
- Zlatan Zvizdic
- Department of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Department of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Una Glamoclija
- Scientific Research Unit, Bosnalijek d.d., Sarajevo, Sarajevo, Bosnia and Herzegovina; Department for Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Denisa Zvizdic
- Eye Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Zvizdic Z, Jonuzi A, Glamoclija U, Zvizdic D, Vranic S. Clinical characteristics and outcome of children with acute cryptorchid testicular torsion: A single-center, retrospective case series study. Am J Emerg Med 2024; 82:4-7. [PMID: 38749372 DOI: 10.1016/j.ajem.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/08/2024] [Accepted: 05/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Cryptorchidism and testicular torsion (TT) are relatively common conditions in clinical practice; however, sparse information about cryptorchid TT is available in the current literature. METHODS We retrospectively reviewed the clinical characteristics, treatment modalities, and long-term outcomes of pediatric patients treated for acute cryptorchid TT. RESULTS We found eight patients with unilateral acute cryptorchid TT with a prevalence of 8.9% (8/90) among all TT cases. The left testis was affected in six patients. The median age of patients at the time of the surgery was 65 months (interquartile range (IQR) 4-136 months). The median duration of symptoms was 16 h (IQR 9-25 h), while the median time to treatment was 60 min (IQR 59-63 min). The most common symptoms were pain (abdominal and inguinal) and inguinal mass with no palpable testis in the ipsilateral hemiscrotum. Preoperative color Doppler ultrasonography revealed absent or decreased testicular blood flow in the affected testes in 7/8 of patients. Various degrees of testicular torsion (median 540°, min 360°, max 1260°) were found during surgery. A necrotic testis that led to orchidectomy was found in 4/8 of patients. The median follow-up period was 42.6 months (IQR 12.5-71.2 months), revealing only one patient with testicular atrophy. The final testicular salvage rate was 35%. CONCLUSIONS Greater awareness among caregivers and primary care physicians about acute cryptorchid TT is required to improve their timely diagnosis and treatment. A physical examination of the external genitalia and inguinal regions should be mandatory to attain a proper diagnosis and treatment without delay.
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Affiliation(s)
- Zlatan Zvizdic
- Department of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Department of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Una Glamoclija
- Scientific Research Unit, Bosnalijek d.d., Sarajevo, Sarajevo, Bosnia and Herzegovina; Department for Biochemistry and Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Denisa Zvizdic
- Eye Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Scheier E. Manual detorsion in pediatric testicular torsion: A narrative review of the literature. Urologia 2024; 91:628-631. [PMID: 38722164 DOI: 10.1177/03915603241229800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Manual detorsion is infrequently performed in pediatric emergency medicine, particularly in centers with urology coverage. In no other emergency condition does an emergency physician not take immediate action to alleviate pain and damage, even if definitive care is close by. A small number of case reports exist in which pediatric emergency physicians have performed manual detorsion. This review the literature presents the case for routine manual detorsion prior to definitive orchiopexy.
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Affiliation(s)
- Eric Scheier
- Department of Pediatric Emergency, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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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 PMCID: PMC11524085 DOI: 10.1111/iju.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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 UrologyShenzhen Children's HospitalShenzhenGuangdongPeople's Republic of China
| | - Weipeng Huang
- Department of Critical Care MedicineSir Run Run Shaw Hospital, Zhejiang University School of MedicineHangzhouPeople's Republic of China
| | - Yingying He
- Department of UrologyShenzhen Children's HospitalShenzhenGuangdongPeople's Republic of China
| | - Mengkui Sun
- Department of UrologyShenzhen Children's HospitalShenzhenGuangdongPeople's Republic of China
| | - Xuerui Sun
- Department of UrologyShenzhen Children's HospitalShenzhenGuangdongPeople's Republic of China
| | - Yiyan Huang
- Department of NursingSir Run Run Shaw Hospital, Zhejiang University School of MedicineHangzhouPeople's Republic of China
| | - Shoulin Li
- Department of UrologyShenzhen Children's HospitalShenzhenGuangdongPeople's Republic of China
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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] [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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Qi X, Yu J, Ding X, Wang Y, Zhu H. Manual reduction in testicular torsion and subsequent treatment after successful reduction: a series of reports in a single institution. Front Pediatr 2024; 12:1362104. [PMID: 38529050 PMCID: PMC10961435 DOI: 10.3389/fped.2024.1362104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/28/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction To explore the factors affecting the success of testicular torsion manual reduction and the safety of subsequent conservative treatment after successful reduction. Methods Clinical data of 66 patients with testicular torsion treated in our emergency department from February 2017 to February 2022 were retrospectively collected. Manual reduction without anesthesia was performed in 19 patients. Patients with successful manual reduction chose different subsequent treatments according to the wishes of themselves and their guardians, including continuing conservative treatment and surgical exploration. Relevant clinical data were collected and analyzed. Results Manual reduction was successful in 11 patients (11/19). Seven of them chose to continue conservative treatment, and four underwent surgical exploration immediately. Among the 7 patients who were treated conservatively, 3 underwent surgical treatment due to scrotal discomfort or testicular torsion at different stages, and the remaining 4 patients showed no recurrence of torsion during follow-up. Compared with other patients, patients with successful manual reduction had the shorter duration of pain (p < 0.05). The time from visiting our hospital to surgery in patients who attempted manual reduction was slightly shorter than those who underwent surgery directly (p > 0.05). The testes of these 11 patients were all successfully preserved. Conclusions The short duration of pain may contribute to the success of manual reduction, and manual reduction did not increase the preparation time before surgery. Due to the unpredictable risk of recurrence, immediate surgical treatment is still recommended, or postponed elective surgical treatment should be offered in the next days or weeks.
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Affiliation(s)
- Xiaokang Qi
- Department of Urology, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Junjie Yu
- Department of Urology, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xuefei Ding
- Department of Urology, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yehua Wang
- Department of Urology, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Haiyan Zhu
- Department of Day Surgery Ward, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
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Gang XH, Duan YY, Zhang B, Jiang ZG, Zhang R, Chen J, Teng XY, Zhang DB. Clinical characteristics of testicular torsion and factors influencing testicular salvage in children: A 12-year study in tertiary center. World J Clin Cases 2024; 12:1251-1259. [PMID: 38524506 PMCID: PMC10955544 DOI: 10.12998/wjcc.v12.i7.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/09/2024] [Accepted: 02/04/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents. Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion. AIM To predict the possibility of testicular salvage (TS) in patients with testicular torsion in a tertiary center. METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University. Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion. The data included clinical findings, physical examinations, laboratory data, color Doppler ultrasound findings, operating results, age, presenting institution status, and follow-up results. RESULTS Our study included 75 patients. TS was possible in 57.3% of all patients; testicular torsion occurred mostly in winter, and teenagers aged 11-15 years old accounted for 60%. Univariate logistic regression analyses revealed that younger age (P = 0.09), body mass index (P = 0.004), torsion angle (P = 0.013), red blood cell count (P = 0.03), neutrophil-to-lymphocyte ratio (P = 0.009), and initial presenting institution (P < 0.001) were associated with orchiectomy. In multivariate analysis, only the initial presenting institution predicted TS (P < 0.05). CONCLUSION The initial presenting institution has a predictive value for predicting TS in patients with testicular torsion. Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.
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Affiliation(s)
- Xiang-Hui Gang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Yuan-Yuan Duan
- Department of Ultrasound Diagnosis, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Bin Zhang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Zheng-Gan Jiang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Rong Zhang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Jun Chen
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Xiang-Yu Teng
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Duo-Bing Zhang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
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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: 0.5] [Reference Citation Analysis] [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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11
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Ye Z, Chen H, Liu X, Wei G. Delayed Care Seeking and Outcomes of Testicular Torsion among Children during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Eur J Pediatr Surg 2023; 33:377-385. [PMID: 36384233 DOI: 10.1055/s-0042-1758153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Since the onset of coronavirus disease 2019 (COVID-19), stay-at-home orders and fear caused by the pandemic have had a significant effect on the timing and outcomes of testicular torsion. However, the evidence was limited since the study results were inconsistent. This study aims to examine the hospitalization rates, timing, and outcomes of testicular torsion in children before and during the pandemic. MATERIALS AND METHODS Using PubMed, Embase, and Google Scholar databases, we conducted a systematic search and meta-analysis of studies reporting the timing and outcomes of children admitted with testicular torsion before and during the COVID-19 pandemic. Subgroup analyses were conducted to explore possible sources of heterogeneity. RESULT The outcomes of 899 testicular torsion patients from eight studies were evaluated. Our study found an increased hospitalization rate for patients with testicular torsion (incidence rate ratio = 1.60, 95% confidence interval [CI]: 1.27-2.03; p = 0.001). Despite a significant increase in the duration of symptoms during the COVID-19 pandemic (weighted mean difference = 11.04, 95% CI: 2.75-19.33; p = 0.009), orchiectomy rates did not increase (odds ratio = 1.33, 95% CI: 0.85-2.10; p = 0.147). CONCLUSION During the COVID-19 pandemic, hospitalization rates for testicular torsion and the duration of symptoms among children increased significantly. Moreover, the rate of orchiectomy did not increase during the pandemic, indicating that pediatric emergency services have remained efficient and have prevented an increase in the number of orchiectomies performed despite pandemic-related closures and delays in transporting patients to medical care.
