Modern approaches to testicular fixation after elimination intravaginal testicular torsion.

Abstract

Introduction. Testicular torsion is the most common emergency urological pathology of boys. If it is impossible to exclude TT, a testicular revision is necessary. In every third case, the torsed testicle is not viable and an orchidectomy is performed. If the testicle is recognized as viable during the operation, then questions arise about the choice of fixation technique, suture material, as well as the need and timing of fixation of the contralateral testicle. The presence of a large number of possible complications after testicular fixation shows the relevance of studying actual experience on this problem. The purpose of the study: to evaluate the experience of using various methods of testicular fixation. Materials and methods. We searched for relevant publications in the PubMed and e-Library databases using the keywords «testicular torsion», «testicular fixation», «emergency urology», «testicular detorsion», «orchidectomy», «orchidopexy». As a result of the search, 43 sources were selected and included in the literature review. Results. We analyzed articles that published the results of using testicular fixation methods. The described methods were divided into four groups: 1. Various options for fixation with interrupted sutures without modeling the tunica vaginalis. 2. Fixation options with fenestration, eversion or excision of the tunica vaginalis. 3. Techniques using the «dartos pouch» method with or without fixation. 4. Exotic fixation techniques. Conclusion. There are very few publications devoted to the analysis of experience in using various methods of testicular fixation during torsion. An anatomical anomaly of the «bell clapper» type is detected in most cases with TT and with contralateral fixation. Currently, fixation techniques with eversion of the tunica vaginalis are not widely used. Leading guidelines on pediatric urology recommend the use of 3-point non-absorbable sutures and fixation using the «dartos pouch» method for testicular fixation after detorsion; however, there is an understanding that the used fixation methods are not universal, not effective and secure enough, which determines the relevance of new research on the «method of choice» for testicular fixation in case of TT.