Clinical and Radiological Characteristics of Testicular Torsion Cases in Children and Adolescents and Postoperatively Follow-Up Results

Abstract

Introduction: Testicular torsion is a surgical acute condition characterised by loss of blood supply to the testicle due to abnormal bending of the testicle. Early diagnosis and treatment are vitally important for the prevention of testicular loss. In this study, we aimed to present the clinical and radiological features and postoperative follow-up results of testicular torsion cases in children and adolescents. Methods: In this cross-sectional study, the data of patients aged 17 years and younger who were operated for testicular torsion between January 2014 and June 2023 were evaluated retrospectively. Patients' age, symptoms, hospital admission time, physical examination findings, scrotal colour Doppler ultrasound results, surgical techniques (manual detorsion or orchiectomy) and late follow-up results were statistically analysed. Results: The mean age of 66 patients operated with the diagnosis of testicular torsion was calculated as 6.55 years (14 days-17 years). Left testicular torsion was detected in 48 (72.7%) and right testicular torsion in 18 (27.2%) patients. There were no cases of bilateral torsion. Four patients had a history of scrotal trauma and three patients had undescended testis. A history of sudden scrotal pain on awakening from sleep in the morning was reported by 31 patients (46.9%). When the time from the onset of symptoms to admission to the emergency department was evaluated, it was found that 50% (n=33) of the patients were admitted within 0-12 hours, 36.3% (n=24) within 12-24 hours and 13.6% (n=9) more than 24 hours. A total of 34 patients underwent orchiopexy and 32 patients underwent orchiectomy. Orchiectomy was performed in 15.1% of the patients with a presentation time of less than 12 hours, 79.1% of the patients with a presentation time of 12-24 hours and 88.9% of the patients with a presentation time of more than 24 hours. None of the patients with 360 degrees of torsion during surgery required orchiectomy. 64.5% of patients with 540 degrees of torsion and 92.3% of patients with 720 degrees of torsion underwent orchiectomy. Late orchiectomy was performed in 7 patients who developed testicular atrophy as a result of clinical follow-up. Conclusion: In children presenting with acute scrotum, it is vital that the differential diagnosis of testicular torsion is made and treated as soon as possible. However, raising public awareness for early presentation is as important as the surgical procedure