Testicular Loss in Children Due to Incorrect Early Diagnosis of Torsion

Abstract

Background. Testicular torsion is a common surgical emergency in children that requires a high index of suspicion, early diagnosis, and exploration. Most children present early to their primary pediatricians or physicians. The aim of this retrospective study is to determine the surgical outcome of testicular torsion with early as well as delayed presentation or referral at our pediatric surgical unit. Methods. Records of 50 patients who presented with testicular torsion at our pediatric surgical unit over the span of 10 years (2007-2017) were reviewed retrospectively. The duration and characteristics of symptoms, initial consultation with primary care health professional, time duration between the initial consultation and referral to a tertiary care center, clinical findings prior to surgery, and operative findings were noted. Results. Fifty patients were in the age group ranging from 38 days to 18 years. All the patients consulted the primary care health professionals within 3 to 6 hours after the onset of testicular pain. The patients presented to our hospital within the range of 3.5 hours to 10 days of onset of initial symptoms. Out of 50 patients who presented to our hospital with torsion testis, 45 (90%) patients underwent orchidectomy as the testicle was gangrenous and 5 patients underwent orchiopexy as the testicle was viable. Conclusion. The risk of testicular loss is very high if there is delay in the initial diagnosis of testicular torsion. Greater effort in educating the primary health care professionals may reduce this delay. Primary objective of treating the acute scrotum should be prevention of testicular loss than treating symptoms.

Demographic, clinical, and socioeconomic factors associated with delayed diagnosis and management of pediatric testicular torsion in West China: a retrospective study of 301 cases in a single tertiary children’s hospital

“…Our findings indicated that it was very important to strengthen the public awareness of TT, and effects must be conducted to continuously re-educate and update physicians working at primary and secondary healthcare units. This finding was consistent with two latest similar studies from India and Brazil [ 7 , 8 ], which indicated that improvement of accurate diagnosis of TT in primary and secondary healthcare units was greatly needed around the world.…”

“…A large number of studies reported that, worldwide, the delayed diagnosis and management of TT was quite common, and a relatively high proportion of TT patients proven to be delayed even in tertiary hospitals [ 7 , 8 ]. Aaron P. Bayne et al [ 1 ] and Christopher E. Bayne et al [ 9 ], in the United States, and Ekici et al [ 10 ] in Turkey, have investigated the clinical, socioeconomic and other factors associated with delayed management of TT, while there have no relevant reports among Chinese populations.…”

Acute Scrotum in Children: A Retrospective Study of Cases With Review of Literature

“…It is shown that MPV is increased in cases with testicular torsion and therefore it could be the indicator of testicular viability [ 15 ]. Several authors in their study have highlighted that despite of improved diagnostic facilities in case of confusion prompt scrotal exploration in the patient is warranted [ 16 - 19 ]. Chun et al in their study found the late presentation of acute scrotum leads to testicular loss.…”

Factors Determining Testicular Torsion and Consequent Orchiectomy in Pediatric Patients Presenting With Scrotal Pain

“…40 Research has evaluated the predictors of TS in children with TT, 12,17 and we identified several risk factors associated with orchiectomy in children with TT in a multivariate analysis, including a longer interval between SP onset and PED arrival, 13,36,37 absent TUBF, 1,3,7,8,16,17,[31][32][33][34] interval between SP onset and surgery of more than 24 hours, 2,7,8,16 and a greater degree of TT. 17,18 Every patient with TTwho needed an orchiectomy on 1 testis had an orchiopexy on the other testis to prevent TT 20,21 and preserve fertility and endocrine function. Preventive orchiopexy on the other testis seemed to be effective in our series.…”