Testicular Torsion: A Perspective from the Middle East

Abstract

Objective: To report our experience in the management of testicular torsion with emphasis on seasonal variation, salvage rate and the status of the torted testis 3–6 months after orchidopexy. Subjects and Methods: Seventy-five patients with a presumptive diagnosis of testicular torsion, who presented to our hospital between January 1999 and December 2002, were included in the study. Following scrotal exploration, 63 patients were found to have testicular torsion. Of these, 11 with nonviable testes had orchiectomy while 52 with viable testes had orchidopexy. Both groups of patients had simultaneous contralateral orchidopexy. Patients who had orchidopexy were followed up 3-monthly by testicular ultrasound to assess the volume of the affected testis. Results: Sixty-three patients were confirmed to have testicular torsion. The average number of new cases in the winter was 6.7 compared to 4 in the summer. Fifty-two patients underwent orchidopexy to give an operative salvage rate of 82.5%. Of 51 patients in whom the duration of torsion was less than 24 h, 1 (2.0%) had a nonviable testis, whereas of 12 patients in whom the duration of torsion was more than 24 h, 10 (83.3%) had a nonviable testis. After a minimum follow-up of 3 months for patients who had orchidopexy, 7 (13.5%) developed testicular atrophy. The incidence rate was estimated to be 7.9 cases per 100,000 population. Conclusion: The highest incidence was during the cold season. The outcome of surgical management of testicular torsion was dependent on the duration of torsion.

Testicular torsion: a race against time

“…For instance, Williams et al (7) in a recent study reported an incidence rate of 30% during the fall season and 24% during the winter season compared with 22% in the summer season. Similar results have been reported by Al‐Hunayan et al (20).…”

“…Testicular atrophy may also develop following surgery. Al‐Hunayan et al (20) in a recent case series reported that 13.5% of the patients developed testicular atrophy on follow up after 3 months. In another recent study, Arap et al (58) studied the effects of surgical management of torsion on postoperative semen parameters.…”

The amount of spermatic cord rotation magnifies the time-related orchidectomy risk in Intravaginal testicular torsion

“…A similar relationship was found by Cummings, that observed that mean rotation in salvaged cases was 412°, contrasting with 630° in non-viable testicles (11). From Kuwait, Al-Hunayan (26) was able to salvage 2 organs after 48 hours of ischemia, and noted that both had less one turn. Tryfonas (27), following 25 of his 75 treated cases, noticed that if rotation was greater than 360°, atrophy ensued after only 4 hours, in a manner similar to what occurred in all cases with ischemia lasting for more than 24 hours.…”

The long-term protective effects of short-interval postconditioning in testicular ischemia-reperfusion injury in rats

“…Of patients treated with bilateral orchiopexy after unilateral testicular torsion, 20% to 40% eventually develop some atrophy of the testis with reduced fertility [8,9].…”