1
|
Saab MM, Shetty VN, McCarthy M, Davoren MP, Flynn A, Kirby A, Robertson S, Shorter GW, Murphy D, Rovito MJ, Shiely F, Hegarty J. Codesign and Launch of 'On the Ball': An Inclusive Community-Based 'Testicular Awareness' Campaign. Health Expect 2024; 27:e14100. [PMID: 38872440 PMCID: PMC11176580 DOI: 10.1111/hex.14100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Increased awareness of testicular diseases can lead to early diagnosis. Evidence suggests that men's awareness of testicular diseases is low, with many expressing their willingness to delay help-seeking for symptoms of concern. The risk of testicular diseases is higher in gender and sexual minority groups. In this study, we discuss the codesign, refinement and launch of 'On the Ball', an inclusive community-based 'testicular awareness' campaign. METHODS The World Café participatory research methodology was used. Individuals from Lesbian, Gay, Bisexual, Transgender and Queer+ friendly organisations, testicular cancer survivors, policymakers, media/marketing experts and graphic designers were recruited. Participants were handed a brief for 'On the Ball', which was designed based on feedback from a previous World Café workshop. They were assigned to three tables. Participants rotated tables at random for three 20-min rounds of conversations. Each table had a facilitator who focussed on one element of the campaign brief. Data were collected using audio recorders and in writing and were analysed thematically. RESULTS Thirteen individuals participated in the workshop. The following themes emerged from the data: (i) campaign identity, (ii) campaign delivery and (iii) campaign impact. Participants recommended enhancements to the campaign logo, slogan, social media posts and poster. They suggested delivering the campaign online via social media and offline using various print and broadcast media. Participants recommended targeting areas with a large number of men such as workplaces. To help measure the impact of the campaign, participants proposed capturing social media analytics and tracking statistics relating to testicular diseases. Recommendations were used to refine the 'On the Ball' campaign and launch it in a university. In total, 411 students engaged with the various elements of the campaign during the soft launch. CONCLUSIONS 'On the Ball' campaign visuals ought to be inclusive. Online and offline campaign delivery is warranted to reach out to a wider cohort. Campaign impact can be captured using social media analytics as well as measuring clinical outcomes relating to testicular diseases. Future research is needed to implement the campaign online and offline, explore its impact and evaluate its feasibility, acceptability, cost and effect on promoting testicular awareness. PATIENT OR PUBLIC CONTRIBUTION The 'On the Ball' campaign was codesigned and refined with members of Lesbian, Gay, Bisexual, Transgender and Queer+ friendly organisations, testicular cancer survivors, health policymakers, media and marketing experts and graphic designers using the World Café participatory research methodology.
Collapse
Affiliation(s)
- Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Varsha N Shetty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Megan McCarthy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Martin P Davoren
- Sexual Health Centre, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Angela Flynn
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Ann Kirby
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Steve Robertson
- School of Allied Health Professions, Nursing & Midwifery, Faculty of Health, University of Sheffield, Sheffield, UK
| | - Gillian W Shorter
- Drug and Alcohol Research Network, School of Psychology, Queen's University Belfast, Belfast, UK
| | - David Murphy
- School of Computer Science & Information Technology, University College Cork, Cork, Ireland
| | - Michael J Rovito
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
| | - Frances Shiely
- School of Public Health, University College Cork, Cork, Ireland
- HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| |
Collapse
|
2
|
Moran GW, Wang CN, Chung R, Movassaghi M, Carpenter CP, Finkelstein JB. Atypical Presentation Delays Treatment of Pediatric Testicular Torsion. Pediatr Emerg Care 2024; 40:255-260. [PMID: 37195643 DOI: 10.1097/pec.0000000000002969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE The aim of the study is to identify patient- and care-related factors associated with time to treatment for acute testicular torsion and the likelihood of testicular loss. METHODS Data were retrospectively collected for patients 18 years and younger who had surgery for acute testicular torsion between April 1, 2005, and September 1, 2021. Atypical symptoms and history were defined as having abdominal, leg, or flank pain, dysuria, urinary frequency, local trauma, or not having testicular pain. The primary outcome was testicular loss. The primary process measure was time from emergency department (ED) triage to surgery. RESULTS One hundred eleven patients were included in descriptive analysis. The rate of testicular loss was 35%. Forty-one percent of all patients reported atypical symptoms or history. Eighty-four patients had adequate data to calculate time from symptom onset to surgery and time from triage to surgery and were included in analyses of factors affecting risk of testicular loss. Sixty-eight patients had adequate data to evaluate all care-related time points and were included in analyses to determine factors affecting time from ED triage to surgery. On multivariable regression analyses, increased risk of testicular loss was associated with younger age and longer time from symptom onset to ED triage, while longer time from triage to surgery was associated with reporting atypical symptoms or history.The most frequently reported atypical symptom was abdominal pain, in 26% of patients. These patients were more likely to have nausea and/or vomiting and abdominal tenderness but equally likely to report testicular pain and swelling and have testicular findings on examination. CONCLUSIONS Patients presenting to the ED with acute testicular torsion reporting atypical symptoms or history experience slower transit from arrival in the ED to operative management and may be at greater risk of testicular loss. Increased awareness of atypical presentations of pediatric acute testicular torsion may improve time to treatment.