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Affiliation(s)
- Zihan Ye
- Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
| | - Hongsong Chen
- Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
| | - Xing Liu
- Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
| | - Guanghui Wei
- Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
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12
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Lacy A, Smith A, Koyfman A, Long B. High risk and low prevalence diseases: Testicular torsion. Am J Emerg Med 2023; 66:98-104. [PMID: 36738571 DOI: 10.1016/j.ajem.2023.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Testicular torsion is a serious condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of testicular torsion, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Testicular torsion is a urological emergency that occurs with rotation of the testicle along its supporting ligaments leading to obstruction of vascular flow. A key risk factor is the presence of a bell-clapper deformity. The most common population affected includes children in a bimodal distribution with the most cases occurring in the first year of life and between 12 and 18 years, although cases do occur in adults. Acute, severe, unilateral scrotal pain is the most common presenting symptom. Nausea and vomiting are common, but the presence or absence of a cremasteric reflex is not a reliable indicator of disease. The TWIST score may assist with clinical decision making in patients presenting with acute testicular pain but should not be used in isolation. If torsion is suspected or confirmed, consultation with the urology specialist should not be delayed, as outcomes are time sensitive. Ultrasound can be used for diagnosis, but a normal ultrasound examination cannot exclude the diagnosis. Treatment includes emergent urology consultation for surgical exploration and detorsion, as well as symptomatic therapy in the ED. Manual detorsion can be attempted in the ED while awaiting transfer or consultation. CONCLUSIONS An understanding of testicular torsion can assist emergency clinicians in diagnosing and managing this disease.
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Affiliation(s)
- Aaron Lacy
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MS, USA.
| | - Amanda Smith
- Department of Emergency Medicine, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam, Houston, TX, USA.
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13
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Zvizdic Z, Bukvic M, Vranic S. A late-diagnosed complete intravaginal testicular torsion with preserved blood flow and viable testis in an adolescent: A case report. Asian J Surg 2023:S1015-9584(23)00113-6. [PMID: 36732177 DOI: 10.1016/j.asjsur.2023.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Melika Bukvic
- Department of Radiology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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14
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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] [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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15
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Komarowska M, Kowalska M, Grubczak K, Pawelczyk A, Hermanowicz A, Debek W, Matuszczak E. Situation of Pediatric Patients with Testicular Torsion in Times of COVID-19. Emerg Med Int 2023; 2023:9960452. [PMID: 37197364 PMCID: PMC10185415 DOI: 10.1155/2023/9960452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/23/2023] [Accepted: 04/23/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To assess whether the COVID-19 pandemic had an influence on presentation of testicular torsion and/or increase in the frequency of orchiectomy. Patients and Methods. This retrospective study included boys under 18 years of age with testicular torsion divided in two groups: pre-COVID operated in 2019 vs. COVID-19 group from 2020. We compared demographic data as well as local and general symptoms. We analyzed additional tests, intraoperative findings, length of operation and hospitalization, and followup. Results. We analyzed the data collected from 44 patients (24 boys from first group vs. 20 boys from second group). The median age was 13.4 years vs. 14.5 years in the latter. The median time of symptoms duration was 6.5 hours and 8.5 hours, respectively. The main manifestation was testicular pain without additional signs. The results of the laboratory tests did not reflect local advancement. In the 2019 group, Doppler ultrasound showed absent blood flow in the affected testicle in 62% vs. 80% in 2020. The mean time from admission to surgery was virtually identical: 75 minutes in 2019 vs. 76 minutes in 2020. The mean duration of scrotal revision was similar in both groups. There was only one significant difference: the degree of twisting. In 2019, the mean was 360° vs. 540° in 2020. Incidence of orchiectomy also did not significantly vary between the analyzed time periods, with 21% during the pandemic and 35% during the pre-COVID-19 period. Conclusion. We did not observe an increase in the number of testicular torsion cases during the COVID-19 pandemic. Most importantly, the rates of orchiectomy did not significantly differ between the patients with testicular torsion presenting during the COVID-19 outbreak.
