Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy

Zambaiti, Elisa; Cerchia, E.; Guanà, Riccardo; Scottoni, Federico; Giannotti, G.; Rosa, Davide Dalla; Pagliara, Camilla; Gobbi, Dalia; Trovalusci, Emanuele; Bucci, Valeria; Carretto, Elena; Bulotta, Anna Lavinia; Chiarenza, Salvatore Fabio; Midrio, Paola; Gamba, Piergiorgio; Cheli, Maurizio; Alberti, Daniele; Gennari, Fabrizio; Nappo, Simona Gerocarni

doi:10.1016/j.jpurol.2022.06.010

Cited by 5 publications

(9 citation statements)

References 19 publications

(31 reference statements)

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“…Testicular torsion is one of the most time-sensitive paediatric emergencies: surgical intervention during the first few hours from the onset of the symptoms increases the chance of testicular salvage. Similarly to other authors investigating this matter, during the first wave of the outbreak, we did not observe a statistically significant difference in the time from the onset of the symptoms to the admission to the emergency department [ 6 – 8 ]. On the other hand, Pogorelic et al noted a lengthening of that period to up to 14 hours during the COVID-19 pandemic, which may be the cause of higher rates of orchiectomy in that time in Croatia [ 9 ].…”

Section: Discussionsupporting

confidence: 85%

Situation of Pediatric Patients with Testicular Torsion in Times of COVID-19

Komarowska

Kowalska

Grubczak

et al. 2023

Emergency Medicine International

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Purpose. To assess whether the COVID-19 pandemic had an influence on presentation of testicular torsion and/or increase in the frequency of orchiectomy. Patients and Methods. This retrospective study included boys under 18 years of age with testicular torsion divided in two groups: pre-COVID operated in 2019 vs. COVID-19 group from 2020. We compared demographic data as well as local and general symptoms. We analyzed additional tests, intraoperative findings, length of operation and hospitalization, and followup. Results. We analyzed the data collected from 44 patients (24 boys from first group vs. 20 boys from second group). The median age was 13.4 years vs. 14.5 years in the latter. The median time of symptoms duration was 6.5 hours and 8.5 hours, respectively. The main manifestation was testicular pain without additional signs. The results of the laboratory tests did not reflect local advancement. In the 2019 group, Doppler ultrasound showed absent blood flow in the affected testicle in 62% vs. 80% in 2020. The mean time from admission to surgery was virtually identical: 75 minutes in 2019 vs. 76 minutes in 2020. The mean duration of scrotal revision was similar in both groups. There was only one significant difference: the degree of twisting. In 2019, the mean was 360° vs. 540° in 2020. Incidence of orchiectomy also did not significantly vary between the analyzed time periods, with 21% during the pandemic and 35% during the pre-COVID-19 period. Conclusion. We did not observe an increase in the number of testicular torsion cases during the COVID-19 pandemic. Most importantly, the rates of orchiectomy did not significantly differ between the patients with testicular torsion presenting during the COVID-19 outbreak.

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Section: Discussionsupporting

confidence: 85%

Situation of Pediatric Patients with Testicular Torsion in Times of COVID-19

Komarowska

Kowalska

Grubczak

et al. 2023

Emergency Medicine International

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“…Finally, eight studies matched our inclusion criteria. The majority of the eight articles in our study were from North America, 8,12-15 two were from Europe, 16,17 and one was from Asia. 18 Three of the studies were multicentric.…”

Section: Results Study Characteristics and Quality Assessmentmentioning

confidence: 79%

“…Four compared the nontime-matched periods. 8,12,16,17 One did not mention the comparative period in detail. 18 One study was a prospective study, 8 while seven studies were retrospective studies.…”

Section: Results Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…18 Three of the studies were multicentric. 8,16,17 Three studies used the time-matched period preceding the COVID-19 pandemic for comparison, [13][14][15] to exclude the effect of seasonal changes. Four compared the nontime-matched periods.…”

Section: Results Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…However, it is reassuring to note that prior studies demonstrated no significant increase in the time between ED presentation and surgery when rapid COVID-19 testing was performed on every patient. 8,15,17,29 Several studies have found that an increase in the incidence of testicular torsion is observed with a decrease in atmospheric temperature, 23,[33][34][35] showing that seasonal variation may introduce bias when comparing various periods. However, our subgroup analysis showed no difference in the hospitalization rate regardless of the comparative periods, indicating that seasonal variation had no effect on the outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Delayed Care Seeking and Outcomes of Testicular Torsion among Children during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Chen

Liu

et al. 2022

Eur J Pediatr Surg

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Introduction Since the onset of coronavirus disease 2019 (COVID-19), stay-at-home orders and fear caused by the pandemic have had a significant effect on the timing and outcomes of testicular torsion. However, the evidence was limited since the study results were inconsistent. This study aims to examine the hospitalization rates, timing, and outcomes of testicular torsion in children before and during the pandemic. Materials and Methods Using PubMed, Embase, and Google Scholar databases, we conducted a systematic search and meta-analysis of studies reporting the timing and outcomes of children admitted with testicular torsion before and during the COVID-19 pandemic. Subgroup analyses were conducted to explore possible sources of heterogeneity. Result The outcomes of 899 testicular torsion patients from eight studies were evaluated. Our study found an increased hospitalization rate for patients with testicular torsion (incidence rate ratio = 1.60, 95% confidence interval [CI]: 1.27–2.03; p = 0.001). Despite a significant increase in the duration of symptoms during the COVID-19 pandemic (weighted mean difference = 11.04, 95% CI: 2.75–19.33; p = 0.009), orchiectomy rates did not increase (odds ratio = 1.33, 95% CI: 0.85–2.10; p = 0.147). Conclusion During the COVID-19 pandemic, hospitalization rates for testicular torsion and the duration of symptoms among children increased significantly. Moreover, the rate of orchiectomy did not increase during the pandemic, indicating that pediatric emergency services have remained efficient and have prevented an increase in the number of orchiectomies performed despite pandemic-related closures and delays in transporting patients to medical care.

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