Collapse
Affiliation(s)
- George W Moran
- From the Department of Urology, Columbia University Irving Medical Center
| | - Connie N Wang
- From the Department of Urology, Columbia University Irving Medical Center
| | - Rainjade Chung
- From the Department of Urology, Columbia University Irving Medical Center
| | - Miyad Movassaghi
- From the Department of Urology, Columbia University Irving Medical Center
| | | | | |
Collapse
|
3
|
Gang XH, Duan YY, Zhang B, Jiang ZG, Zhang R, Chen J, Teng XY, Zhang DB. Clinical characteristics of testicular torsion and factors influencing testicular salvage in children: A 12-year study in tertiary center. World J Clin Cases 2024; 12:1251-1259. [PMID: 38524506 PMCID: PMC10955544 DOI: 10.12998/wjcc.v12.i7.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/09/2024] [Accepted: 02/04/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents. Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion. AIM To predict the possibility of testicular salvage (TS) in patients with testicular torsion in a tertiary center. METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University. Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion. The data included clinical findings, physical examinations, laboratory data, color Doppler ultrasound findings, operating results, age, presenting institution status, and follow-up results. RESULTS Our study included 75 patients. TS was possible in 57.3% of all patients; testicular torsion occurred mostly in winter, and teenagers aged 11-15 years old accounted for 60%. Univariate logistic regression analyses revealed that younger age (P = 0.09), body mass index (P = 0.004), torsion angle (P = 0.013), red blood cell count (P = 0.03), neutrophil-to-lymphocyte ratio (P = 0.009), and initial presenting institution (P < 0.001) were associated with orchiectomy. In multivariate analysis, only the initial presenting institution predicted TS (P < 0.05). CONCLUSION The initial presenting institution has a predictive value for predicting TS in patients with testicular torsion. Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.
Collapse
Affiliation(s)
- Xiang-Hui Gang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Yuan-Yuan Duan
- Department of Ultrasound Diagnosis, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Bin Zhang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Zheng-Gan Jiang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Rong Zhang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Jun Chen
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Xiang-Yu Teng
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Duo-Bing Zhang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| |
Collapse
|
4
|
Saab MM, Davoren MP, Murphy A, Murphy D, Cooke E, Landers M, Fitzgerald S, Richardson N, Rovito MJ, Von Wagner C, Murphy M, Dahly D, Hegarty J. Promoting men's awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions. HRB Open Res 2023; 1:16. [PMID: 32002508 PMCID: PMC6973532 DOI: 10.12688/hrbopenres.12837.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/17/2023] Open
Abstract
Background: Testicular cancer (TC) is among the most commonly diagnosed cancers in men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders, such as testicular torsion and epididymitis, can lead to testicular ischemia, sepsis, and infertility if left untreated. This updated systematic review aims to evaluate the effectiveness of studies promoting men's knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular disorder symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsycINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, and Clinicaltrials.gov were searched for studies published between April 2018 and August 2023. Methodological quality was assessed and results were synthesised meta-narratively. Results: Five studies were included. The majority of the reviewed interventions were successful in increasing men's awareness of TC and self-examination, including a PowerPoint presentation, an online educational brochure, video-assisted teaching, a motivational video, and a virtual reality game. Only one study addressed help-seeking for testicular symptoms and promoted men's awareness of benign as well as malignant testicular diseases. Conclusions: This review highlights the importance of evaluating innovative educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular disorder symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The protocol of the previous version of this review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.
Collapse
Affiliation(s)
- Mohamad M. Saab
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Martin P. Davoren
- School of Public Health, University College Cork, Cork, Ireland
- Sexual Health Centre, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, University College Cork, Cork, Ireland
| | - David Murphy
- School of Computer Science & Information Technology, University College Cork, Cork, Ireland
| | - Eoghan Cooke
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
- Health Research Board National Clinical Trials Office, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Margaret Landers
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Serena Fitzgerald
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Noel Richardson
- Department of Science and Health, South East Technological University, Carlow, Ireland
| | - Michael J. Rovito
- College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
| | - Christian Von Wagner
- Behavioural Science and Health, Institute of Epidemiology & Health, University College London, London, UK
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Darren Dahly
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| |
Collapse
|
5
|
Mehmetoğlu F. Patient Query in Adolescent Testicular Torsion Cases: "Was it Necessary to Mention My Scrotal Pain?". Cureus 2023; 15:e47386. [PMID: 37869046 PMCID: PMC10588814 DOI: 10.7759/cureus.47386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 10/24/2023] Open
Abstract
Objective This study investigates the reasons for the failure to diagnose testicular torsion (TT) in different healthcare facilities (HCFs) and by various physicians. Method We retrospectively analyzed all male patients who underwent TT surgery within the adolescent age group between 2015 and 2023. Healthy adolescent patients who initially presented or were referred to an HCF and were subsequently diagnosed at our hospital for TT surgery were analyzed, focusing on why they were not diagnosed earlier. Results A total of 11 patients aged 10 to 17 who were surgically confirmed to have TT at our hospital between 2015 and 2023 were analyzed retrospectively. These patients had been admitted to various public and private HCFs due to the sudden onset of symptoms such as abdominal pain, vomiting, fainting, sweating, and walking difficulties during and after working hours. Four patients had previously been admitted to one HCF, while seven had been admitted two to six times to an HCF. All patients were healthy, and all but one had received age-appropriate education. However, only two of them had reported experiencing scrotal pain. Laboratory tests and/or radiological examinations were conducted on eight patients, and nine patients received medical treatment and/or prescriptions. None of the patients were initially diagnosed with acute scrotum. Conclusion Despite having unrestricted and free access to well-equipped HCFs, the early diagnosis and treatment of TT are not ensured. Factors contributing to this delay include patients' concealment of, or failure to fully disclose, scrotal complaints, as well as physicians' incomplete history taking and genital examinations. The physician's male gender was not found to contribute to an earlier diagnosis of TT. A mandatory genital examination should be included in the emergency assessment protocol for male patients.
