Orchidopexy for testicular torsion: A systematic review of surgical technique

Abstract

Acute testicular torsion is a common urological emergency. Accepted practice is surgical exploration, detorsion and orchidopexy for a salvageable testis. ObjectiveTo critically evaluate methods of orchidopexy and their outcomes with a view to determining optimal surgical technique. Evidence AcquisitionThe review protocol was published via PROSPERO [CRD42016043165] and conducted in accordance with PRISMA. EMBASE, MEDLINE and CENTRAL databases were searched using terms: 'orchidopexy', 'fixation', 'exploration', 'torsion', 'scrotum' and variants. Article screening was performed by two reviewers independently. The primary outcome was retorsion rate of the ipsilateral testis following orchidopexy. Secondary outcomes included testicular atrophy and fertility. Evidence SynthesisTo our knowledge, this is the first systematic review on this topic. The search yielded 2257 abstracts. Five studies (n=138 patients) were included.All five techniques differed in incision and/or type of suture and/or point(s) of fixation. Postoperative complications were reported in one study and included scrotal abscess in 9.1% and stitch abscess in 4.5%. The contralateral testis was fixed in 57.6% of cases.Three studies reported follow-up duration (range 6-31 weeks). No study reported any episodes of ipsilateral retorsion. In the studies reporting ipsilateral atrophy rate, this ranged from 9.1-47.5%. Fertility outcomes and patient reported outcome measures were not reported in any studies.