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Affiliation(s)
- Marta Komarowska
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Kowalska
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
| | - Kamil Grubczak
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland
| | - Alicja Pawelczyk
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
| | - Adam Hermanowicz
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
| | - Wojciech Debek
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Matuszczak
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
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16
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Cabo J, Graham K, Chen H, Zhao S, Burger C, Arnold D, Taylor A, Pope J, Clayton D, Brock JW, Adams M, Adams C, Thomas J. Increasing utilization of the TWIST score in workup of patients with acute scrotal pain: Role in diagnosis and risk stratification. J Pediatr Urol 2022; 18:845.e1-845.e8. [PMID: 36244901 DOI: 10.1016/j.jpurol.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/25/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The TWIST score is a 5-component physical examination score used to aid in diagnosis of testicular torsion (TT) and could lessen need for radiologic testing in certain clinical scenarios. OBJECTIVE TWIST use was not previously widespread at our institution. The primary objective of this quality improvement study was to achieve 100% compliance in TWIST utilization among urology and ED residents and to assess for score concordance between ED and urology assessments. Secondary goals were correlation of TWIST components with need for orchiectomy. METHODS ED staff were educated about the TWIST score and asked to complete assessment for patients presenting with acute scrotal pain. Simultaneously, an electronic medical record-based dot phrase was introduced for urology trainees to complete an independent TWIST evaluation. Spearman correlation was performed to assess association between ED and Urology TWIST scores. Multivariable logistic regression was performed to assess association of TWIST score components and need for orchiectomy. RESULTS 103 patients presented to the ED from 3/2018-11/2020 with a complaint of acute scrotal pain; 47 were diagnosed with torsion. As compared to our retrospective cohort, the documentation rate of complete TWIST score components on exam rose from 9% to 98% (P < 0.001) on ED evaluation and 16%-66% on urology evaluation (P < 0.001). Rates of repeat ultrasound for patient's transferred between facilities was similar (58% vs. 63%; p = 0.66) as was median time to OR (160 min vs. 145 min; p = 0.5). Using TWIST cutoff of >5 yielded a specificity of 94.5% for diagnosis of torsion, with corresponding strong correlation between ED and urology scores (rho = 0.71). A firm testicle was noted on urology evaluation in 100% of orchiectomy patients (vs. 61% of salvage patients) with persistent association after controlling for duration of symptoms (OR 28.1; P = 0.016). DISCUSSION Through two-pronged quality improvement efforts, we significantly improved utilization of the TWIST score by ED and urology staff for workup of patients with acute testicular pain. We confirmed the high sensitivity and specificity of the TWIST score and demonstrated inter-rater reliability between ED and urology assessments. On prospective analysis, testicular firmness on exam was predictive of need for orchiectomy. CONCLUSION The TWIST score is an accurate diagnostic tool for both ED and urology providers in workup of children with acute scrotal pain, with a normal score essentially ruling out the condition. Future work should aim at minimizing unnecessary testing in patients demonstrated to be at high risk for torsion.
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Affiliation(s)
- Jackson Cabo
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA.
