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

Abstract

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.

Çocuklarda Testis Torsiyonu: 10 Yıllık Retrospektif Bir Çalışma

“…TT, TAT and EO are the most prevalently seen causes of acute scrotum in childhood period (5). Although, TT and TAT have been reported to be the most frequently detected pathologies in the prepubertal men, however, prevalence of each pathological diagnosis present variety among regions (6). Perinatal torsion is not frequently seen and make up 10% of pediatric cases (7).…”

Testicular salvage: using machine learning algorithm to develop a predictive model in testicular torsion

“…[9] Previously published literature showed that the testicular vitality is signi cantly associated with the duration of symptoms and torsion grade. [10,11] Although it was stated that testicular vitality could be protected in 90-100% of TT cases provided that the surgical intervention was performed within the rst 6 hours, this rate decreased to 50% in cases that were surgically explored after the 12th hour. [12] On the other hand, it is known that all TT cases explored after the 12th hour do not necessitate orchiectomy, and in 44% of the cases surgically treated during the rst 6-hour period, testicular volume loss could occur.…”

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

“…In testicular torsion, ischemia duration and torsion degree are the most important factors in preserving the functional features of the testis 14 . Irreversible damage starts after four to six hours and affects both the spermatogenesis and the endocrine functions 15,16 .…”