Management and Outcome of Testicular Torsion

Murithi, John; Mwachi, Abidan; Abdalla, Ramadhani; Chavda, Sundeep

doi:10.4314/aas.v14i2.11

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…Contrary to our findings, multiple studies in high-income countries reported much lower percentages of orchiectomy including: 42% in Iowa [ 13 ], 28% in Canada [ 14 ] and 40% in Jordan [ 15 ]. Studies that reported significantly higher rates of orchiectomy include one in Kenya with 82% [ 4 ], and another in Ethiopia where 83% had orchiectomy [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…The acutely painful scrotum has been described as a urologic emergency, requiring a high index of clinical suspicion, and prompt surgical intervention with the management aimed at avoiding testicular loss and infertility [ 1 ]. Usually, salvage rates depend on the duration of symptoms and speed of diagnosis [ 4 ]. A study reported that the salvage rate is high if the treatment is initiated within six hours after the onset of symptoms, and inversely decreases with the increase in duration of symptoms [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Patients in resource limited settings often present late as they wait for the pain to resolve with self-medication. Moreover, clinicians may prescribe antibiotics and analgesics when a misdiagnosis has been made, resulting in late presentation [ 4 ]. Generally, in our setting, it’s unlikely for a patient to present within six hours due to long travel distances to access surgical specialty services and the tendency to use alternative medicine.…”

Section: Introductionmentioning

confidence: 99%

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Testicular salvageability and its predictors among patients with testicular torsion in a resource limited setting: a multicentre longitudinal study

Mohamed,

Abraha,

Olasinde

et al. 2023

BMC Surg

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Introduction Testicular torsion refers to ischemia of the testicle due to twisting or rotation of the vessels supplying the testes. It is a urologic emergency requiring a high index of clinical suspicion and prompt surgical intervention with management aimed at avoiding testicular loss and resulting infertility. This paper gives an update on the current situation regarding this topic in low-income settings. The aim of this study was to determine testicular salvageability and its predictors amongst patients with testicular torsion at two tertiary African hospitals. Methods This was a hospital-based multicentre longitudinal study at two tertiary hospitals in western Uganda. Patients with acute scrotum were enrolled and evaluated for testicular torsion. Those with confirmed testicular torsion underwent surgery and salvageability was reported as the primary outcome. Predictors for testicular salvageability were determined using backward binary logistic regression in SPSS version 22. Results During the study period, 232 patients with acute scrotum were enrolled. The mean age was 35.3 (SD = 20.4) years. Forty-one (17.7%) patients had testicular torsion. Only 16 (39.0%) of patients with torsion had viable testes that were salvageable. Orchiectomy was performed on 25 patients (61.0%). At multivariate analysis, a patient who presented after 48 h from the onset of symptoms was 34.833 times more likely to have orchiectomy compared to one who presented within 12 h [AOR = 34.833, (95% CI = 5.020-60.711), P < 0.001]. Conclusion In this study, the testicular salvage rate was low. The only predictor of salvageability was the time from the onset of symptoms to presentation. All males should be sensitized about the clinical features of testicular torsion to ensure early presentation to increase salvage rates.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Testicular salvageability and its predictors among patients with testicular torsion in a resource limited setting: a multicentre longitudinal study

Mohamed,

Abraha,

Olasinde

et al. 2023

BMC Surg

View full text Add to dashboard Cite

show abstract

“…The acutely painful scrotum has been described as a urologic emergency requiring a high index of clinical suspicion and prompt surgical intervention with the management aimed at avoiding testicular loss and infertility (1). Usually, salvage rates depend on the duration of symptoms and speed of diagnosis (4). A study reported that the salvage rate is high if the treatment is initiated within six hours after the onset of the symptoms and inversely decreases with increase in duration of symptoms (5).…”

Section: Introductionmentioning

confidence: 99%

“…Many patients in resource limited settings present late as they are waiting for the pain to resolve with self-medication. Moreover, clinicians may prescribe antibiotics and analgesics when a misdiagnosis has been made resulting in late presentation (4). Generally in our setting, it's unlikely for a patient to present within six hours due to long travel distances to access surgical specialty services and also the tendency to use alternative medicine.…”