| | - Kyle Graham
- Surgical Outcomes Center for Kids-Monroe Carrell Jr Children's Hospital, Department of Biostatistics, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA
| | - Heidi Chen
- Surgical Outcomes Center for Kids-Monroe Carrell Jr Children's Hospital, Department of Biostatistics, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA
| | - Shilin Zhao
- Surgical Outcomes Center for Kids-Monroe Carrell Jr Children's Hospital, Department of Biostatistics, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA
| | - Catherine Burger
- Department of Emergency Medicine, Vanderbilt University Medical, Center1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Donald Arnold
- Department of Emergency Medicine, Vanderbilt University Medical, Center1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Abby Taylor
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - John Pope
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - Douglass Clayton
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - John W Brock
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - Mark Adams
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - Cyrus Adams
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - John Thomas
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
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17
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Wei SM, Huang YM. Baicalein Alleviates Testicular Ischemia-Reperfusion Injury in a Rat Model of Testicular Torsion-Detorsion. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:1603469. [PMID: 36388170 PMCID: PMC9652068 DOI: 10.1155/2022/1603469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 07/27/2023]
Abstract
Testicular torsion/detorsion-induced ischemia/reperfusion injury is partly due to the overgeneration of reactive oxygen species. Baicalein, a main bioactive constituent derived from the dried root of Scutellaria baicalensis Georgi, possesses powerful antioxidative and anti-inflammatory properties. Therefore, we designed the research to explore the possible protective effect of baicalein against testicular ischemia-reperfusion injury. Sprague-Dawley rats were randomized into 4 groups, including control, testicular ischemia-reperfusion, testicular ischemia-reperfusion+vehicle injection, and testicular ischemia-reperfusion+baicalein therapy groups. The control group received surgical exposure of the left testis without torsion-detorsion. In the testicular ischemia-reperfusion group, the left testis underwent 720° counterclockwise torsion for two hours and then was allowed detorsion. Rats in the testicular ischemia-reperfusion+vehicle injection group received intraperitoneal injection of the vehicle at detorsion. In the baicalein-treated group, the intraperitoneal administration of baicalein dissolved in the vehicle was performed at detorsion. At four hours or three months following testicular detorsion, testicular tissues were removed to detect the levels of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) which can recruit neutrophils into the testis, myeloperoxidase activity (an index of neutrophil infiltration in the testis), protein expression of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase in neutrophils which can catalyze reactive oxygen species production, malondialdehyde concentration (a common marker of reactive oxygen species), and spermatogenesis. Both testicular ischemia-reperfusion and testicular ischemia-reperfusion+vehicle injection significantly increased the TNF-α and IL-1β levels, myeloperoxidase activity, NADPH oxidase protein expression, and malondialdehyde concentration, while decreased spermatogenesis in ipsilateral testes. In contrast, baicalein administration remarkably reduced TNF-α and IL-1β levels, myeloperoxidase activity, NADPH oxidase protein expression, and malondialdehyde concentration and also elevated spermatogenesis in ipsilateral testes. The results of our experiment demonstrate that baicalein alleviates testicular ischemia-reperfusion injury by inhibiting TNF-α and IL-1β secretion, neutrophil infiltration in the testis, and NADPH oxidase protein expression in neutrophils to reduce reactive oxygen species production.
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Affiliation(s)
- Si-Ming Wei
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou City, Zhejiang Province 310015, China
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province 310053, China
| | - Yu-Min Huang
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou City, Zhejiang Province 310058, China
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18
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Seker U, Kavak DE, Guzel BC, Baygeldi SB, Yuksel M, Unay Demirel O, Irtegun Kandemir S, Sener D. Targeting soluble guanylate cyclase with Riociguat has potency to alleviate testicular ischaemia reperfusion injury via regulating various cellular pathways. Andrologia 2022; 54:e14616. [DOI: 10.1111/and.14616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/17/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ugur Seker
- Department of Histology and Embryology, School of Medicine Harran University Sanliurfa Turkey
| | - Deniz Evrim Kavak
- Department of Medical Biology, School of Medicine Dokuz Eylul University Izmir Turkey
| | - Baris Can Guzel
- Department of Veterinary Anatomy, Faculty of Veterinary Medicine Firat University Elazig Turkey
| | - Saime Betul Baygeldi
- Department of Veterinary Anatomy, Faculty of Veterinary Medicine Firat University Elazig Turkey
| | - Meral Yuksel
- Department of Medical Laboratory, Vocational School of Health‐Related Professions Marmara University Istanbul Turkey
| | - Ozlem Unay Demirel
- Department of Medical Biochemistry, School of Medicine Bahcesehir University Istanbul Turkey
| | | | - Dila Sener
- Department of Histology and Embryology, School of Medicine Bahcesehir University Istanbul Turkey
