Testicular Salvage and Age-Related Delay in the Presentation of Testicular Torsion

Abstract

Testicular torsion represents a continuing source of morbidity among male patients. Early diagnosis and surgical exploration improve testis salvage but even this approach will result in orchiectomy if there is excessive delay in patient presentation. A 10-year retrospective review of testicular torsion was performed. The interval between onset of scrotal pain and presentation to the emergency department was determined. A specific age-related delay in presentation was identified between patients less than 18 years old (group 1, median delay 20 hours) and those greater than 18 years old (group 2, median delay 4 hours, p less than 0.001). At exploration 44 per cent of the group 1 patients required orchiectomy versus 8 per cent in group 2. Patients less than 18 years old are a high risk group for testicular loss after torsion and represent more than 90 per cent of the orchiectomies performed. We believe that this group should be targeted for improved health education, emphasizing early evaluation of scrotal pain to improve testicular salvage.

Testicular torsion and weather conditions: analysis of 21,289 cases in Brazil

“…Incidence in Brazil during 2010 could be estimated of 1.4 torsions/100.000 men. This incidence is lower than estimated for colder countries of 27-48 torsions/100.000 men (5,20) and even in hotter middle-east countries, with incidence of 7.9 torsions/100.000 men estimated (8). We are not sure about the factors associated with these remarkable low rates of testicular torsion in Brazil.…”

“…Possible explanations could be the underreporting of cases, demographic characteristics or possibly the hot weather. Maybe colder countries have higher incidences of testicular torsion (5,20).…”

Predictors of testicular viability in testicular torsion

“…Jefferson et al reported that in their experience no testicle with a history >12 h could be salvaged [7], and Barada et al warned that patients younger than 18 years old are at increased risk of delayed presentation [8]. Testicular infarction begins after 2 h of ischemia, becomes irreversible after 6 h and complete infarction is established after 24 h. Although our experience is consistent with such a natural history, we also observed testicular necrosis (or atrophy after orchidopexy) in patients undergoing early surgery (history <10 h).…”

Montelukast prevents testes against ischemia-reperfusion injury through suppression of iNOS expression

“…The incidence has been reported as high as 1/4000 in males up to 25 years old. [1] Early recognition and treatment of the disease is of the utmost importance to preserve testicular function and save the testis from orchiectomy. However, even after surgical detorsion of the testis, the salvage rates are between 42 and 88%, and the long-term function of these testes are unknown.…”