Our Experience in Treatment of Testicular Torsion in Children

Abstract

The objective of the research was to analyze personal experience and world literature on the diagnosis and treatment of boys with testicular torsion and to improve the process of providing specialized care. Problem statement and analysis of the recent researchTesticular torsion (TT) is an emergency condition caused by twisting of the spermatic cord which results in strangulation of the blood supply leading to testicular infarction and organ loss [5,9,10,14]. TT is one of the most common acute conditions accompanied by syndrome of hyperemic and swollen scrotum [1,3,4,6]; it is reported to occur in approximately 90% of adolescents [2,7]. The objective of the research was to analyze personal experience and world literature on the diagnosis and treatment of boys with TT and to improve the process of providing specialized care. Materials and methods of the researchThe results of diagnosis and treatment of 141 children with TT who were treated in the surgical department of the IvanoFrankivsk Regional Children's Clinical Hospital over a period of 10 years (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) were analyzed. The patients' age ranged within 1 month to 18 years. All the boys were hospitalized to the emergency department and examined: a complete anamnesis was collected, testicular examination and Doppler ultrasound examination were performed, the organs of the scrotum were palpated. In addition, all children underwent a standardized clinical examination. Results of the research and their discussionThere was a tendency toward the increase in the incidence of pathology during the following years (2007 -9 cases, 2008 -12 cases, 2009 -13 cases, 2010 -9 cases, 2011 -18 cases, 2012 -10 cases, 2013 -11 cases, 2014 -14 cases, 2015 -19 cases, 2016 -26 cases). Torsion of the left testicle was observed in 98 (70%) boys; torsion of the right testicle was found in 43 (30%) boys. Torsion of cryptococcal testicle was detected in 18 (12.8%) children. 1 (0.7%) child was at the age of 0 -1 months; 15 (10.6%) children were at the age of 1 month -1 year; 13 (9.2%) children were at the age of 1-3 years; 11 (7.8%) children were at the age of 3-6 years; 16 (11.3%) children were at the age of 6-12 years old; 85 (60.3%) children were at the age of 12-18 years. The degree of twisting of the testicle ranged from 180 to 10800. In 133 cases, surgery was performed (44 (33.3%) children underwent detorsion, ipsilateral and contralateral orchiopexy; 29 (21.9%) children underwent orchiectomy with contralateral orchiopexy, 24 (18.1%) boys underwent orchiectomy, 24 (18.1%) boys underwent orchiopexy and in 12 (9.09%) cases, detorsion was performed); manual testicular detorsion was attempted in 8 (5.7%) cases only. Only 24 (17%) children were hospitalized timely (up to 6 hours). In this group, 18 boys were surgically treated, 3 boys underwent detorsion, and in 4 cases, manual detorsion was attempted.64 (45.4%) children were examined 7-24 hours after TT. In this group, the auxiliary procedures including heating of the

Patient Query in Adolescent Testicular Torsion Cases: "Was it Necessary to Mention My Scrotal Pain?"

“…It is evident that the general awareness of TT is deficient, with most individuals unaware that TT can occur, potentially leading to testicular loss. This deficiency in awareness appears to be true for all levels of society and educational ability, as in our patients' families [5,8,[15][16][17][18]. In comparison to families whose children underwent surgery for other reasons, our families demonstrated erratic behavior when confronted with the possibility of testicular loss due to delay.…”

“…In fact, some adolescents experience sexual shyness, leading them to conceal their scrotal complaints and instead report abdominal or inguinal pain, along with other associated symptoms. These patients later admitted that they did not understand the importance of discussing scrotal pain and changes with their families and physicians, often due to feelings of embarrassment [4,6,8,9].…”