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19
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Delgado-Miguel C, García A, Muñoz-Serrano AJ, López-Pereira P, Martínez-Urrutia MJ, Martínez L. The role of neutrophil-to-lymphocyte ratio as a predictor of testicular torsion in children. J Pediatr Urol 2022; 18:697.e1-697.e6. [PMID: 36175289 DOI: 10.1016/j.jpurol.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/16/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Doppler ultrasound constitutes the gold standard for the diagnosis of testicular torsion (TT), although sometimes the spermatic cord twisting and absence of testicular flow are difficult to visualize. To date, no laboratory markers have been shown to be useful for preoperative TT diagnosis. OBJECTIVE Our aim is to analyze the role of the neutrophil-to-lymphocyte ratio (NLR) as a predictor of pediatric TT. STUDY DESIGN A retrospective single-center case-control study was performed in patients with ultrasound suspicion of TT, in whom surgical testicular examination was performed between 2016 and 2020. Patients were divided into two groups according to the intraoperative findings: TT group (testicular torsion), defined as spermatic cord twisting on itself around its longitudinal axis at least 360°, and non-TT group (no torsion). Demographics, clinical, ultrasound and laboratory features at admission were analyzed. Sensitivity and specificity were determined by the area under the curve (AUC) represented on the receiver operating characteristic (ROC) curves. RESULTS A total of 159 patients were included (117 TT group; 42 non-TT group), with no demographic or clinical differences. TT group patients presented significantly shorter median time since symptoms onset (4 vs. 8 h; p < 0.012). Laboratory inflammatory test were significantly higher in TT group: Leukocytes (10,900 × 103/μl vs. 7,980 × 103/μl; p < 0.001), neutrophils (8,050 × 103/μl vs. 3,350 × 103/μl; p < 0.001) and NLR (4.6 vs. 1.1; p < 0.001). In ROC curve analysis, NLR presented the highest AUC (0.903), significantly higher than all other laboratory and ultrasound parameters. NLR of 2.3 was the cut-off point with maximum sensitivity (86.9%) and specificity (94.8%). DISCUSSION This is, to the best of our knowledge, the first study to analyze the usefulness of NLR in predicting the diagnosis of TT in patients with clinical and ultrasound suspicion. The limitations are mainly derived from being a single-center retrospective study. For this reason, multicenter studies with a higher number of patients and prospective design may be useful to minimize these biases. The sample size of our study, although not large, has allowed us to identify significant differences between the distinct parameters analyzed as predictors of TT. However, the absence of other similar studies in pediatric patients has hindered the comparison of our results. CONCLUSION NLR should be considered as a predictor of pediatric TT in cases with nuclear ultrasound suspicion that may help to anticipate the urgent surgical treatment in these patients.
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Affiliation(s)
| | - Antonella García
- Department of Pediatric Surgery, La Paz Children´s Hospital, Madrid, Spain
| | | | | | | | - Leopoldo Martínez
- Department of Pediatric Surgery, La Paz Children´s Hospital, Madrid, Spain; Institute for Biomedical Resarch La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
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20
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Beşler MS, Gökhan MB, Ölçücüoğlu E, Özdemir FAE. Shear wave elastography for the evaluation of testicular salvage after testicular torsion. Andrologia 2022; 54:e14565. [PMID: 35973680 DOI: 10.1111/and.14565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/29/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to assess the utility of shear wave elastography in the follow-up of testicular detorsion, evaluate long-term outcomes, and explore its relationship with parameters such as tissue stiffness values, pain duration, and torsion type. Elastography examinations were independently performed by two radiologists to evaluate patients who presented to our hospital for follow-up after being diagnosed with testicular torsion and age-matched controls. Inter-observer variability of the mean testicular tissue elasticity was excellent (Intraclass correlation coefficient: 0.939, p < 0.001). Median time between testicular detorsion and follow-up ultrasound examination was 18 months (range, 11-36 months). Torsion side, torsion degree, and pain duration were recorded, and testicular volumes were calculated. The study population comprised 24 patients (48 testes) with a mean age of 21.1 ± 7.8 years. The mean testicular volume was measured as 12.3 ± 5.4 ml for the testicular salvage group, 13.9 ± 3.8 ml for the contralateral testes, and 13.7 ± 2.7 ml for the control group (p = 0.553). The mean testicular speed mode values were higher in the testicular salvage group (1.34 ± 1.21 m/s) compared with the contralateral testes group (1.00 ± 0.08 m/s), and the control group (1.01 ± 0.06 m/s), however there was no statistically significant difference between the three groups (p = 0.861). While testicular atrophy was detected in three patients, an intraparenchymal wedge-shaped focal hypoechoic area developed after torsion in a further three patients. The elastography examination for focal hypoechoic areas revealed an increase or decrease in tissue stiffness compared to the normal parenchyma. The tissue stiffness values of the testicular salvage group were higher in complete torsion compared to incomplete torsion. The elastography method contributes to other imaging methods in distinguishing focal lesion areas that can be seen after testicular torsion from malignant conditions. Elastography presents as a feasible and practical complementary modality for the follow-up of testicular salvage after torsion.