Collapse
|
6
|
Hegarty J, McCarthy M, Davoren M, Shiely F, Harrington JM, Shorter G, Murphy D, Cooke E, O'Mahony B, M. Saab M. Enhancing men's awareness of testicular diseases (E-MAT) feasibility trial: Protocol for a mixed method process evaluation. HRB Open Res 2023; 5:25. [PMID: 37636246 PMCID: PMC10450256 DOI: 10.12688/hrbopenres.13515.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 08/29/2023] Open
Abstract
Background: Testicular cancer (TC) is the most common malignancy in men under 50 years. Athletes are particularly at risk of testicular trauma and diseases. Experiencing negative testicular symptoms does not necessarily imply that men seek help. Men's awareness of testicular diseases is often lacking and their intention to seek help for testicular symptoms is sub-optimal. The use of virtual reality (VR) may be effective in promoting men's awareness of testicular diseases. The Enhancing Men's Awareness of Testicular diseases (E-MAT) feasibility trial aims to test the effect of E-MAT VR (intervention; interactive experience using virtual reality [VR]) compared to information delivered Electronically E-MAT E (control; same information as E-MAT VR delivered as plain text and images) on testicular knowledge, and testicular self-examination among male athletes affiliated with a national sports organisation. The overall aim of this mixed method process evaluation will be to describe (i) the experiences of participants and key stakeholders (e.g., researchers); (ii) the perceived effectiveness of intervention components; (iii) acceptability of the feasibility trial and intervention procedures; (iv) the relationship between implementation, mechanisms, and context; and (v) the barriers and facilitators to support effective conduct of a future definitive trial. Methods: This mixed method process evaluation will use a descriptive realist evaluation. Quantitative data will be gathered using a usability and satisfaction survey, in addition to fidelity checks during intervention delivery. Quantitative data will be analysed using descriptive and inferential statistics. Qualitative data will be gathered from semi-structured interviews and focus groups with participants and key stakeholders to investigate their experiences of E-MAT VR and E-MAT E, and explore areas for improvement. Thematic analysis of transcripts will be conducted. Conclusions: This process evaluation will provide an in-depth understanding of how the interventions worked within this cohort and lessons for a future definitive trial.
Collapse
Affiliation(s)
- Josephine Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Megan McCarthy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Frances Shiely
- Trials Research and Methodologies Unit, Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - Janas M. Harrington
- Health Research Board Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Gillian Shorter
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - David Murphy
- School of Computer Science and Information Technology, University College Cork, Cork, Ireland
| | - Eoghan Cooke
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Billy O'Mahony
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mohamad M. Saab
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| |
Collapse
|
7
|
Michelson KA, Bachur RG, Grubenhoff JA, Cruz AT, Chaudhari PP, Reeves SD, Porter JJ, Monuteaux MC, Dart AH, Finkelstein JA. OUTCOMES OF MISSED DIAGNOSIS OF PEDIATRIC APPENDICITIS, NEW-ONSET DIABETIC KETOACIDOSIS, AND SEPSIS IN FIVE PEDIATRIC HOSPITALS. J Emerg Med 2023; 65:e9-e18. [PMID: 37355425 PMCID: PMC10527892 DOI: 10.1016/j.jemermed.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/15/2023] [Accepted: 04/10/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Missed diagnosis can predispose to worse condition-specific outcomes. OBJECTIVE To determine 90-day complication rates and hospital utilization after a missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis (DKA), and sepsis. METHODS We evaluated patients under 21 years of age visiting five pediatric emergency departments (EDs) with a study condition. Case patients had a preceding ED visit within 7 days of diagnosis and underwent case review to confirm a missed diagnosis. Control patients had no preceding ED visit. We compared complication rates and utilization between case and control patients after adjusting for age, sex, and insurance. RESULTS We analyzed 29,398 children with appendicitis, 5366 with DKA, and 3622 with sepsis, of whom 429, 33, and 46, respectively, had a missed diagnosis. Patients with missed diagnosis of appendicitis or DKA had more hospital days and readmissions; there were no significant differences for those with sepsis. Those with missed appendicitis were more likely to have abdominal abscess drainage (adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 2.4-3.6) or perforated appendicitis (aOR 3.1, 95% CI 2.5-3.8). Those with missed DKA were more likely to have cerebral edema (aOR 4.6, 95% CI 1.5-11.3), mechanical ventilation (aOR 13.4, 95% CI 3.8-37.1), or death (aOR 28.4, 95% CI 1.4-207.5). Those with missed sepsis were less likely to have mechanical ventilation (aOR 0.5, 95% CI 0.2-0.9). Other illness complications were not significantly different by missed diagnosis. CONCLUSIONS Children with delayed diagnosis of appendicitis or new-onset DKA had a higher risk of 90-day complications and hospital utilization than those with a timely diagnosis.
