Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children

Grimsby, Gwen M.; Schlomer, Bruce J.; Menon, Vani S.; Ostrov, Lauren; Keays, Mélise; Sheth, Kunj R.; Villanueva, Carlos; Granberg, Candace F.; DaJusta, Daniel; Hill, Martinez; Sanchez, Emily; Harrison, Clanton B.; Jacobs, Micah A.; Burgu, Berk; Hennes, Halim; Baker, Linda A.

doi:10.1016/j.urology.2018.03.009

Cited by 42 publications

(52 citation statements)

References 22 publications

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“…Preoperative risk factors associated with future testicular atrophy are pain duration for 12 hours or more, heterogeneous echogenicity of testicular parenchyma, and red scrotal skin [8]. All patients whose testes had a sudden blackened or hemorrhagic appearance five minutes after detorsion had more than 80% volume loss [8]. In one of our cases, testis size after torsion gradually decreased and revealed heterogeneous echogenicity on follow-up ultrasonography (Fig.…”

Section: Testicular Torsionmentioning

confidence: 66%

“…Testicular atrophy is a significant complication of testicular torsion. Preoperative risk factors associated with future testicular atrophy are pain duration for 12 hours or more, heterogeneous echogenicity of testicular parenchyma, and red scrotal skin [8]. All patients whose testes had a sudden blackened or hemorrhagic appearance five minutes after detorsion had more than 80% volume loss [8].…”

Section: Testicular Torsionmentioning

confidence: 99%

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Small testes: clinical characteristics and ultrasonographic findings

et al. 2021

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The purpose of this pictorial essay is to describe the ultrasonographic and clinical findings in patients with various causes of small testes. We retrospectively reviewed the ultrasonographic and clinical findings of various causes of small testes. We present various causes of small testes on ultrasonography including Klinefelter syndrome, testicular torsion, mumps orchitis, inguinal hernia, cryptorchidism, varicocele and trauma. On ultrasonography, small testes in patients with testicular torsion, mumps orchitis, and trauma usually revealed heterogeneous echogenicity. The atrophic testes were homogeneously hypoechoic in cryptorchidism and inguinal hernia and were isoechoic to the normal testis in varicocele. Klinefelter syndrome patients had small hyperechoic or hypoechoic nodules, but the echogenicity of the remnant portion of the testes were homogeneous. Ultrasonographys is helpful for detection of small testes and differential diagnosis of variable causes of small testes.

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Section: Testicular Torsionmentioning

confidence: 66%

Section: Testicular Torsionmentioning

confidence: 99%

Small testes: clinical characteristics and ultrasonographic findings

et al. 2021

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“…Intra-operative decision to remove or not the twisted testicle was based on the recoloration of the testicle after detorsion. In general, orchiectomy was performed for testicles that were black or hemorrhagic 5 min after detorsion [7]. Only patients who underwent surgery on the same day of presentation in the hospital were included in the present study.…”

Section: Methodsmentioning

confidence: 99%

“…The risk of necrosis increases exponentially after 6 h of ischemia [26]. Grimsby et al [7] have showed that patients with symptom duration over 12 h have a testis volume loss of 88% compared with the normal contralateral testis. Thus, understanding the factors that influence delays to presentation and treatment is crucial to testicular survival after torsion.…”

Section: Influence Of Prehospital and In-hospital Times On Testicularmentioning

confidence: 99%

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

Steeman

Ngatchou

Ramadan

et al. 2021

Acta Chirurgica Belgica

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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.

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“…Currently, there is no standard definition of TA. We used a similar definition as suggested by relevant references ( 7 , 8 ); TA was defined as the following: TVL ≥80% or no sustained blood supply in the follow-up.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy

et al. 2020

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Objective: To analyze the risk factors for testicular atrophy (TA) in children with testicular torsion (TT) following emergent orchiopexy. Methods: Clinical data of patients with TT undergoing orchiopexy were retrospectively reviewed, including age at surgery, affected side, delayed surgery (12–24 h and more than 24 h), echogenicity of testicular parenchyma on ultrasonography (ETPU), testicular blood flow on Color Doppler ultrasonography (CDUS), surgical findings (intraoperative blood supply, the degree of torsion, and surgical approaches), and follow-up. The primary outcome was the rate of TA after orchiopexy. The secondary outcome was the testicular volume loss (TVL) between the affected testis and the contralateral. Results: A total of 113 patients were enrolled in this study with a median age of 11 years. The median follow-up was 21 months. Patients had a median TVL of 51.02% and 44 (38.94%) of them developed severe TA during follow-up. TA was significantly associated with age at surgery ( P < 0.0001), delayed surgery ( P = 0.0003), ETPU ( P = 0.0001), and intraoperative blood supply ( P = 0.0005). Multivariate logistic regression analysis showed that school-age children (OR = 0.069, P < 0.001) and puberty (OR = 0.177, P = 0.007) had a decreased risk of TA compared with preschool children, and that heterogeneous ETPU (OR = 14.489, P = 0.0279) and delayed surgery >24 h (OR = 3.921, P = 0.040) increased the risk of TA. Multivariate analysis demonstrated that ETPU ( F = 16.349, P < 0.001) and delayed surgery ( F = 6.016, P = 0.003) were independent risk factors for TVL. Conclusions: Age at surgery, delayed surgery, and ETPU may play a crucial role in predicting the TA in children with TT following emergent orchiopexy. Moreover, blood flow measured by CDUS could not predict the outcome properly.

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Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children

Cited by 42 publications

References 22 publications

Small testes: clinical characteristics and ultrasonographic findings

Small testes: clinical characteristics and ultrasonographic findings

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

Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy

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