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Affiliation(s)
| | | | - Esin Ölçücüoğlu
- Department of Radiology, Ankara City Hospital, Ankara, Turkey
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21
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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]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 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] [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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22
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Testicular volume loss in the long-term follow-up after surgical detorsion of the testis. Pediatr Surg Int 2022; 38:907-911. [PMID: 35366086 DOI: 10.1007/s00383-022-05118-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
AIM The aim of this study is to evaluate sonographic testicular volume of patients who underwent surgical detorsion due to testicular torsion and to reveal the frequency of long-term testicular volume loss and the factors affecting it. METHOD The files of patients who underwent surgical detorsion due to unilateral testicular torsion in our hospital between 2011 and 2019 were reviewed retrospectively. Age at the time of detorsion surgery, time from the onset of pain to surgery, degree of torsion, and ultrasonographic testicular volumes before detorsion were noted. Afterward, patients with at least 6 months of follow-up were contacted by phone and testicular volumes were measured by scrotal ultrasonography (US). The sonographic formula Length × Width × Height × 0.72 was used to determine testicular volumes. RESULTS There were 97 patients who underwent surgical detorsion within the given time frame. However, 43 of these patients accepted to be involved in the study and a follow-up scrotal US was performed. The mean age at the time of detorsion was 13.6 ± 5.6 years, whereas it was 16.7 ± 6.2 years at the time of the follow-up visit. The median time from the onset of pain to surgery was 4 h (range 1-36 h). In the preoperative US, the mean volume of the affected testis was 10.8 ± 5.6 mm3, while the mean contralateral testis volume was 10.2 ± 5.4 mm3 (p = 0.134). The median follow-up time in our study was 24 months (range 6-96 months). In the control US, the mean volume of the affected testis was 9.5 ± 7.1 mm3, while the mean volume of the contralateral testis was 14.4 ± 9 mm3 (p = 0.001). The affected testicular volumes decreased in 23 patients (range 1.1-100%), there was no change in testicular volumes in two patients, and there was an increase in testicular volumes in 18 patients (range 3.8-100%). In the ROC analysis, risk of testicular volume loss can be predicted with 87.5% sensitivity and 83.9% specificity when the time from the onset of pain to surgery exceeds 5.5 h (AUC = 0.904). CONCLUSION Our results indicated that if the time from the onset of pain to surgery exceeds 5.5 h, the testicular volume loss may be expected in the long term. Thus, patients and parents should be informed accordingly.
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23
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Comparison of demographic and clinical characteristics in distinguishing testicular torsion from torsion of the appendix testis: A single-center retrospective study. Asian J Urol 2022. [DOI: 10.1016/j.ajur.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Chen P, Huang W, Liu L, Chen N, Zhou G, Sun M, Li S. Predictive value of hematological parameters in testicular salvage: A 12-year retrospective review. Front Pediatr 2022; 10:989112. [PMID: 36061382 PMCID: PMC9428396 DOI: 10.3389/fped.2022.989112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aimed to evaluate the predictive value of preoperative hematological parameters for testicular salvage in patients with testicular torsion. METHODS Clinical data of patients with testicular torsion treated at Shenzhen Children's Hospital from January 2010 to December 2021 were analyzed retrospectively. The data collected included age, symptom duration, degree of spermatic cord torsion, the surgical approach adopted, hematological parameters, and ultrasound results during postoperative follow-up. RESULTS The study participants were classified into three groups as follows: the successful testicular salvage group (n = 43), failed testicular salvage group (n = 124), and control group (n = 100). Univariate analysis showed that testicular salvage was related to patient age, duration of symptoms, spermatic cord torsion degree, white blood cell count, lymphocyte count, monocyte count, platelet-lymphocyte ratio, and neutrophil-lymphocyte ratio. However, multivariate analysis revealed that symptom duration (OR = 0.948, P < 0.001), degree of spermatic cord torsion (OR = 0.994, P < 0.001), and monocyte count (OR = 0.020, P = 0.011) were independent risk factors for testicular torsion salvage. The monocyte count in the failed salvage group was significantly higher than in the successful salvage and control groups (P < 0.01). CONCLUSION Monocyte count is an independent predictor of testicular salvage. Therefore, clinicians can predict the success rate of testicular salvage in patients with testicular torsion based on the monocyte count.