Collapse
Affiliation(s)
- Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Richard G Bachur
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Joseph A Grubenhoff
- Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colorado
| | - Andrea T Cruz
- Divisions of Pediatric Emergency Medicine and Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Scott D Reeves
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | - John J Porter
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Arianna H Dart
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Jonathan A Finkelstein
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| |
Collapse
|
8
|
Shields LBE, Daniels MW, Peppas DS, Rosenberg E. Differences in Clinical Characteristics Between Prepubescent and Postpubescent Males With Testicular Torsion. Clin Pediatr (Phila) 2023; 62:209-214. [PMID: 35982605 DOI: 10.1177/00099228221116705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Testicular torsion represents a pediatric surgical emergency. In this 6-year study with 140 patients, prepubescent (<13 years) and postpubescent (≥13 years) males with testicular torsion were identified. Prepubescent boys had a longer symptom duration (P = .016) and underwent more orchiectomies (P = .005) compared with postpubescent boys. The risk of orchiectomy decreased by 15% per 1-year increase in age (P = .002). Boys who underwent an orchiectomy had a longer symptom duration (P < .001), were younger (P = .002), had scrotal swelling (P = .001), scrotal erythema (P < .001), higher degrees of torsion (P = .036), and more left-sided surgeries (P = .014) compared with those who had an orchiopexy. Postpubescent boys were 63% less likely to receive an orchiectomy versus an orchiopexy compared with prepubescent boys. Pediatricians should be cognizant of the age discrepancies between prepubescent and postpubescent males with testicular torsion and educate parents about the importance of urgent evaluation in the Emergency Department to reduce the likelihood of an orchiectomy.
Collapse
Affiliation(s)
- Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY, USA
| | - Michael W Daniels
- Department of Bioinformatics & Biostatistics, University of Louisville, Louisville, KY, USA
| | - Dennis S Peppas
- Norton Children's Urology, Norton Healthcare, Louisville, KY, USA
| | - Eran Rosenberg
- Norton Children's Urology, Norton Healthcare, Louisville, KY, USA
| |
Collapse
|
9
|
Hu S, Guo M, Xiao Y, Li Y, Luo Q, Li Z, Zhu C. Mapping trends and hotspot regarding testicular torsion: A bibliometric analysis of global research (2000-2022). Front Pediatr 2023; 11:1121677. [PMID: 36925671 PMCID: PMC10011162 DOI: 10.3389/fped.2023.1121677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
Background Testicular torsion is an acute scrotal disorder requiring immediate emergency treatment. Ischemic injury and reperfusion injury are important causes of oxidative stress and irreversible oxidative damage after testicular torsion. Although a large number of literatures have discussed the causes and treatment of testicular torsion, there is currently a lack of systematic exploration of the historical evolution of testicular torsion and the construction of a knowledge framework. Method The Web of Science Core Collection was searched for studies on testicular torsion published between 2000 and 2022. The basic data of the literature were analyzed by using Excel and CiteSpace software. Result A total of 1,007 publications on testicular torsion published were found in 64 countries between 2000 and 2022, with an increasing annual publication level. Early detection, early diagnosis and early treatment of testicular torsion had always been at the core of clinical practice, and the pathological cascade reaction of ischemic injury and ischemia-reperfusion injury after testicular torsion were also at the core of basic research. Emphasis had been placed on the development of protective drugs for ischemia and reperfusion after testicular torsion in various countries, regions and institutions. Conclusion Over the past 20 years, the research on testicular torsion had been widely concerned. Hot topics in testicular torsion in recent years were ischemia-reperfusion injury, oxidative stress, rat, doppler ultrasonography, diagnosis and orchiectomy. This article may provide a useful resource for clinicians and basic researchers regarding testicular torsion.
