Testicular Torsion Patients Should Be Manually Detorsed at Diagnosis

Abstract

The aim of the study was to assess organ salvage in testicular torsion patients submitted to manual detorsion according to interhospital transfer and surgical wait times.Methods: Retrospective analysis of consecutive surgically treated testicular torsion patients between 2012 and 2018. We compared testicular surgical salvage in testicular torsion patients submitted to manual detorsion either at clinical diagnosis (immediate detorsion) or after interhospital transfer from lower level-of-care facilities (delayed detorsion) and estimated the influence of interhospital transfer and surgical wait times on outcomes. Analysis included Bayesian logistic regression after propensity score matching. We excluded patients first examined at off-state and private facilities, with prediagnostic time of more than 24 hours, not initially diagnosed with testicular torsion or not submitted to manual detorsion at any time.Results: One hundred sixty-two patients (median age, 15.8 years) fulfilled inclusion criteria. The median prediagnostic, transfer, and surgical wait times were respectively 4.9, 2.4, and 4.3 hours, with 58 patients undergoing immediate and 104 delayed detorsion. Propensity score matching for prediagnostic and surgical wait times paired 58 immediate with 40 delayed detorsion patients, with corresponding surgical salvage rates of 54/58 (93%) and 33/40 (82%). Forty-seven patients (29%) still had torsion at surgery. Transfer time was inversely associated with testicular salvage, with median 13% greater probability of an unfavorable outcome for each hour of transfer time. Similarly, each hour of surgical wait time decreased surgical salvage by 6%.Conclusions: Immediate detorsion led to improved surgical outcomes in testicular torsion patients. Because of residual torsion, surgery for detorsed patients should not be postponed.

Prediction of testicular atrophy based on sonographic findings immediately after successful manual detorsion

“…Successful manual detorsion was defined as the restoration of blood flow within the testis as confirmed using ultrasound, the disappearance of whirlpool signs on ultrasound, and the absence of residual spermatic cord twisting during surgical exploration after manual detorsion. 6,8,14,15 Surgical exploration Surgical exploration was performed by paediatric surgeons or urologists. Orchiopexy was performed in all the patients to prevent testicular torsion recurrence.…”

“…However, in the manual procedure, only detorsion is performed, while orchiopexy to prevent recurrence of testicular torsion and fasciotomy to prevent testicular compartment syndrome due to reperfusion cannot be performed. 2,4,[6][7][8][9][10][11][12] Surgical exploration is usually performed following manual detorsion, regardless of whether detorsion is successful; however, the time between manual detorsion and surgical exploration varies among patients and hospitals. 6,8,13 Therefore, successful manual detorsion is important for decreasing testicular ischemic time.…”

“…2,4,[6][7][8][9][10][11][12] Surgical exploration is usually performed following manual detorsion, regardless of whether detorsion is successful; however, the time between manual detorsion and surgical exploration varies among patients and hospitals. 6,8,13 Therefore, successful manual detorsion is important for decreasing testicular ischemic time. Clinically, the success of manual detorsion is usually determined based on the patients' symptoms and sonographic findings, which are finally recognised during surgical exploration.…”

“…Compared with surgical exploration, manual detorsion is advantageous since this bedside procedure can be performed immediately after torsion. However, in the manual procedure, only detorsion is performed, while orchiopexy to prevent recurrence of testicular torsion and fasciotomy to prevent testicular compartment syndrome due to reperfusion cannot be performed 2,4,6–12 …”

“…Surgical exploration is usually performed following manual detorsion, regardless of whether detorsion is successful; however, the time between manual detorsion and surgical exploration varies among patients and hospitals 6,8,13 . Therefore, successful manual detorsion is important for decreasing testicular ischemic time.…”