Surge in testicular torsion in pediatric patients during the COVID-19 pandemic

Abstract

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Impact of COVID‐19 on the associated complications of high‐risk conditions in a statewide pediatric emergency network

“…In considering the potential etiologies for this notable change, COVID‐19–related inflammation, postinfectious inflammatory response, and direct viral injury have been proposed in the pathophysiology of these conditions. 6 , 7 , 8 Given the limited availability of COVID‐19 testing at the time of this study, it is unclear how many pediatric patients had COVID‐19–related illness or exposure contributing to their clinical presentations. What is evident, however, is that the pandemic alone, when accounting for other variables, conveyed an increased adjusted odds of being diagnosed with several of these high‐risk conditions.…”

Sonography Findings Predict Testicular Viability in Pediatric Patients With Testicular Torsion

“…Several clinical findings are closely associated with testicular torsions such as the sudden onset of severe testicular and spermatic cord pain, lower abdominal pain, nausea, vomiting, testicular swelling, abnormal cremasteric reflex, horizontal testicular lie, and high testicular position [1][2][3][4]6,8,[10][11][12]. While obtaining a history of testicular torsion is valuable in the detection of testicular torsion, diagnosing this condition based solely on the clinical history may be difficult as 50%-86% of testicular explorations result in negative findings despite numerous clinical scoring systems [13].…”

Impact of Distance From the Hospital and Patient Transfer on Pediatric Testicular Torsion Outcomes

“…With an incidence of 3.8 per 100,000 males <18 years annually, testicular torsion represents a pediatric surgical emergency requiring accurate and timely diagnosis to prevent testicular loss [1][2][3][4]. Presenting as sudden onset unilateral scrotal pain, this condition occurs when the spermatic cord rotates, which curtails testicular blood flow.…”

“…Presenting as sudden onset unilateral scrotal pain, this condition occurs when the spermatic cord rotates, which curtails testicular blood flow. Testicular pain greater than four-eight hours in duration is strongly associated with permanent ischemic damage [1,[3][4][5][6]. Within the first six hours of symptom onset, there is a 90-100% chance of testicular salvage, which plunges to 0-10% by 12-24 hours [7].…”

“…Several features have been reported that may delay the diagnosis of testicular torsion, which increases the probability that an orchiectomy will be performed, including isolated abdominal pain, a lack of complete genitourinary evaluation, scrotal ultrasound (US), delayed arrival at the Emergency Department (ED), and intellectual and developmental disabilities [4,5,[10][11][12][13][14]. We have previously reported that testicular and epididymal heterogeneity as well as a thickened scrotal wall on Doppler scrotal US are associated with testicular demise in patients with testicular torsion, while testicular heterogeneity and scrotal wall thickening are more likely to occur with a longer symptom duration [13].…”