Collapse
Affiliation(s)
- Shaowen Hu
- Department of Urinary Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Mingjie Guo
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Yafei Xiao
- Gastrointestinal Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Yang Li
- Department of Urinary Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Qingyang Luo
- Department of Urinary Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Zun Li
- Department of Urinary Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Chaoyang Zhu
- Department of Urinary Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| |
Collapse
|
10
|
Cabo J, Graham K, Chen H, Zhao S, Burger C, Arnold D, Taylor A, Pope J, Clayton D, Brock JW, Adams M, Adams C, Thomas J. Increasing utilization of the TWIST score in workup of patients with acute scrotal pain: Role in diagnosis and risk stratification. J Pediatr Urol 2022; 18:845.e1-845.e8. [PMID: 36244901 DOI: 10.1016/j.jpurol.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/25/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The TWIST score is a 5-component physical examination score used to aid in diagnosis of testicular torsion (TT) and could lessen need for radiologic testing in certain clinical scenarios. OBJECTIVE TWIST use was not previously widespread at our institution. The primary objective of this quality improvement study was to achieve 100% compliance in TWIST utilization among urology and ED residents and to assess for score concordance between ED and urology assessments. Secondary goals were correlation of TWIST components with need for orchiectomy. METHODS ED staff were educated about the TWIST score and asked to complete assessment for patients presenting with acute scrotal pain. Simultaneously, an electronic medical record-based dot phrase was introduced for urology trainees to complete an independent TWIST evaluation. Spearman correlation was performed to assess association between ED and Urology TWIST scores. Multivariable logistic regression was performed to assess association of TWIST score components and need for orchiectomy. RESULTS 103 patients presented to the ED from 3/2018-11/2020 with a complaint of acute scrotal pain; 47 were diagnosed with torsion. As compared to our retrospective cohort, the documentation rate of complete TWIST score components on exam rose from 9% to 98% (P < 0.001) on ED evaluation and 16%-66% on urology evaluation (P < 0.001). Rates of repeat ultrasound for patient's transferred between facilities was similar (58% vs. 63%; p = 0.66) as was median time to OR (160 min vs. 145 min; p = 0.5). Using TWIST cutoff of >5 yielded a specificity of 94.5% for diagnosis of torsion, with corresponding strong correlation between ED and urology scores (rho = 0.71). A firm testicle was noted on urology evaluation in 100% of orchiectomy patients (vs. 61% of salvage patients) with persistent association after controlling for duration of symptoms (OR 28.1; P = 0.016). DISCUSSION Through two-pronged quality improvement efforts, we significantly improved utilization of the TWIST score by ED and urology staff for workup of patients with acute testicular pain. We confirmed the high sensitivity and specificity of the TWIST score and demonstrated inter-rater reliability between ED and urology assessments. On prospective analysis, testicular firmness on exam was predictive of need for orchiectomy. CONCLUSION The TWIST score is an accurate diagnostic tool for both ED and urology providers in workup of children with acute scrotal pain, with a normal score essentially ruling out the condition. Future work should aim at minimizing unnecessary testing in patients demonstrated to be at high risk for torsion.
Collapse
Affiliation(s)
- Jackson Cabo
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA.
| | - Kyle Graham
- Surgical Outcomes Center for Kids-Monroe Carrell Jr Children's Hospital, Department of Biostatistics, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA
| | - Heidi Chen
- Surgical Outcomes Center for Kids-Monroe Carrell Jr Children's Hospital, Department of Biostatistics, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA
| | - Shilin Zhao
- Surgical Outcomes Center for Kids-Monroe Carrell Jr Children's Hospital, Department of Biostatistics, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, USA
| | - Catherine Burger
- Department of Emergency Medicine, Vanderbilt University Medical, Center1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Donald Arnold
- Department of Emergency Medicine, Vanderbilt University Medical, Center1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Abby Taylor
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - John Pope
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - Douglass Clayton
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - John W Brock
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - Mark Adams
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - Cyrus Adams
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| | - John Thomas
- Department of Urology, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3823, Nashville, TN 37232, USA
| |
Collapse
|
11
|
Zambaiti E, Cerchia E, Guanà R, Scottoni F, Giannotti G, Dalla Rosa D, Pagliara C, Gobbi D, Trovalusci E, Bucci V, Carretto E, Bulotta AL, Chiarenza SF, Midrio P, Gamba P, Cheli M, Alberti D, Gennari F, Gerocarni Nappo S. Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy. J Pediatr Urol 2022; 18:530.e1-530.e6. [PMID: 35842391 PMCID: PMC9188680 DOI: 10.1016/j.jpurol.