Orchidopexy for Testicular Torsion: A Systematic Review of Surgical Technique

Abstract

ContextAcute testicular torsion is a common urological emergency. Accepted practice is surgical exploration, detorsion and orchidopexy for a salvageable testis. ObjectiveTo critically evaluate methods of orchidopexy and their outcomes with a view to determining optimal surgical technique. Evidence AcquisitionThe review protocol was published via PROSPERO [CRD42016043165] and conducted in accordance with PRISMA. EMBASE, MEDLINE and CENTRAL databases were searched using terms: 'orchidopexy', 'fixation', 'exploration', 'torsion', 'scrotum' and variants. Article screening was performed by two reviewers independently. The primary outcome was retorsion rate of the ipsilateral testis following orchidopexy. Secondary outcomes included testicular atrophy and fertility. Evidence SynthesisTo our knowledge, this is the first systematic review on this topic. The search yielded 2257 abstracts. Five studies (n=138 patients) were included.All five techniques differed in incision and/or type of suture and/or point(s) of fixation. Postoperative complications were reported in one study and included scrotal abscess in 9.1% and stitch abscess in 4.5%. The contralateral testis was fixed in 57.6% of cases.Three studies reported follow-up duration (range 6-31 weeks). No study reported any episodes of ipsilateral retorsion. In the studies reporting ipsilateral atrophy rate, this ranged from 9.1-47.5%. Fertility outcomes and patient reported outcome measures were not reported in any studies.

Testicular fixation and its effect on ipsilateral and contralateral testis in prepubertal rat model

“…There is considerable variation in surgical practice of operative techniques used for orchidopexy. The literature on orchidopexy technique is heterogeneous and scarce, with variation reported in the type of suture use, fixation methods, synchronous procedures, and contralateral testicular fixation [13]. The fixation of the testis by whatever methods used has some degree of a detrimental effect on the spermatogenesis of the testis.…”

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

“…Even though contralateral orchiopexy of the testis is controversial, there is still evidence in the literature indicating the risk of future torsions 25 . Hence, this approach is recommended to avoid the possible risk.…”

Erişkin Testis Torsiyonu Hastalarında Manuel Detorsiyonun Testis Kurtarma Oranlarına Etkisi: Tek Merkez Deneyimi

“…Testicular torsion is a disease that is characterized by rotation of the spermatic cord around itself, causes ischemic organ damage in the affected testis, and requires urgent diagnosis and treatment (1). It is the second most common cause of acute scrotum after acute epididymoorchitis.…”

“…It is the second most common cause of acute scrotum after acute epididymoorchitis. Since it is known that ischemic damage to the testicle is associated with the amount and duration of cord rotation, time is of critical importance in testicular torsion (1)(2)(3)(4). Delay in diagnosis and detorsion of the affected spermatic cord results in high rates of orchiectomy (5)(6)(7).…”