A multicenter study of acute testicular torsion in the time of COVID-19

Abstract

Background Testicular torsion is a surgical emergency, and time to detorsion is imperative for testicular salvage. During the COVID-19 pandemic, patients may delay emergency care due to stay-at-home orders and concern of COVID-19 exposure. Objective To assess whether emergency presentation for testicular torsion was delayed during the COVID-19 pandemic, and whether the rate of orchiectomy increased compared to a retrospective period. Study Design Patients were prospectively enrolled in a multicenter study from seven institutions in the United States and Canada. Inclusion criteria were patients two months to 18 years of age with acute testicular torsion from March through July 2020. The retrospective group included patients from January 2019 through February 2020. Statistical analysis was performed using Kruskal-Wallis tests, Chi-square tests, and logistic regression. Results A total of 221 patients were included: 84 patients in the COVID-19 cohort and 137 in the retrospective cohort. Median times from symptom onset to emergency department presentation during COVID-19 compared to the retrospective period were 17.9 hours (IQR 5.5-48.0) and 7.5 hours (IQR 4.0-28.0) respectively (p = 0.04). In the COVID-19 cohort, 42% of patients underwent orchiectomy compared to 29% of pre-pandemic controls (p = 0.06). During COVID-19, 46% patients endorsed delay in presentation compared to 33% in the retrospective group (p = 0.04). Discussion We found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a higher proportion of patients reported delaying care. Strengths of the study include the number of included patients and the multicenter prospective design during the pandemic. Limitations include a retrospective pre-pandemic comparison group. Conclusions In a large multicenter study we found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a significantly higher proportion of patients reported delaying care. Based on the findings of this study, more patient education is needed on the management of testicular torsion during a pandemic.

The Impact of COVID-19 Pandemic on Admission Times, Manual Detorsion Rates and Outcomes in Testicular Torsion

“…Both Littman et al and Nelson et al showed no significant alterations in orchiectomy rates of testicular torsion cases during the pandemic which this study was consistent with 11,12 . Contrarily, in the multicenter study by WPUC, significantly delayed patients during the pandemic resulted in a non-significant but numerically higher percentages of orchiectomies 13 . In this study, during the COVID-19 pandemic, the number and percentage of orchiectomies have decreased numerically but not significantly.…”

“…Similar to this study, Littman et al and Nelson et al found no delay in the time of presentation of testicular torsion cases during COVID-19 pandemic 11,12 . On the other hand, a very recent multicenter study from the Western Pediatric Urology Consortium (WPUC) suggests significantly longer presentation times of testicular torsion cases during the pandemic 13 .…”

Surge in testicular torsion in pediatric patients during the COVID-19 pandemic

“…Few studies have reported the association between COVID-19 and testicular torsion in the pediatric population [13][14][15]. Nelson [13]. These authors determined a significantly longer time from testicular torsion symptom onset to presentation during COVID-19 compared to pre-COVID-19 (17.9 hours vs 7.5 hours, p = 0.04) and a higher proportion of patients who reported a delay in presentation (46% vs 33%).…”

“…Gagliardi and colleagues described epididymoorchitis in a 14-year-old boy with COVID-19 without respiratory symptoms [29]. Few studies have reported the association between COVID-19 and testicular torsion in the pediatric population [13][14][15]. Nelson [13].…”

“…COVID-19 may enter the host cell by binding to the ACE2 receptor, whose expression is highest in the testes. A paucity of studies have addressed the association between COVID-19 and testicular torsion in the pediatric population [13][14][15]. This study investigated whether there was a significantly higher number of testicular torsion cases during the COVID-19 pandemic.…”