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/23/2022] [Accepted: 06/09/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The literature reported an increased avoidance of the Emergency Department (ED) during COrona VIrus Disease 19 (COVID-19) pandemic, causing a subsequent increase of morbidity and mortality for acute conditions. Testicular torsion is a surgical emergency, which can lead to the loss of the affected testicle if a delayed treatment occurs. As testicular loss is time-related, outcome was hypothesized to be negatively affected by the pandemic. OBJECTIVE The aim is to investigate whether presentation, treatment and outcomes of children with testicular torsion were delayed during COVID-19. STUDY DESIGN Medical records of pediatric patients operated for testicular torsion of six Paediatric Surgical Units in Northern Italy between January 2019 and December 2020 were retrospectively reviewed. Patients were divided as for ones treated during (dC) or before the pandemic (pC). To reflect possible seasonality, related to lockdown restrictions, winter and summer calendar blocks were also analysed. For all cohorts, demographic data, pre-operative evaluation, operative notes and post-operative outcomes were reviewed. Primary outcomes were referral time, time from diagnosis to surgery and ischemic time, while secondary outcomes were orchiectomy and atrophy rates. Statistic was conducted as appropriate. RESULTS A total of 188 patients with acute testicular torsion were included in the study period, 89 in the pre-COVID-19 (pC) period and 99 during COVID-19 (dC). Time from symptom onset to the access to the Emergency Department (T1) was not different among the two populations (pC: 5,5 h, dC: 6 h, p 0.374), and similarly time from diagnosis to surgery (pC: 2,5 h, dC: 2,5 h, p 0.970) and ischemic time (pC: 8,2 h, dC: 10 h, p 0.655). T1 was <6 h in 46/99 patients (46%) pC and 45/89 patients (51%) dC (p = 0.88, Fisher's exact test). Subgroup analysis accounting for different lockdown measures, confirm the absence of any difference. Orchiectomies rate was 23% (23/99) dC and 21% (19/89) pC (p = 0.861, Fisher's exact test) and rate of post-operative atrophy was 9% dC (7/76) and 14% pC (10/70), p = 0,44, Fisher's exact test. DISCUSSION Despite worldwide pediatric ED accesses reduction, we reported that neither ischemic time nor the long-term outcomes in children with testicular torsion increased during the COVID-19 pandemic. In the available literature, few studies investigated the topic and are controversial on the results. Similarly to our findings, some studies found that timing and orchiectomy rates were not significantly different during the pandemic, while others reported a correlation to pandemic seasonality. Furthermore, in the recent pediatric literature it has been reported a delayed testicular torsion diagnosis due to shame in informing parents. Strengths of this study are the large numerosity, its multicentric design and a long study period. Its main limitation is being retrospective. CONCLUSIONS We reported our large cohort from one of the most heavily COVID-19-affected regions, finding that referral, intra-hospital protocols and ischemic time in testicular torsion were not increased during to the pandemic, as well as orchiectomy rate and atrophy.
Collapse
Affiliation(s)
- Elisa Zambaiti
- Paediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy.
| | - Elisa Cerchia
- Paediatric Urology, Regina Margherita Children's Hospital, Turin, Italy
| | - Riccardo Guanà
- Paediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Federico Scottoni
- Paediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | | | | | - Camilla Pagliara
- Paediatric Surgery, University Hospital of Padova, Padova, Italy
| | - Dalia Gobbi
- Paediatric Surgery, Ospedale Ca' Foncello, Treviso, Italy
| | | | - Valeria Bucci
- Paediatric Surgery, Ospedale San Bortolo, Vicenza, Italy
| | - Elena Carretto
- Paediatric Surgery, Ospedale San Bortolo, Vicenza, Italy
| | | | | | - Paola Midrio
- Paediatric Surgery, Ospedale Ca' Foncello, Treviso, Italy
| | | | - Maurizio Cheli
- Paediatric Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Daniele Alberti
- Paediatric Surgery, ASST Degli Spedali Civili, Brescia, Italy
| | - Fabrizio Gennari
- Paediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | | |
Collapse
|
12
|
Shields LB, Daniels MW, Peppas DS, Rosenberg E. Impact of Distance From the Hospital and Patient Transfer on Pediatric Testicular Torsion Outcomes. Cureus 2022; 14:e25284. [PMID: 35755550 PMCID: PMC9225051 DOI: 10.7759/cureus.25284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Testicular torsion is the most common pediatric emergency that requires prompt diagnosis and surgical treatment to prevent testicular loss. Distance from the hospital where the patient will be undergoing treatment for testicular torsion and transfer from an outside facility are factors that may impact whether a testis is salvageable. We sought to determine whether these factors play a role in pediatric testicular torsion outcomes. Materials and Methods: We identified males aged 1-18 years with testicular torsion between January 1, 2015 and December 31, 2020. The patients’ distance from our hospital and whether they were transferred from an outlying hospital were a particular focus. Results: The number of miles from our hospital and transfer from an outlying hospital were not significantly different between boys who underwent an orchiectomy versus an orchiopexy (p=0.258 and p=0.574, respectively). The number of miles from our hospital was negatively correlated to age at surgery (rho=-0.22, p=0.01). Significantly (p<0.001) more transfers were seen in patients who lived far (>22.1 miles) from our hospital (32/69 (46%)) versus near our hospital (10/68 (15%)). For every mile boys lived from our hospital, there was no difference (adjusted odds ratio (OR)=0.98 (0.96, 1.00), p=0.10) in the likelihood of receiving an orchiectomy versus an orchiopexy when adjusting for age, symptom duration, and degrees of torsion. Conclusions: Our study determined that neither distance from our hospital nor transfer from an outlying hospital affected the orchiectomy rate. An expedited medical evaluation and surgery offer the best prognosis for salvaging the testes.
Collapse
|
13
|
Steeman A, Ngatchou W, Ramadan AS, Entezari K, Kirkove P, Mélot C, Mols P, Bartiaux M, Youatou Towo P. Impact of treatment delays on outcome of acute testicular torsion: a 15-year retrospective study. Acta Chir Belg 2022; 122:116-122. [PMID: 33538652 DOI: 10.1080/00015458.2021.1883391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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 = 27.26, 95% CI 2.32-320.59, p = .009), prehospital time (OR = 1.04, 95% CI 1.01-1.07, p = .003) and nausea (OR = 9.25, 95% IC 1.33-64.52, p = .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.
