Factors Influencing Rate of Testicular Salvage in Acute Testicular Torsion at a Tertiary Pediatric Center

Abstract

IntroductionStudies have demonstrated that variables other than duration of symptoms can affect outcomes in children with acute testicular torsion. We examined demographic and logistical factors, including inter-hospital transfer, which may affect outcomes at a tertiary pediatric referral center.MethodsWe reviewed charts of all pediatric patients with acute testicular torsion during a five-year period. Data were collected regarding age, insurance type, socioeconomic status, duration of symptoms prior to presentation, transfer status, time of day, time to surgical exploration, and testicular salvage.ResultsOur study included 114 patients. Testicular salvage was possible in 55.3% of patients. Thirty-one percent of patients included in the study were transferred from another facility. Inter-hospital transfer did not affect testicular salvage rate. Time to surgery and duration of pain were higher among patients who underwent orchiectomy versus orchidopexy. Patients older than eight years of age were more likely to undergo orchidopexy than those younger than eight (61.5% vs. 30.4%, p=0.01). Ethnicity, insurance type, or time of day did not affect the testicular salvage rates. On multivariate analysis, only duration of symptoms less than six hours predicted testicular salvage (OR 22.5, p<0.001).ConclusionEven though inter-hospital transfer delays definitive surgical management, it may not affect testicular salvage rates. Time to presentation is the most important factor in predicting outcomes in children with acute testicular torsion.

State appellant cases for testicular torsion: Case review from 1985 to 2015

“…Testicular salvage rates are 85–97% if operated on within 6 h of the initial symptoms [19]. Although the time to consultation has not been shown to be directly related to testicular loss [20], early involvement of urology is recommended.…”

Prospective Validation of Clinical Score for Males Presenting With an Acute Scrotum

“…Males with testicular torsion most commonly present with acute scrotal/testicular pain and swelling (the acute scrotum), which can also be the presenting symptoms for epididymitis‐orchitis, torsion of the appendix testis, and scrotal trauma . Testicular torsion is caused by the twisting of the spermatic cord along with the vasculature of the testicle and requires prompt surgical intervention to prevent testicular loss from ischemia . This occurs in approximately 1 in 1,500 to 1 in 4,000 males by the age of 25 .…”

“…This occurs in approximately 1 in 1,500 to 1 in 4,000 males by the age of 25 . It is important to quickly differentiate between the different testicular conditions associated with the acute scrotum to optimize the time to surgery to preserve testicular viability for those with testicular torsion . One study found that for males treated within 6 hours of the onset of symptoms there is a 90% to 100% rate of testicular salvage.…”

Managing testicular torsion – time is of the essence

“…A similar study carried out in California also showed that inter-hospital transfer certainly delayed surgical management, but did not seem to impact on testicular salvage rates. 9 Although the protocols overseas will differ from those in the UK, the recurrent theme across these studies is that outcomes are not being affected by delays following hospital assessment. Time from symptom onset to theatre may be prolonged by many factors following presentation, but most of the delay appears to be occurring prior to arrival at a medical centre.…”