Torsion of the testis: why is the prognosis so poor?

Bennett, Sarah P; Nicholson, M S; Little, T

doi:10.1136/bmj.294.6575.824

Cited by 28 publications

(19 citation statements)

References 1 publication

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“…We observed an overall low surgical salvage rate (47.2%) with rather long TrD and PrD, reiterating that time is key when treating testicular torsion, for prolonged ischemia times are unequivocally associated with disappointing salvage rates (3, 15, 16). Limited knowledge of this fact may partially explain the 10% salvage rate often seen until 40 years ago (17), and, thankfully, there has been a trend towards better salvage rates in the last decades.…”

Section: Discussionmentioning

confidence: 62%

“…Investigators from California noted that patients' transfers from primary and secondary to tertiary facilities was an independent risk factor for orchidectomy (22). In addition, an English study (15) revealed that caregivers waited in average 32 hours (range 3–240 hours) to bring a patient with acute scrotum to medical attention. This extended time was claimed to be responsible for their 45% salvage rate.…”

Section: Discussionmentioning

confidence: 99%

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

Filho¹,

Alves²,

Filho³

et al. 2016

Int. braz j urol.

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PurposeTo investigate the roles of age, testicular rotation and time in the surgical outcome of intravaginal testicular torsion (iTT).Patients and MethodsWe retrieved the records of all iTT patients treated in our unit from January 2012 to January 2014. Explanatory variables were: age (years); presentation delay (PrD, time between symptoms and hospitalization); surgical delay (SurgD, time between hospitalization and surgery) and testicular rotation (rotation), with surgical outcome (orchidopexy, orchidectomy) as response variable. Differences in PrD, SurgD, age and rotation by surgical outcome were evaluated non-parametrically. Step-down logistic regression included age, PrD, SurgD and rotation as predictors. Statistical significance and confidence intervals (CI) were set at p<0.05 and 0.95. Odds ratios (OR) were computed from the model's coefficients.ResultsComplete variable information was available for 117 patients, and most (61, 52.1%) underwent orchidectomy. Ages were similar between orchidectomy and orchidopexy patients (median 15.8 vs. 16.0 years, p=0.78). In contrast, PrD (85.0 vs. 8.4 hours, p<0.001), SurgD (3.0 vs. 16.0 hours, p<0.001) were different between orchidectomy and orchidopexy patients. SurgD was similar with PrD<24 hours (4.0 vs. 2.8, p=0.1). Orchidectomy patients had greater rotation (3.0π vs. 2.0π radians, p<0.001). Logistic regression revealed that PrD (OR 0.94; 0.92–0.97; p<0.001) and rotation (OR 0.43; 0.27–0.70; p<0.001) were inversely associated with orchidopexy.ConclusionTesticular rotation exerts a multiplicative effect on PrD, so time should not be regarded as the sole predictor of surgical outcome in iTT.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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

Filho¹,

Alves²,

Filho³

et al. 2016

Int. braz j urol.

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“…Testicular torsion is an important and a frequent cause of acute scrotal pain. In the United Kingdom, it is estimated that the incidence of testicular torsion is 1 case per 4,000 below the age of 25 [2] and about 400 boys a year will lose a testis in this way [3]. In addition, epidemiological data show a rise in the hospital discharge rate for torsion of the testis from 10.7 per 100,000 in 1968 to 27.0 per 100,000 in 1980 [4].…”

Section: Introductionmentioning

confidence: 95%

Testicular Torsion: A Perspective from the Middle East

et al. 2004

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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.

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“…Loss of testis in various series due to torsion has been reported from 55% to 80% [19]. Bennett et al, [20] has attributed delay by the patient or his parents in seeking medical attention as the main reason for the poor prognosis in cases of testis torsion.…”

Section: Discussionmentioning

confidence: 99%

Paediatric Surgical Pathology – a Profile of Cases from Western India and Review of Literature

Shah

Kamdar³

et al. 2015

JCDR

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Aim: The paediatric surgical pathology specimens manifest a wide spectrum of morphological and histological features. The present work has been undertaken to know the prevalence and to describe the profile of paediatric surgical pathology specimens from western India as seen in Ahmedabad, India from 2008 to 2010. Materials and Methods:We reviewed 140 paediatric surgical specimens, 118 specimens rendered definitive diagnosis were included for the analysis. Cases were divided in two groups, one of developmental and congenital conditions and another of acquired lesions.Results: This study included 118 patients of which 79.3 % were male and 20.7 % were female. Age range of the patients was one day to twelve years. Children of one month to one year age group (infants) were the most vulnerable (31.3% cases). Group of developmental and congenital conditions consisted

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Torsion of the testis: why is the prognosis so poor?

Abstract: The cases of 83 boys who were admitted to hospital with acute testicular pain or swelling were studied. l'wenty seven had torsion of the testis, and 15 (55%) ofthese lost a testis. The main reason for the poor results was delay by the patient or his parents in seeking medical attention.

Cited by 28 publications

References 1 publication

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

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

Testicular Torsion: A Perspective from the Middle East

Paediatric Surgical Pathology – a Profile of Cases from Western India and Review of Literature

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