Recurrent testicular torsion post orchidopexy ‐ an occult emergency: a systematic review

Abstract

Background: Recurrent Testicular Torsion (RTT) is a rarely reported event after previous testicular torsion (TT) repair. Both conditions have similar signs and symptoms. Various techniques have been attempted to reduce the incidence of retorsion. This review assesses the presentation, diagnosis, risk factors, management and outcomes associated with RTT. Methods: After PROSPERO Registration (CRD42021258997), a systematic search of PubMed, Google Scholar, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, Global Index Medicus and Cumulative Index to Nursing and Allied Health Literature (CIANHL) was performed using specific search terms. Study metadata including patient demographics, orchidopexy techniques, RTT rates and RTT timing were extracted. Results: Twenty-six articles, comprising 12 case series and 14 case reports, with a total of 46 patients were included. Overall, the median (IQR) age of the pooled cohort was 18 (15-26) years, the median (IQR) time to presentation was 6 (3-36) hours from the onset of testicular pain. The most common presenting features were testicular pain (100%), testicular swelling (60.9%) and a high riding testicle (34.8%). The left testicle was most commonly affected (63.0%), RTT was on the ipsilateral side in relation to the primary episode of TT in 52.2% of cases, the median (IQR) interval between torsion and retorsion events was 4 (1.3-10.0) years, non-absorbable sutures were the most common suture material used during orchidopexy after RTT (88.9%). Conclusion: RTT is a rare presentation to the Emergency Department. Even with a prior history of TT, RTT should be considered in patients presenting with classic symptoms.

Analysis of factors associated with delayed diagnosis and treatment of testicular torsion in 1005 cases from Chongqing city, China: a cross-sectional study

“…Absent cremasteric reflex was found as a protective factor for delayed surgery for more than 6 h from onset of symptoms to surgery, because it assisted doctors to accurately diagnose TT, and shortened the time to diagnosis 18 . A negative high riding testis was identified as a risk factor for delayed surgery for more than 6 h from the onset of symptoms to surgery, which is consistent with previously reported findings 19 , 20 .…”

Long-Term Follow-Up after Testicular Torsion: Prospective Evaluation of Endocrine and Exocrine Testicular Function, Fertility, Oxidative Stress and Erectile Function

“…The majority of our patients had been asleep or in a state of rest at the onset of symptoms. A recurrent TT is a rare event [ 29 ]. We registered no recurrence in our population.…”

Spontaneous (idiopathic) rupture of the urinary bladder: a systematic review of case series and reports

“…Since all studies meeting the inclusion criteria were case reports and case series, a modification to the tool proposed by Murad et al [13] was used to assess the methodological quality of the included manuscripts. This modified tool has been used in several other systematic reviews of case reports [14,15]. The original tool comprises four domains with eight questions in total.…”

“…[13] was used to assess the methodological quality of the included manuscripts. This modified tool has been used in several other systematic reviews of case reports [14,15]. The original tool comprises four domains with eight questions in total.…”