The amount of spermatic cord rotation magnifies the time-related orchidectomy risk in Intravaginal testicular torsion

Filho, Aderivaldo Cabral Dias; Alves, João Ricardo; Filho, Hélio Buson; Oliveira, Paulo Gonçalves de

doi:10.1590/s1677-5538.ibju.2016.0166

Cited by 20 publications

(26 citation statements)

References 25 publications

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“…Animal models have shown a relationship between various testicular outcomes and degrees of rotation in the spermatic cord [21,22]. In humans, Dias Filho et al [23] demonstrated that the degree of twisting has a multiplicative effect on the role of pre- sentation delay in TT. Greater degree of testicular rotation is seen in patients undergoing orchidectomy than orchiopexy.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Testicular Torsion and Identification of Predictors of Testicular Salvage in Children: A Retrospective Study in a Single Institution

et al. 2020

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Testicular torsion (TT) is a serious surgical emergency. Prompt diagnosis and treatment of TT are essential to improve the incidence of salvaged testes. The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. Materials and Methods: We retrospectively reviewed the records of 136 males who presented with TT to our institution. Clinical findings, physical examinations, laboratory data, color Doppler ultrasound findings, operating results, and the results of followup were collected and analyzed. Patients with neonatal torsion, negative scrotal exploration, or testicular appendix torsion were excluded. A multivariable logistic regression model was used to identify predictors of testicular salvage. Receiver operator characteristics analyses were performed to determine the probability of a non-salvageable torsed testis based on time and degree of twisting. Results: A total of 136 children with TT were identified. Patients were aged from 1 to 16 years, with a mean age of 9.7 years (median, 12; range, 1-16 years). The peak incidences of TT were found between ages of 12 and 14 years. Acute TT is significantly more common in the winter. Testicular salvage occurred in 49 (36%) cases. Of the 49 cases of testicular salvage, 5 patients developed subsequent testicular atrophy. Cutoff values of 13.5 h and 530 degrees of torsion would provide sensitivities of 96 and 61%, with specificity of 80 and 70%, respectively. Multivariate analysis showed that time to surgery and degree of testicular twist were correlated with the risk of a non-salvageable testis. Conclusions: Testicular salvage can be predicted by the duration of symptoms along with degree of twisting. Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. A certain percentage of children with TT presenting with lower abdominal pain should have their testicles checked to make sure that they do not have torsion, especially those visitors in cold season.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Testicular Torsion and Identification of Predictors of Testicular Salvage in Children: A Retrospective Study in a Single Institution

et al. 2020

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“…Filho et al recently reviewed their records of 117 patients with testis torsion, and found a correlation in time (median of 8.4 h in the orchiopexy group) and degree of torsion in the orchiopexy group. Orchiectomy rates increased starting at 540°, in which duration of symptoms became more relevant in testis survival rates seen between 6 and 12 h. Testes were salvaged in all patients less than 360° and removed in all patients over 1,080° of twisting ( 9 ). Based on this study combined with prior animal research, it appears that somewhere between 360–540° of twisting during testicular torsion lies the point where significant occlusion to arterial flow occurs with risk of damage to the testicle.…”

Section: Discussionmentioning

confidence: 99%

“…Greater degree of testicular rotation is seen in patients undergoing orchidectomy vs. orchiopexy. However, testicular atrophy rates at follow-up were not measured ( 9 ). The purpose of our study is to further explore how the degree of torsion factors into testicular outcome.…”

Section: Introductionmentioning

confidence: 99%

Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion

Howe¹,

Vasudevan²,

Kongnyuy³

et al. 2017

Transl. Androl. Urol.

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BackgroundTesticular torsion is surgical emergency. Prompt diagnosis and treatment of testicular torsion is essential for testicular viability. At surgical exploration, the spermatic cord is seen twisted a variable number of times around its longitudinal axis. There is scant data regarding the degree of twisting and its association with testis outcomes. The purpose of our study is to explore how the degree of torsion factors into testicular outcome using follow-up data.MethodsWe retrospectively reviewed the records of adolescent males who presented with testicular torsion to our institution, looking at duration of pain symptoms, degree of torsion documented in the operative note, procedure performed (orchiopexy versus orchiectomy), and follow-up clinic data for whether testicular atrophy after orchiopexy was present. A non-salvageable testis was defined as orchiectomy or atrophy. Receiver operator characteristics (ROC), multivariate, and logistic regression analyses were performed to determine the probability of a non-salvageable torsed testis based on time and degree of twisting.ResultsEighty-one patients met our study criteria, with 55 testes deemed viable and 26 non-salvageable. We found a 25.7% atrophy rate after orchiopexy. Cut-off values of 8.5 h and 495 degrees of torsion would provide sensitivities of 73% and 53%, respectively, with specificity of 80% for both. Only duration and age were correlated with the risk of non-salvage on multivariate analysis. Logistic regression generated linear probability formulas of 4 + (3 ¡Á hours) and 7 + (0.05 ¡Á degrees) in calculating the probability of non-salvage with strong correlation.ConclusionsWe were able to derive separate formulas to determine the viability of the torsed testis based on symptom duration and degrees of twisting. Fifteen h of symptoms and 860 degrees of torsion gives testes a 50% salvage rate. Interestingly, we also found that about 1 out of every 4 testes undergoes atrophy after orchiopexy.

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“…In hierarchical health care systems such as the one we have in Brazil (8), where patients with scrotal emergencies are often first examined by general practitioners at primary or secondary level-of-care facilities, then referred to tertiary facilities for treatment, this not only requires the first examining physician to perceive the case as an emergency, but also that referral is not deferred for supplemental diagnostic testing. Thus, in the ideal situation -where patients rapidly seek medical attention, and are promptly examined by a competent diagnostician with immediate access to expert diagnostic imaging and referral protocols -one should observe low orchidectomy rates (9), which, unfortunately, have not been our experience (10).…”

Section: Introductionmentioning

confidence: 97%

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

Filho

Maroccolo²,

Ribeiro³

et al. 2020

Int. braz j urol.

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Purpose: To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. Patients and Methods: Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. Results: 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). Conclusion: Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing populationwide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.

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The amount of spermatic cord rotation magnifies the time-related orchidectomy risk in Intravaginal testicular torsion

Cited by 20 publications

References 25 publications

Clinical Characteristics of Testicular Torsion and Identification of Predictors of Testicular Salvage in Children: A Retrospective Study in a Single Institution

Clinical Characteristics of Testicular Torsion and Identification of Predictors of Testicular Salvage in Children: A Retrospective Study in a Single Institution

Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

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