Impact of treatment delays on outcome of acute testicular torsion: a 15-year retrospective study

Abstract

Introduction: Preservation of the testicle is directly associated with the duration of torsion. The aim in this retrospective study was to identify factors that influence pre-and in-hospital times and measure the extent to which these times affect testicle survival. Patients and methods: A retrospective review of 116 patients who underwent exploration for testicular torsion between 2000 and 2015. Patients were divided into orchiectomy and salvaged testicle groups. Times in patient management and clinical features were compared with Mann-Whitney, chi-squared, and Fisher exact tests. Multivariate logistical regression was used to identify independent factors associated with orchiectomy. Results: The median prehospital time of 48 h (15.4-138 h) in the orchiectomy group was longer than the 2.4 h (1.6 h-5.2h) in the salvaged group. Patients examined by a general practitioner (GP) prior to presenting at hospital had a median prehospital time of 48 h, compared to 3 h for patients not examined before presentation at hospital. In-hospital times between admission and operation room, as well as times between ultrasonography and operation room, were also longer in the orchiectomy group. Previous GP consultation (OR ¼ 27.26, 95% CI 2.32-320.59, p ¼ .009), prehospital time (OR ¼ 1.04, 95% CI 1.01-1.07, p ¼ .003) and nausea (OR ¼ 9.25, 95% IC 1.33-64.52, p ¼ .025) were independent predictive factors associated with orchiectomy. Conclusion: Prehospital time was a determining factor in orchiectomy. For each extra hour of prehospital delay, the risk of orchiectomy increased by 4%. The rate of orchiectomy was higher among patients who first consulted a GP.

Comparison of the outcomes of testicular torsion among children presenting during the Coronavirus Disease 2019 (COVID-19) pandemic versus the pre-pandemic period: A systematic review and meta-analysis

“…Testicular torsion is the cause of pediatric acute scrotum in 10-15% of cases, and in such cases, about 40% of surgical explorations result in an orchiectomy [1][2][3]. To avoid unfavorable outcomes and to ensure the viability of the testis, a diagnosis must be made promptly, ideally within 6 hours [4][5]. It is therefore important to know the classic presentation of testicular torsion which consists of sudden onset unilateral testicular pain which may be accompanied by nausea and/or vomiting [6][7][8].…”

Testicular Torsion in Patients With Intellectual and Developmental Disabilities

“… 3 , 10 Confirmatory findings demonstrate decreased or lack of blood flow to the affected testicle. While it has been reported that scrotal imaging may contribute to the delay in surgically treating testicular torsion and result in increased orchiectomy rates, 3 , 9 failure to perform this test often leads to misdiagnosis of this urgent condition. 10 …”

“…1,3 Patients who have orchiectomies are often hospitalized for longer periods of time which results in higher healthcare costs. 9 Delayed and incorrect diagnosis are the primary reasons for unsalvageable testes. 3 Prompt and accurate diagnosis of testicular torsion is imperative to avert testicular loss.…”

“…Several factors are associated with delayed or inaccurate diagnosis of testicular torsion which increase the likelihood that the affected testicle will not be salvaged, including isolated abdominal pain, failure to perform a thorough genitourinary exam, scrotal imaging, late presentation to the Emergency Department (ED), and pediatrician evaluation prior to the ED. 9 - 12 …”

Access to emergency paediatric surgery for testicular torsion or intestinal volvulus in New Zealand: A system perspective

“…Patients presenting to a primary medical practitioner generally have a longer median pre‐hospital time 16 . Online learning modules and training offer the opportunity to improve the triage and assessment of children with urgent surgical conditions 17 .…”