Section: Introductionmentioning

confidence: 99%

Testicular salvageability and its predictors among patients with testicular torsion in a resource limited setting; a multicentre longitudinal study

Mohamed,

Abraha,

Olasinde

et al. 2023

Preprint

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Introduction Testicular torsion refers to ischemia of the testicle due to twisting or rotation of the vessels supplying the testes. It is a urologic emergency requiring a high index of clinical suspicion and prompt surgical intervention with management aimed at avoiding testicular loss and resulting infertility. There is a paucity of data on this subject in low-income settings. This study was aimed at assessing testicular salvageability and its predictors among patients with testicular torsion at two tertiary African hospitals. Methods This was a hospital-based multicentre longitudinal study at two tertiary hospitals in western Uganda. Patients with acute scrotum were enrolled and assessed for testicular torsion. Those with torsion underwent surgery and salvageability was recorded as the primary outcome. Predictors were determined using backward binary logistic regression in SPSS version 22. Results During the study period, 232 patients with acute scrotum were enrolled. The mean age was 35.3 (SD=20.4) years. Forty-one (17.7%) patients had testicular torsion. Of the 41 diagnosed with torsion, only 16 (39.0%) had viable testis that were salvageable. Orchiectomy was done for 25 (61.0%). At multivariate analysis, a patient who presented after 48 hours from the onset of symptoms was 34.833 times more likely to have orchiectomy compared to one that presented within 12 hours [AOR=34.833, (95% CI=5.020-60.711), P<0.001]. Conclusion In this study, the testicular salvage rate was low. The only predictor of salvageability was the time from the onset of symptoms to presentation. All males should be sensitized about the clinical features of testicular torsion to ensure early presentation in to increase salvage rates.

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Testicular torsion in Sub-Saharan Africa: a scoping review

Nedjim,

Biyouma,

Mahamat

et al. 2023

Afr J Urol

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Testicular torsion is a surgical emergency caused by rotation of the vascular pedicle of the testicle around its axis. If left untreated, testicular necrosis can set in, necessitating orchiectomy and loss of the testicle. The authors of this article reviewed articles on testicular torsion published in sub-Saharan Africa. The aim of this work is to establish the patient profile, consultation delay and orchiectomy rate in the sub-Saharan context. Data from the review will be compared with large non-sub-Saharan series and journals. Twenty-three articles were selected for review. All these articles were published between 1985 and 2022. A total of 1410 patients were included in the review. The average age was 19.7 years. The majority of patients were from urban areas. Risk factors for torsion were identified in 9 publications. The mode of hospital admission varied. Acute scrotal pain was the main symptomatology reported. The mean time in hours between onset of symptoms and consultation was 52.5 h. The left side was affected in 46.04% and the right in 49.81%. Four authors reported referral to a health center, and 8 authors reported scrotal ultrasonography. The rate of orchiectomy performed was found in 21 publications, the mean for the review as a whole was 46.4% with extremes of 13.2 and 72%. The orchiectomy rate was 52.4% in studies that reported an initial referral to a health center (patient transfer), versus 36.9% in studies that did not. In studies reporting ultrasound, the orchiectomy rate was 52.5%, compared with 36.9% in those not reporting ultrasound. On the basis of these results, we can formulate the following recommendations and actions: (i) further study of this pathology in sub-Saharan countries; (ii) raise public awareness of this pathology; (iii) train and retrain community workers and health center managers; and (iv) train general practitioners and surgeons in emergency scrototomy, orchidopexy and orchidectomy.

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Management and Outcome of Testicular Torsion

Cited by 3 publications

References 14 publications

Testicular salvageability and its predictors among patients with testicular torsion in a resource limited setting: a multicentre longitudinal study

Testicular salvageability and its predictors among patients with testicular torsion in a resource limited setting: a multicentre longitudinal study

Testicular salvageability and its predictors among patients with testicular torsion in a resource limited setting; a multicentre longitudinal study

Testicular torsion in Sub-Saharan Africa: a scoping review

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