Neglected Spermatic Cord Twisting: Experience of the University Hospital Center of Casablanca

Abstract

Introduction: Spermatic cord twisting (SCT) is a life-threatening emergency of the testis, causing testicular ischemic lesions by vascular constriction. Neglected SCT is an atypical variant of torsion with a late diagnostic delay. It is characterized by the presence of testicular necrosis, requiring an orchiectomy. The objective of our study is to investigate possible factors that may be responsible for the delayed diagnosis of TCS, and thus favor the occurrence of the neglected form. In order to act on these factors and prevent the harmful consequences of SCT, in particular testicular necrosis.
 Material and methods: This is a retrospective and descriptive study, conducted over a period of 7 years (January 2013-December 2019). Interesting 34 patients admitted to the urology department of the CHU Ibn Rochd of Casablanca, in a neglected SCT picture. The collection of information was carried out from the patients' files through an exhaustive exploitation sheet.
 Results: A total of 34 cases of neglected SCT were collected. The mean age was 17.97 years (extremes: 14-37 years). 94% of the subjects were less than 25 years old. 15% of the subjects were from rural areas. 77% of cases occurred during the cold season. The absence of employment characterized 61.5% of the major subjects and 42.8% of the guardians of the minor patients. Only 26.5% of subjects had health coverage. Non-education characterized 62% of adult patients and 65% of guardians of minor patients. The occurrence of neglected SCT was on an ectopic testicle in 1 case (3%) and on an oscillating testicle in 1 case (3%). The involvement was on the left side in 70.6% of cases. The average time to visit the emergency room at the CHU was 86 hours with extremes of 12 hours and 12 days. 38% of the patients had consulted directly at the CHU, while 62% were referred from other health structures. All patients were admitted to the emergency room after the pain had disappeared (scrotal in 94% and inguinal with vacuity of the homolateral bursa in 6%). Echodoppler allowed the dg to be applied in 100% of cases. Delayed consultation of the patient was present in 82.4% of cases. A diagnostic delay due to anaberration in medical management was found in 17.6%. Therapeutic management was orchidectomy in 100% of the cases, and orchidopexy of the contralateral testis was immediate in 24% of the cases and delayed in 76% of the cases. 24% of the cases and delayed in 76% of the cases. Only 29.4% of patients presented for medical check-up at 6 months postoperatively. 80% of these patients had testicular atrophy on clinical and ultrasound examination, and frank oligospermia with asthenospermia on spermogram.
 Conclusion: Multiple factors are likely to act on the prolongation of the diagnostic delay of SCT and may be at the origin of the occurrence of its neglected form. The delay in the diagnosis of SCT may be related to a delay in patient consultation or to an aberration in medical management, thus favoring the development of testicular necrosis and consequently requiring an orchiectomy. Hence the interest in knowing these factors in order to act on them by raising public awareness of the importance of emergency consultation in the face of acute scrotal pain, as well as continuing education of physicians and medical staff to prevent the occurrence of neglected SCT.

Testicular torsion in Sub-Saharan Africa: a scoping review

“…In France, the average presentation time reported in a multicenter study was 5 h [34]. In Morocco, in a study of neglected testicular torsions, the mean time to presentation was reported to be 86 h [35]. In a systematic review including 2116 patients, testicular recovery within the first 12 h was 90.4%, survival from 13 to 24 h was 54.0% and survival beyond 24 h was 18.1%.…”

“…Torsion is a time-dependent event, and factors (distance from hospital and delay associated with transfer to hospital) that delay time to treatment result in a high rate of testicular loss [36]. El Mehdi et al [35] reported that 15% of their patients with testicular loss were from rural areas. We found an association between the mode of admission and the probability of testicular salvage.…”

“…The rate of orchiectomy is highly variable in the literature: 7.6% in France [34], 23% in Australia [39] and 24.3% in Korea [40] and 100% [35] in Morocco. Testicular salvage depends on presentation, diagnosis and timely surgical intervention [40].…”