Should manual detorsion be a routine part of treatment in testicular torsion?

Demirbaş, Arif; Demir, Demirhan Orsan; Ersoy, Erim; Kabar, Mucahit; Özcan, Serkan; Karagöz, Mehmet Ali; Demirbaş, Özgecan; Doluoğlu, Ömer Gökhan

doi:10.1186/s12894-017-0276-5

Cited by 30 publications

(33 citation statements)

References 18 publications

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“…The median ischemia-free time gained was 90 (20–240) minutes compared to the group of patients that underwent surgical exploration without manual detorsion. 50 …”

Section: Discussionmentioning

confidence: 99%

“…Manual detorsion should be followed by surgical exploration and orchidopexy. 50 A recent study reported that 20 out of 26 patients were successfully detorted by manual detorsion with elective surgery thereafter being performed at a median of 10 (0-45) days later. None of the patients had recurrent episodes of torsion while awaiting surgery.…”

Section: Dovepressmentioning

confidence: 99%

“…The median ischemiafree time gained was 90 (20-240) minutes compared to the group of patients that underwent surgical exploration without manual detorsion. 50 Patient compliance can be a limiting factor, as manual detorsion is generally performed without the administration of anesthesia. This is to allow for monitoring of pain which can be used as a surrogate marker of successful detorsion or recurrence of torsion.…”

Section: Dovepressmentioning

confidence: 99%

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<p>Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies</p>

Laher¹,

Ragavan²,

Mehta³

et al. 2020

OAEM

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Testicular torsion is a challenging and time-sensitive diagnosis that is encountered frequently in daily practice, especially in the emergency room. A thorough history, the presence of a painful and swollen testis and testicular ultrasonography plays a vital role in the prompt diagnosis of testicular torsion. Prompt diagnosis is essential to prevent complications of testicular torsion which include testicular infarction, necrosis, and sub/infertility. This can be challenging as there are various other conditions that may mimic the presentation of testicular torsion. Since testicular torsion is an extremely time-sensitive diagnosis, it may also be a subject of many medicolegal challenges. This review article serves as a guide for clinicians involved with the diagnosis and management of testicular torsion. We review and discuss detection and management strategies based on their validity, statistical significance, and effectiveness in enabling prompt diagnosis and management of testicular torsion. Medicolegal implications of testicular torsion are also highlighted.

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“…The median ischemia-free time gained was 90 (20–240) minutes compared to the group of patients that underwent surgical exploration without manual detorsion. 50 …”

Section: Discussionmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

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<p>Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies</p>

Laher¹,

Ragavan²,

Mehta³

et al. 2020

OAEM

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“…In our study, manual detorsion applied in 32 patients among those presented within 48 h of onset of symptoms was associated with a salvage surgery or testicular fixation surgery in 28 out of 32 (87.5%) performed manual detorsion. This procedure which helps reduce the testicular ischemic time needs to always be followed by orchidopexy [23]. In our institution, we always strive to reduce to a minimum possible the time from admission to emergency surgery for every suspected testicular torsion presented within 72 h. The median (IQR) time from admission to surgery in those presented within 72 h of onset being 3 h, most of the time, due to emergency trauma cases (gun shots, stab wounds), hence manual detorsion as a routine part of management of testicular torsion will always find its significance in preventing more ischemic damages to the testis.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and management of testicular torsion in patients admitted to the Urology Department at Chris Hani Baragwanath Academic Hospital

2020

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Background: The study was carried out to determine the trend of referrals with testicular torsion; the pre-surgery duration of symptoms; the rate of orchidectomy; as well as the seasonality and the age-related laterality of testicular torsion. Methods: This was a retrospective study conducted at Chris Hani Baragwanath Academic Hospital using patients' records from 2006 to 2018 from which data were obtained and analyzed. Results: A total of 308 patients with testicular torsion were included in this study; the mean age was 17.2 ± 4.12 (10-33) years. The median (IQR) time from onset to hospital was 47 h, and 194/308 (63%) underwent orchidectomy. Although the orchidectomy rate was higher (95%) in those who had surgery beyond 72 h, 3.6% had reperfusion after detorsion in theater followed by orchidopexy. In the 112 patients who underwent a bilateral orchidopexy, the time from onset of symptoms to surgery was significantly shorter at a median (IQR) of 13 (9-26) h, compared to 144 (40-264) h in the 194 patients who had an orchidectomy (p < 0.0001). The odds of presenting with a right-sided testicular torsion increases by 6% (p = 0.047) for every 1-year increase in age. Conclusion: This study shows that there is a significant association between the pre-surgery duration of symptoms and the testicular salvage rate. Testicular salvage is possible beyond 72 h from the onset of symptoms, although the salvage rate reduces from 75% within 24 h to 3.6% beyond 72 h. In addition, it also shows that older patients tend to present with right-sided torsion.

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“…In regards to prompt management, manual detorsion has been described by Nash in 1893, has been proposed as urgent procedure reducing the duration of ischemia of torsioned testis 19 . Various studies in literature suggests that this method may be an alternative to exploration and surgical detorsion [20][21][22] . On the other hand, some studies in literature suggest the risk of residual torsion and subsequent testicular atrophy 23,24 .…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 Pandemic on Admission Times, Manual Detorsion Rates and Outcomes in Testicular Torsion

Tokuç

Artuk

Kayar

et al. 2021

Preprint

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Aim: This study aims to assess the admission times, manual detorsion rates and outcomes of the testicular torsion cases during COVID-19 pandemic. Methods: A retrospective analysis of the testicular torsion cases was done through our hospital’s electronic archive. Patients with were distributed into two groups as “COVID-19 era” (between 11th of March 2020 – March 2021) and “pre-COVID-19 era” (between January 2018 and 10th of March 2020). Time between the onset of symptoms and the moment of detorsion was calculated as the duration of ischemia. Two groups were compared in terms of ischemia duration, manual detorsion rates and operational outcomes. Results: No statistically significant differences was detected between groups in terms of ischemia duration, manual detorsion rates and surgical procedure type (all p>0.05). During the COVID-19 pandemic, the number and percentage of manual detorsions have increased, resulting in a numerical decrease in orchiectomies. Conclusions: Conditions caused by COVID-19 may prompt urologists to manual detorsion more to set up safer surgical environment. Moreover, this approach may result in a decrease in orchiectomy rates by saving time and preserving the vascularity of the testis. Further studies with larger samples sizes and meta-analyses may support this concept. Keywords: testicular torsion, COVID-19, manual detorsion, orchiectomy, emergency

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Should manual detorsion be a routine part of treatment in testicular torsion?

Cited by 30 publications

References 18 publications

<p>Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies</p>

<p>Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies</p>

Characteristics and management of testicular torsion in patients admitted to the Urology Department at Chris Hani Baragwanath Academic Hospital

The Impact of COVID-19 Pandemic on Admission Times, Manual Detorsion Rates and Outcomes in Testicular Torsion

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