Orchio-Septopexy: A new technique to cover and fix detorsed testis undergoing fasciotomy of tunica albuginea

Abstract

Purpose: Compartment Syndrome (CS) has been recognized as a potential factor that worsens testicular viability after detorsion, especially in borderline cases of prolonged ischemia. Fasciotomy of the testicular tunica albuginea to relieve the pressure associated with CS has been proposed to accommodate edema after detorsion, embracing the raw fasciotomy area with tunica vaginalis flap (TVF) or graft. Fashioning the TVF can be tedious in cases of severe scrotal edema. Herein we present a technique that facilitates and expedites the procedure, maintaining the fasciotomy area decompressed. Materials and Methods: In testicular torsion, where the testis remains with dark coloration and questionable viability after detorsion a longitudinal releasing incision is made in the tunica albuginea (fasciotomy) to decrease compartmental pressure. If signs of parenchymal recovery (bleeding points, better color) are seen an orchio-septopexy is performed, suturing the incised albuginea's edges to the septum with a running suture, avoiding CS as well as re-torsion. Results: Orchio-septopexy was performed in 11 cases with a mean age of 11.9 years (3-17). All cases had clinic follow-up and testicular Doppler US with a mean of 9.5 months (6-24). 6/11 cases (54%) were salvaged, with good vascularity in the Doppler US and maintained more than 50% testicular volume compared to the contralateral side. Conclusion: Orchio-septopexy after testicular fasciotomy is a simple and fast technique that can be utilized in cases of prolonged testicular ischemia and questionable viability. More than half of the testes recovered, encouraging us to propose its utilization as well as its validation by other surgeons.

Collagen fleece (Tachosil®) for treating testis torsion: A case report

“…However, harvesting the flap is meticulous, tedious, and time consuming. Thus, other methods such as orchio-septopexy have been suggested as alternatives[ 2 ].…”

“…Testis torsion is time sensitive to ischemia. The rate of orchiectomy can reach 80% to 90% when ischemia time exceeds 24 h[ 2 ]. Thus, it is essential to perform urgent surgical exploration in all cases of testicular torsion within 24 h of symptom onset[ 3 ].…”

“…It is also associated with bleeding, especially if scrotal edema and inflammatory reaction are present. Therefore, other methods such as orchio-septopexy as alternative techniques have been reported[ 2 ].…”

Vesical imaging reporting and data system (VI-RADS) in bladder cancer diagnosis in review in this number of International Brazilian Journal of Urology

“…Dr. Elifranji and colleagues from Doha -Qatar performed in page 706 (8) the description of a interesting surgical technique to cover and fix detorsed testis undergoing fasciotomy of tunica albuginea and concluded that the orchio-septopexy after testicular fasciotomy is a simple and fast technique that can be utilized in cases of prolonged testicular ischemia and questionable viability. More than half of the testes recovered, encouraging us to propose its utilization as well as its validation by other surgeons.…”