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

Tian, Xiaomao; Tan, Xiao-Hui; Shi, Qinlin; Wen, Sheng; Lü, Peng; Liu, Xing; Li, Xuliang; He, Dalin; Lin, Tao; Wei, Guanghui

doi:10.3389/fped.2020.584796

Cited by 10 publications

(31 citation statements)

References 19 publications

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“…The longest follow-up in this study was 198 months after salvage orchiopexy. The overall TA rate after orchiopexy was 56.6% compared with the previously reported TA rate range of 12.0%–68.0%, 8 9 while the severe TA rate was 41.5%, neither of which were sufficiently low for testicular salvageability. Furthermore, of the 27 patients who underwent reluctant orchiopexy who were surgically assessed as Arda grade III and inviable, 88.9% had their testes resected subsequently or atrophied during follow-up, and only 7.4% (2/27) had normal testicular volume and activity.…”

Section: Discussionmentioning

confidence: 53%

“…These results are in accordance with those of previously published literature reports. 8 9 Furthermore, 98.1% (104/106) of orchiopexies had ipsilateral fixation of the affected testes, and 51.9% had contralateral exploration and fixation during the same operation. Additionally, 24.5% of torsed testes had bell clapper deformity, which was present in only 16.4% of contralateral explored testes and 10.9% of bilateral explored testes.…”

Section: Resultsmentioning

confidence: 99%

“… 8 All TA definitions were taken into consideration, and we defined TA as TVL >50% during the follow-up, and severe TA as TVL >80% or no sustained blood supply. 8 9 15 Testicular length (L), width (W), and height (H) were measured by ultrasound of high frequency at our hospital. The testicular volume was calculated according to the formula of L × W × H × 0.71 cm 3 .…”

Section: Participants and Methodsmentioning

confidence: 99%

“…According to the current available literature, the rate of TA ranges from 12% to 68% of detorsed testes that undergo salvage orchiopexy, even when intraoperatively assessed as viable. 8 9 Although most patients with TT have preserved endocrine function, the exocrine function is considerably more variable and controversial. 10 11 12 13 Arap et al .…”

Section: Introductionmentioning

confidence: 99%

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Long-term follow-up results of testicular torsion in children

Jiang¹,

Wu²,

Yu³

et al. 2022

Asian Journal of Andrology

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A retrospective cohort study was conducted at the Children’s Hospital of Chongqing Medical University from November 2004 to December 2020 to investigate the long-term follow-up results after testicular torsion (TT) in children. Boys with TT were divided into the salvage orchiopexy group and the orchiectomy group, and the baseline characteristics, ultrasonographic indications, intraoperative findings, testicular volumes, and adverse events during follow-up were compared. A total of 145 cases were included in this study. Approximately 56.6% of patients who underwent salvage orchiopexy had testicular atrophy (TA), and the median testicular volume loss of the testes was 57.4%. Age less than 6 years, delayed surgery, and intraoperative poor blood supply were associated with TA in pediatric TT after orchiopexy. Most atrophied testes appeared within 3–6 months after surgery. Compared with the corresponding age-matched healthy controls, the contralateral testicular volumes were larger in the orchiopexy ( P = 0.001 without TA, and P = 0.042 with TA) and orchiectomy groups ( P = 0.033). The adverse events were comparable in patients with orchiectomy or orchiopexy. In summary, follow-up before 3 months after surgery may not offer sufficient clinical value, while that 3 months after surgery should be regarded as the first follow-up time for testicular monitoring. The contralateral testes of patients with TT showed compensatory hypertrophy. We suggest performing orchiectomy when torsed testes are surgically assessed as Arda grade III or inviable.

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Section: Discussionmentioning

confidence: 53%

Section: Resultsmentioning

confidence: 99%

Section: Participants and Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term follow-up results of testicular torsion in children

Jiang¹,

Wu²,

Yu³

et al. 2022

Asian Journal of Andrology

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“…Children need to be followed up for a long time after testicular torsion, and the testicular development is evaluated by ultrasound. Studies have reported that 38.94–41.4% of patients with testicular torsion who had undergone testicular fixation on the affected side eventually developed testicular atrophy ( 38 , 39 ). Yang et al ( 6 ) reported that among five patients with cryptorchid testicular torsion in whom the affected testis was retained, only one experienced postoperative ischemic atrophy, and the rest of the patients had normal testicular blood flow during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of cryptorchid testicular torsion in children: A 12-year retrospective study

et al. 2022

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PurposeTo investigate the clinical characteristics, treatment, and prognosis of cryptorchid testicular torsion in children.MethodsThe clinical data of 25 children who received treatment for cryptorchid testicular torsion between January 2010 and December 2021 were retrospectively reviewed. The median age of the patients was 64.5 months (range: 2 months to 15 years). All patients had unilateral torsion, and the duration of symptoms ranged from 3 to 192 h.ResultsAmong the 25 patients, five underwent orchidopexy, while the remaining 20 underwent orchiectomy. After 6 months to 8 years of follow up, the 20 patients who had undergone orchiectomy had a well-developed testis on the healthy side. Four of the five patients who had undergone orchidopexy of the affected testis had well-developed testes bilaterally, while one experienced testicular atrophy.ConclusionCryptorchid testicular torsion is a rare urological emergency that displays a delayed presentation and is often misdiagnosed. Clinicians need to carefully review the patient's medical history and ultrasound findings and perform a thorough physical examination to make a correct diagnosis. Active testicular exploration is required for patients suspected to have cryptorchid testicular torsion, and the decision to perform orchidopexy or orchiectomy depends on the intraoperative situation.

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Indocyanine green fluorescence imaging as a predictor of long-term testicular atrophy in testicular torsion: a pilot study

Komatsu,

Terui,

Takenouchi

et al. 2024

Surg Today

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Purpose This pilot study evaluated indocyanine green-guided near-infrared fluorescence (ICG-NIRF) imaging of testicular blood flow to predict long-term testicular atrophy after testicular torsion (TT) surgery. Methods The subjects of this retrospective study were patients who underwent surgery for TT at our hospital between December, 2020 and July, 2022. After detorsion, testicular blood flow was evaluated by ICG-NIRF imaging and classified into three categories: fluorescence detected, no fluorescence detected, and fluorescence detected only in the tunica albuginea vessels. Testicular volume was measured by ultrasonography up to 12 months after surgery to evaluate long-term outcomes. Results Twelve patients were included in this analysis. We found a 100% correlation between the absence of ICG-NIRF signals and subsequent testicular atrophy. In three patients without an ICG-NIRF signal, the median testis size 12 months postoperatively was significantly smaller (16.5% of the contralateral testis; range 13–20%) than that in six patients with an ICG-NIRF signal (96%; 89–115%) (p = 0.013). Mild atrophy (74.5%; 73–76%) was also observed in the three patients for whom an ICG-NIRF signal was detected only in the tunica albuginea vessels. Conclusions Our pilot study highlights the potential of ICG-NIRF imaging as a prognostic tool for guiding surgical decision-making for patients with TT, by predicting postoperative testicular atrophy.

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

Cited by 10 publications

References 19 publications

Long-term follow-up results of testicular torsion in children

Long-term follow-up results of testicular torsion in children

Diagnosis and treatment of cryptorchid testicular torsion in children: A 12-year retrospective study

Indocyanine green fluorescence imaging as a predictor of long-term testicular atrophy in testicular torsion: a pilot study

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