Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion

Abstract

BackgroundTesticular torsion is surgical emergency. Prompt diagnosis and treatment of testicular torsion is essential for testicular viability. At surgical exploration, the spermatic cord is seen twisted a variable number of times around its longitudinal axis. There is scant data regarding the degree of twisting and its association with testis outcomes. The purpose of our study is to explore how the degree of torsion factors into testicular outcome using follow-up data.MethodsWe retrospectively reviewed the records of adolescent males who presented with testicular torsion to our institution, looking at duration of pain symptoms, degree of torsion documented in the operative note, procedure performed (orchiopexy versus orchiectomy), and follow-up clinic data for whether testicular atrophy after orchiopexy was present. A non-salvageable testis was defined as orchiectomy or atrophy. Receiver operator characteristics (ROC), multivariate, and logistic regression analyses were performed to determine the probability of a non-salvageable torsed testis based on time and degree of twisting.ResultsEighty-one patients met our study criteria, with 55 testes deemed viable and 26 non-salvageable. We found a 25.7% atrophy rate after orchiopexy. Cut-off values of 8.5 h and 495 degrees of torsion would provide sensitivities of 73% and 53%, respectively, with specificity of 80% for both. Only duration and age were correlated with the risk of non-salvage on multivariate analysis. Logistic regression generated linear probability formulas of 4 + (3 ¡Á hours) and 7 + (0.05 ¡Á degrees) in calculating the probability of non-salvage with strong correlation.ConclusionsWe were able to derive separate formulas to determine the viability of the torsed testis based on symptom duration and degrees of twisting. Fifteen h of symptoms and 860 degrees of torsion gives testes a 50% salvage rate. Interestingly, we also found that about 1 out of every 4 testes undergoes atrophy after orchiopexy.

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

“…In this study, several potential risk factors for TA have been retrospectively evaluated, showing that age at surgery, delayed surgery, ETPU, and intraoperative blood supply were significantly correlated to the prognosis. Delayed surgery and the degree of torsion were known prognostic factors for testicular viability during operation (13,14). In a retrospective study, Lian et al found that a higher incidence of postoperative TA was related to a delay of more than 24 h (6).…”

Application value of real-time shear wave elastography in differential diagnosis of testicular torsion

“…Irreversible damage to spermatogenic tissues can occur after 6 hours of testicular tissue ischemia [4]. Therefore, testicular torsion should be diagnosed as early as possible to facilitate testicular survival and protect spermatogenic function [5,6]. High frequency color Doppler ultrasonography is accepted to be the primary imaging method used in these cases [7,8]; however, some cases of incomplete testicular torsion can be unrecognized due to atypical sonographic findings [7,9].…”

Effect of unilateral testicular torsion at different ages on male fertility

“…Ischemic infarction and necrosis of the twisted testicle is dependent on the degree of torsion, as well as the time between onset and relief of torsion. 8 Thus, early diagnosis and timely management is critical for resolution of ischemia and preservation of the injured testicle. CDFI is considered a reliable method for diagnosis of TT, with accuracy of 97% and specificity near 100%.…”