Treatment patterns, testicular loss and disparities in inpatient surgical management of testicular torsion in boys: a population‐based study 1998–2010

Sood, Akshay; Li, Hanhan; Suson, Kristina D.; Majumder, Kaustav; Sedki, Mai; Abdollah, Firas; Sammon, Jesse D.; Friedman, Ariella; Löppenberg, Björn; Lakshmanan, Yegappan; Trinh, Quoc‐Dien; Elder, Jack S.

doi:10.1111/bju.13557

Cited by 9 publications

(4 citation statements)

References 25 publications

(47 reference statements)

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“…The annual incidence of TT has been estimated to be around 0.004% among children <18 years (2). TT may occur at any age, but the vast majority of cases occur after age 10 years with a peak at 12 to 16 years (3). This disease features a dramatic reduction of testicular blood supply due to the torsion of the spermatic cord, with left-sided predominance, and rare bilaterality.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy

et al. 2020

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Objective: To analyze the risk factors for testicular atrophy (TA) in children with testicular torsion (TT) following emergent orchiopexy. Methods: Clinical data of patients with TT undergoing orchiopexy were retrospectively reviewed, including age at surgery, affected side, delayed surgery (12–24 h and more than 24 h), echogenicity of testicular parenchyma on ultrasonography (ETPU), testicular blood flow on Color Doppler ultrasonography (CDUS), surgical findings (intraoperative blood supply, the degree of torsion, and surgical approaches), and follow-up. The primary outcome was the rate of TA after orchiopexy. The secondary outcome was the testicular volume loss (TVL) between the affected testis and the contralateral. Results: A total of 113 patients were enrolled in this study with a median age of 11 years. The median follow-up was 21 months. Patients had a median TVL of 51.02% and 44 (38.94%) of them developed severe TA during follow-up. TA was significantly associated with age at surgery ( P < 0.0001), delayed surgery ( P = 0.0003), ETPU ( P = 0.0001), and intraoperative blood supply ( P = 0.0005). Multivariate logistic regression analysis showed that school-age children (OR = 0.069, P < 0.001) and puberty (OR = 0.177, P = 0.007) had a decreased risk of TA compared with preschool children, and that heterogeneous ETPU (OR = 14.489, P = 0.0279) and delayed surgery >24 h (OR = 3.921, P = 0.040) increased the risk of TA. Multivariate analysis demonstrated that ETPU ( F = 16.349, P < 0.001) and delayed surgery ( F = 6.016, P = 0.003) were independent risk factors for TVL. Conclusions: Age at surgery, delayed surgery, and ETPU may play a crucial role in predicting the TA in children with TT following emergent orchiopexy. Moreover, blood flow measured by CDUS could not predict the outcome properly.

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Section: Introductionmentioning

confidence: 99%

Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy

et al. 2020

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“…However, since the 1980s, salvage rates have not improved further [9,10]. Even in 'salvaged' cases, longer-term atrophy remains high in 30-67% of cases [9,10]. A rapid evidence search carried out by the authors of the present study found no published studies evaluating interventions designed to improve salvage rates.…”

Section: Introductionmentioning

confidence: 63%

“…From the 1960s to the 1980s, salvage rates improved from 45% to 67% [8]. However, since the 1980s, salvage rates have not improved further [9,10]. Even in 'salvaged' cases, longer-term atrophy remains high in 30-67% of cases [9,10].…”

Section: Introductionmentioning

confidence: 99%

Serious incidents in testicular torsion management in England, 2007–2019: optimizing individual and training factors are the key to improved outcomes

et al. 2021

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To establish the healthcare factors that contribute to testicular torsion adverse events (orchidectomies) and 'near misses'. The secondary objective was to identify areas suitable for impactful quality improvement initiatives to be undertaken by National Health Service (NHS) healthcare providers nationally. Materials and MethodsThis was a retrospective record review and analysis, carried out in four phases. We applied the well-validated London Protocol patient safety incident analysis framework to all eligible serious incidents related to testicular torsion submitted by English NHS Trusts over a 12-year period to the Strategic Executive Information System database. Clinical reviewers established the incident population (Phase 1), were trained and piloted the feasibility of using the London Protocol (Phase 2), applied the protocol and themed the identified contributing factors linked to adverse events (orchidectomies) and nearmisses (Phase 3), and reviewed the evidence for improvement interventions (Phase 4).

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“…Challenges still persist at present in ensuring that the incidence of missed testicular torsion is minimized. Sood et al 7 analyzed the temporal trend in the management of testicular torsion between 1998 and 2010 in the United States, using a cohort of over 17,000 patients, and found no improvement in the rate of testicular loss over this period. A number of factors may be involved, and the key to improving outcomes lies in identifying which of these factors are most influential so they can be addressed.…”

Section: Discussionmentioning

confidence: 99%

Testicular pain pathway in children: Investigating where missed torsion occurs most often

Bastianpillai¹,

Haddad²,

Green³

2018

European Urology Supplements

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Treatment patterns, testicular loss and disparities in inpatient surgical management of testicular torsion in boys: a population‐based study 1998–2010

Cited by 9 publications

References 25 publications

Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy

Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy

Serious incidents in testicular torsion management in England, 2007–2019: optimizing individual and training factors are the key to improved outcomes

Testicular pain pathway in children: Investigating where missed torsion occurs most often

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