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Affiliation(s)
- Pengyu Chen
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Weipeng Huang
- Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Lei Liu
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Nana Chen
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Guanglun Zhou
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
| | - Mengkui Sun
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
| | - Shoulin Li
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
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25
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Yu C, Zhao J, Lu J, Wei Y, Jiang L, Zhao T, Lin T, He D, Wen S, Wu S, Wei G. Demographic, clinical, and socioeconomic factors associated with delayed diagnosis and management of pediatric testicular torsion in West China: a retrospective study of 301 cases in a single tertiary children's hospital. BMC Pediatr 2021; 21:553. [PMID: 34872532 PMCID: PMC8647496 DOI: 10.1186/s12887-021-03001-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the association between geographic, clinical, socioeconomic factors and delayed management of pediatric testicular torsion (TT) in West China. Methods A retrospective study was conducted on TT at Children’s Hospital of Chongqing Medical University in West China from November 2004 to December 2020. Univariate analysis and logistic regression analysis were conducted to determine the association between these factors and delayed management of TT. Results A total of 301 cases were included in this study. The misdiagnosis rate of TT in primary, secondary healthcare units and tertiary hospitals was 93.8, 71.1, and 8.9%, respectively. Approximately 26.9% of TT boys received timely surgical management (within 12 h from symptoms inset to surgery). Logistic regression analyses suggested the following factors were associated with delayed repair of TT: age less than 6 years (P = 0.001), with a history of symptoms progress (P = 0.001) or former treatment (P <0.001), absence of other diagnosis (P = 0.011) and those boys living far away from the main city zones (P <0.001). Conclusions Delayed surgical management for TT was more likely for boys with age less than 6 years, the absence of other diagnosis, with a history of former treatment or symptoms progress, and those living far away from the main city zone. To maximize the possibility of timely surgical management for TT, it is vital to strengthen the public awareness of TT and conduct continuously re-education and update physicians working at primary and secondary healthcare units.
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Affiliation(s)
- Chengjun Yu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Jie Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Jiandong Lu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Yi Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Li Jiang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianxin Zhao
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China
| | - Sheng Wen
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China. .,National Clinical Research Center for Child Health and Disorders, Chongqing, China. .,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China. .,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China.
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China
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Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic?-A retrospective multicenter study. J Pediatr Urol 2021; 17:479.e1-479.e6. [PMID: 33994321 PMCID: PMC8087574 DOI: 10.1016/j.jpurol.2021.04.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/09/2021] [Accepted: 04/25/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Testicular torsion is a real emergency condition which requires prompt diagnosis and surgical management to prevent testicular loss. During the coronavirus (COVID-19) pandemic, an increased avoidance of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature. OBJECTIVE The aim of this study was to investigate whether the COVID-19 pandemic caused increased number of orchiectomies in pediatric patients presenting with acute testicular torsion compared to pre-COVID-19 period. STUDY DESIGN A total number of 119 pediatric patients who underwent surgery for acute testicular torsion from January 2019 to December 2020 were enrolled in retrospective multi-center study from six institutions in Croatia. The patients were divided in two groups. The first group (pre-COVID-19) consisted of the patients who underwent surgery before COVID-19 pandemic (n = 68), while the second group (COVID-19) consisted of the patients who underwent surgery during the COVID-19 pandemic (n = 51). Main outcomes of the study were orchiectomy rates and time from onset of the symptoms to emergency department presentation. RESULTS During the COVID-19 pandemic period 43.1% (22/51) of the patients underwent orchiectomy while orchiectomy was performed in 16.2% (11/68) of the patients from the pre-COVID group (p = 0.001). Median time from onset of the symptoms to emergency department presentation during COVID-19 pandemic and pre-COVID-19 periods was 14h (IQR 5, 48) and 6h (IQR 3, 22) (p = 0.007), respectively. A higher proportion of patients waited over 24 h to present to emergency department during the COVID-19 pandemic compared to the pre-COVID-19 period (47% vs 8.8%, p = 0.007). CONCLUSION During COVID-19 pandemic a significantly higher rates of orchiectomies and increase in delayed presentations for testicular torsion was found. More patient education during pandemic in regards to management of emergency conditions such as testicular torsion is required.
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