Collapse
Affiliation(s)
| | | | | | - Kim Entezari
- Urology Department, CHU Saint-Pierre, Brussels, Belgium
| | | | | | - Pierre Mols
- Emergency Department, CHU Saint-Pierre, Brussels, Belgium
| | | | | |
Collapse
|
14
|
Marshall TL, Rinke ML, Olson APJ, Brady PW. Diagnostic Error in Pediatrics: A Narrative Review. Pediatrics 2022; 149:184823. [PMID: 35230434 DOI: 10.1542/peds.2020-045948d] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
A priority topic for patient safety research is diagnostic errors. However, despite the significant growth in awareness of their unacceptably high incidence and associated harm, a relative paucity of large, high-quality studies of diagnostic error in pediatrics exists. In this narrative review, we present what is known about the incidence and epidemiology of diagnostic error in pediatrics as well as the established research methods for identifying, evaluating, and reducing diagnostic errors, including their strengths and weaknesses. Additionally, we highlight that pediatric diagnostic error remains an area in need of both innovative research and quality improvement efforts to apply learnings from a rapidly growing evidence base. We propose several key research questions aimed at addressing persistent gaps in the pediatric diagnostic error literature that focus on the foundational knowledge needed to inform effective interventions to reduce the incidence of diagnostic errors and their associated harm. Additional research is needed to better establish the epidemiology of diagnostic error in pediatrics, including identifying high-risk clinical scenarios, patient populations, and groups of diagnoses. A critical need exists for validated measures of both diagnostic errors and diagnostic processes that can be adapted for different clinical settings and standardized for use across varying institutions. Pediatric researchers will need to work collaboratively on large-scale, high-quality studies to accomplish the ultimate goal of reducing diagnostic errors and their associated harm in children by addressing these fundamental gaps in knowledge.
Collapse
Affiliation(s)
- Trisha L Marshall
- Division of Hospital Medicine.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Michael L Rinke
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York
| | - Andrew P J Olson
- Departments of Medicine.,Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Patrick W Brady
- Division of Hospital Medicine.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| |
Collapse
|
15
|
Clinical Features and Misdiagnosis Analysis of Testicular Torsion in 313 Children. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
16
|
Chen P, Yang Z, Chen N, Liu L, Su J, Sun M, Li S. Diagnosis and treatment of cryptorchid testicular torsion in children: A 12-year retrospective study. Front Pediatr 2022; 10:968997. [PMID: 36071885 PMCID: PMC9441697 DOI: 10.3389/fped.2022.968997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the clinical characteristics, treatment, and prognosis of cryptorchid testicular torsion in children. METHODS The clinical data of 25 children who received treatment for cryptorchid testicular torsion between January 2010 and December 2021 were retrospectively reviewed. The median age of the patients was 64.5 months (range: 2 months to 15 years). All patients had unilateral torsion, and the duration of symptoms ranged from 3 to 192 h. RESULTS Among the 25 patients, five underwent orchidopexy, while the remaining 20 underwent orchiectomy. After 6 months to 8 years of follow up, the 20 patients who had undergone orchiectomy had a well-developed testis on the healthy side. Four of the five patients who had undergone orchidopexy of the affected testis had well-developed testes bilaterally, while one experienced testicular atrophy. CONCLUSION Cryptorchid testicular torsion is a rare urological emergency that displays a delayed presentation and is often misdiagnosed. Clinicians need to carefully review the patient's medical history and ultrasound findings and perform a thorough physical examination to make a correct diagnosis. Active testicular exploration is required for patients suspected to have cryptorchid testicular torsion, and the decision to perform orchidopexy or orchiectomy depends on the intraoperative situation.
Collapse
Affiliation(s)
- Pengyu Chen
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Zhilin Yang
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
| | - Nana Chen
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Lei Liu
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Jiahong Su
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
| | - Mengkui Sun
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
| | - Shoulin Li
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, China
| |
Collapse
|
17
|
Shields LBE, Daniels MW, Peppas DS, Rosenberg E. Testicular Torsion in Patients With Intellectual and Developmental Disabilities. Glob Pediatr Health 2021; 8:2333794X211059119. [PMID: 34869797 PMCID: PMC8637397 DOI: 10.1177/2333794x211059119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/23/2021] [Indexed: 11/17/2022] Open
Abstract
Patients with intellectual/developmental disabilities are at risk of delayed diagnosis of testicular torsion due to their inability to effectively communicate their symptoms. We identified males ages 1 to 18 years with testicular torsion between January 1, 2015 and December 31, 2020, focusing on patients with intellectual and/or developmental disabilities. Of the 140 patients with testicular torsion, 5 (3.6%) patients exhibited intellectual/developmental disabilities with an inability to effectively verbalize testicular/groin/scrotal pain. The patients with intellectual/developmental disabilities underwent more orchiectomies (5/5, 100%, P = .009) and had a longer duration of symptoms (median = 48 hours, P = .047) compared to those without intellectual/developmental disabilities (51/135, 38% and median = 9 hours, respectively) (51/134, 38%) (P = .038). Parents and other caregivers of males with intellectual/developmental disabilities who are unable to adequately verbalize their testicular/groin/scrotal pain should be cognizant of the signs and symptoms associated with testicular torsion, perform a genitalia examination, and seek an immediate evaluation to diagnose and treat this urgent condition.
