Acute and intermittent testicular torsion: Analysis of presentation, management, and outcome in South East, Nigeria

Ugwumba, FO; Okoh, AD; Echetabu, KN

doi:10.4103/1119-3077.179291

Cited by 14 publications

(10 citation statements)

References 12 publications

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“…Left untreated, the almost universal outcome is testicular hemorrhagic infarction. The disease is a frequent cause of organ loss by either orchidectomy or atrophy, especially in emerging countries ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

Filho

Maroccolo²,

Ribeiro³

et al. 2020

Int. braz j urol.

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Purpose: To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. Patients and Methods: Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. Results: 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). Conclusion: Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing populationwide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.

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Section: Introductionmentioning

confidence: 99%

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

Filho

Maroccolo²,

Ribeiro³

et al. 2020

Int. braz j urol.

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“…This miserable outcome is still commonly seen in our environment. [14] The overall salvage rate is very low in late presentation, delayed referral, and surgical intervention. [1,2] Peeraully et al [15] in a single-center retrospective analysis of the source of referral to a tertiary hospital for emergency scrotal exploration found that the orchidectomy rate was higher with those referred either from primary care centers (43%) or transferred from other hospitals (50%) when compared to patients who presented directly to their emergency department (23%).…”

Section: Discussionmentioning

confidence: 99%

Testicular torsion: An assessment of knowledge and referral pattern among health care workers in primary health-care facilities in Auchi, Nigeria

Ogbetere

Akerele

2021

ANMRP

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Objectives: Testicular torsion is the twisting of the spermatic cord with attendant loss of the blood supply to the affected testis. It is a common urological emergency and one of the frequent causes of acute scrotum in adolescents and young adults. Prompt diagnosis and immediate surgical intervention are necessary for testicular salvage. Testicular loss is directly linked to delay in presentation, surgery, and the referral patterns at the point of the first contact with health-care providers. The purpose of our study is to assess the knowledge, management methods, and referral pattern among health care workers in the primary health-care facilities in Auchi primary health-care zone, Nigeria. Material and Methods: This was a cross-sectional carried out among primary health care workers in Auchi primary health-care zone between May and October 2020. A structured self-administered questionnaire was given to all the first contact health care workers in this zone. The knowledge, management, and referral pattern of testicular torsion were determined based on responses to the questionnaires. Data were analyzed using SPSS version 21. Results were displayed with frequency distribution tables and charts. Results: Eighty-seven health care workers met the inclusion criteria and were given questionnaires to fill. The mean age of the respondents was 37.74 ± 7.53 years. The majority of the health workers (n = 66, 75.9%) have more than 5 years’ experience with only 12 (13.8%) having a secondary level of education. Most respondents have heard of testicular torsion (n = 77, 88.5%) and know the symptoms (n = 68, 78.2%) but they have a poor knowledge of the age group predominantly affected (n = 36, 41.1%) and testicular survival time following torsion (n= 41, 47.7%). Only about a third (n = 28, 32.2%) had attended to patients with testicular torsion. Of the 28 health workers who had managed patients with testicular torsion, less than half (n = 11, 39.3%) referred almost immediately, while about half treated conservatively (n = 14, 49.9%) keeping the patients under their care for a period of 3–7 days. Conclusion: This study showed that a comprehensive education of all categories of health workers in the primary health-care centers is needed. This is necessary for the early identification and appropriate surgical intervention or prompt referral of patients with testicular torsion to prevent avoidable testicular losses.

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“…Sin embargo, existen reportes de manejo conservador mediante rectificación manual mediante maniobras externas de la torsión que puede ser otra opción, sin resolver la patología de base y con el riesgo de recurrencias y progresión a necrosis que resulte en orquiectomía del testículo con episodios previos de torsiones intermitentes, por lo que se recomienda la orquidopexia programada bilateral. (13,14) Los signos encontrados durante el ultrasonido Doppler incluyen ausencia del flujo, que en los casos de torsión intermitente se asocia en un 79% al signo en remolino en la escala de grises, las imágenes con Doppler color o pseudomasa en el cordón, (15) 10% presentan un engrosamiento "boggy" o pantanoso del cordón y 10% tienen una apariencia normal. (3) Es importante una alta sospecha diagnóstica y un diagnóstico oportuno para esta patología, dado que el tratamiento tardío comprende la orquiectomía del testículo necrótico y la orquidopexia del testículo contralateral.…”

Section: Discussionunclassified

Ultrasound whirlpool sign in intermittent testicular torsion: Presentation of two cases

et al. 2020

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Descripción del caso: Se presentan dos casos caracterizados por múltiples episodios de dolor muy intenso que se resolvían de manera espontánea. En ambos casos se realizó un ultrasonido testicular mientras persistía el cuadro agudo, en donde se identificó el signo del remolino junto con compromiso vascular del testículo sugerente de torsión testicular intermitente, que ameritó tratamiento quirúrgico. Relevancia: El objetivo es señalar que la torsión testicular intermitente es un padecimiento infrecuente que se debe de sospechar en pacientes jóvenes con episodios de dolor intenso en los que se debe de insistir en el ultrasonido en el episodio para el diagnóstico. Implicaciones clínicas: Debido al compromiso vascular en el testículo, es necesario realizar un diagnóstico oportuno que debe iniciar con una sospecha diagnóstica apoyada por las manifestaciones clínicas del paciente para proceder a la fijación testicular bilateral temprana y que el testículo no culmine en necrosis. Conclusiones: La torsión testicular intermitente es rara y de difícil diagnóstico, por lo que encontrar el signo del remolino en el episodio agudo con prontitud en los cuadros de dolor es esencial para el diagnóstico y prevenir la pérdida de la gónada por el menosprecio del dolor de repetición.

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Acute and intermittent testicular torsion: Analysis of presentation, management, and outcome in South East, Nigeria

Abstract: Late presentation was observed, especially in the intermittent variety. Delay occurred both at pre- and intra-hospital phases. Testicular salvage rate may be improved by physician/health worker and community enlightenment. Adoption of local anesthetic may reduce intrahospital delay.

Cited by 14 publications

References 12 publications

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

Testicular torsion: An assessment of knowledge and referral pattern among health care workers in primary health-care facilities in Auchi, Nigeria

Ultrasound whirlpool sign in intermittent testicular torsion: Presentation of two cases

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