Does the source of referral affect outcomes for paediatric testicular torsion?

Abstract

Introduction This single centre study retrospectively analysed the intraoperative findings relative to source of referral for emergency scrotal explorations performed in a tertiary level paediatric surgery department. Methods All patients who underwent emergency scrotal exploration under the care of paediatric surgeons in our unit between April 2008 and April 2016 were identified. Clinical data were obtained from contemporaneous records. Results Over the 8-year study period, 662 boys underwent emergency scrotal exploration: 6 (1%) were internal referrals, 294 (44%) attended our emergency department (ED) directly, 271 (41%) were referred from primary care and 91 (14%) were transferred from other hospitals. Excluding procedures in neonates, testicular torsion was present in 100 cases (15%). Testicular detorsion with bilateral 3-point testicular fixation was performed in 66 (66%) and orchidectomy with contralateral fixation in 34 (34%) where the torted testis was non-viable intraoperatively. The orchidectomy rate in the presence of torsion was 23% in ED referrals (12/52), 43% in primary care referrals (12/28) and 50% for transfers (10/20). The difference in rates between ED referrals and patients transferred from other hospitals was significant (p=0.026). There was no significant difference in median age between any of the groups (p=0.10). Conclusions Boys undergoing emergency scrotal exploration had a higher orchidectomy rate when transferred from other hospitals to our unit. This difference was statistically significant when compared with boys presenting directly to our ED. This supports advice from The Royal College of Surgeons of England for undertaking paediatric scrotal explorations in the presenting hospital when safe to do so rather than delaying the care of these patients by transferring them to a tertiary paediatric surgical unit.

Characteristics and management of testicular torsion in patients admitted to the Urology Department at Chris Hani Baragwanath Academic Hospital

“…Peeraully et al in a single center retrospective analysis of intraoperative findings relative to source of referral to a tertiary hospital for emergency scrotal exploration found that the orchidectomy rate was lower (23%) in patients presented directly to their emergency department compared with those referred either from primary care centers (43%) or transferred from other hospitals (50%) [18].…”

The Role of Manual Detorsion in Pediatric Testicular Torsion During the Global COVID-19 Pandemic: Experience From 2 Centres

“…Notably, according to the advice of the Royal College of Surgeons of England, scrotal exploration for pediatric testicular torsion should be performed in the hospital of arrival, when it is safe to do so, rather than delaying the care of these patients by transferring them to the lead center. 13 Therefore, an additional advantage of this maneuver is that it could be easily performed also in first level centers, thus allowing to gain time for transfer to a pediatric center and increase the chance of testicular preservation.…”

Predictive factors for orchiectomy in adult’s spermatic cord torsion: a case‐control study

“…Therefore, the mode of hospital admission indirectly impacts the risk of orchiectomy by increasing the management delay. The Royal College of Surgeons in England recommends to perform surgical exploration in the hospital where the patient is seen for the first time [ 12 ]. The objective is to avoid transferring the patient in order to reduce the management delay.…”