Collapse
|
18
|
Yu C, Zhao J, Lu J, Wei Y, Jiang L, Zhao T, Lin T, He D, Wen S, Wu S, Wei G. Demographic, clinical, and socioeconomic factors associated with delayed diagnosis and management of pediatric testicular torsion in West China: a retrospective study of 301 cases in a single tertiary children's hospital. BMC Pediatr 2021; 21:553. [PMID: 34872532 PMCID: PMC8647496 DOI: 10.1186/s12887-021-03001-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the association between geographic, clinical, socioeconomic factors and delayed management of pediatric testicular torsion (TT) in West China. Methods A retrospective study was conducted on TT at Children’s Hospital of Chongqing Medical University in West China from November 2004 to December 2020. Univariate analysis and logistic regression analysis were conducted to determine the association between these factors and delayed management of TT. Results A total of 301 cases were included in this study. The misdiagnosis rate of TT in primary, secondary healthcare units and tertiary hospitals was 93.8, 71.1, and 8.9%, respectively. Approximately 26.9% of TT boys received timely surgical management (within 12 h from symptoms inset to surgery). Logistic regression analyses suggested the following factors were associated with delayed repair of TT: age less than 6 years (P = 0.001), with a history of symptoms progress (P = 0.001) or former treatment (P <0.001), absence of other diagnosis (P = 0.011) and those boys living far away from the main city zones (P <0.001). Conclusions Delayed surgical management for TT was more likely for boys with age less than 6 years, the absence of other diagnosis, with a history of former treatment or symptoms progress, and those living far away from the main city zone. To maximize the possibility of timely surgical management for TT, it is vital to strengthen the public awareness of TT and conduct continuously re-education and update physicians working at primary and secondary healthcare units.
Collapse
Affiliation(s)
- Chengjun Yu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Jie Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Jiandong Lu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Yi Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Li Jiang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianxin Zhao
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China
| | - Sheng Wen
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China. .,National Clinical Research Center for Child Health and Disorders, Chongqing, China. .,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China. .,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China.
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China
| |
Collapse
|
19
|
Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic?-A retrospective multicenter study. J Pediatr Urol 2021; 17:479.e1-479.e6. [PMID: 33994321 PMCID: PMC8087574 DOI: 10.1016/j.jpurol.2021.04.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/09/2021] [Accepted: 04/25/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Testicular torsion is a real emergency condition which requires prompt diagnosis and surgical management to prevent testicular loss. During the coronavirus (COVID-19) pandemic, an increased avoidance of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature. OBJECTIVE The aim of this study was to investigate whether the COVID-19 pandemic caused increased number of orchiectomies in pediatric patients presenting with acute testicular torsion compared to pre-COVID-19 period. STUDY DESIGN A total number of 119 pediatric patients who underwent surgery for acute testicular torsion from January 2019 to December 2020 were enrolled in retrospective multi-center study from six institutions in Croatia. The patients were divided in two groups. The first group (pre-COVID-19) consisted of the patients who underwent surgery before COVID-19 pandemic (n = 68), while the second group (COVID-19) consisted of the patients who underwent surgery during the COVID-19 pandemic (n = 51). Main outcomes of the study were orchiectomy rates and time from onset of the symptoms to emergency department presentation. RESULTS During the COVID-19 pandemic period 43.1% (22/51) of the patients underwent orchiectomy while orchiectomy was performed in 16.2% (11/68) of the patients from the pre-COVID group (p = 0.001). Median time from onset of the symptoms to emergency department presentation during COVID-19 pandemic and pre-COVID-19 periods was 14h (IQR 5, 48) and 6h (IQR 3, 22) (p = 0.007), respectively. A higher proportion of patients waited over 24 h to present to emergency department during the COVID-19 pandemic compared to the pre-COVID-19 period (47% vs 8.8%, p = 0.007). CONCLUSION During COVID-19 pandemic a significantly higher rates of orchiectomies and increase in delayed presentations for testicular torsion was found. More patient education during pandemic in regards to management of emergency conditions such as testicular torsion is required.
Collapse
|
20
|
Holzman SA, Ahn JJ, Baker Z, Chuang KW, Copp HL, Davidson J, Davis-Dao CA, Ewing E, Ko J, Lee V, Macaraeg A, Nicassio L, Sadighian M, Stephany HA, Sturm R, Swords K, Wang P, Wehbi EJ, Khoury AE. A multicenter study of acute testicular torsion in the time of COVID-19. J Pediatr Urol 2021; 17:478.e1-478.e6. [PMID: 33832873 PMCID: PMC7977032 DOI: 10.1016/j.jpurol.2021.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Testicular torsion is a surgical emergency, and time to detorsion is imperative for testicular salvage. During the COVID-19 pandemic, patients may delay emergency care due to stay-at-home orders and concern of COVID-19 exposure. OBJECTIVE To assess whether emergency presentation for testicular torsion was delayed during the COVID-19 pandemic, and whether the rate of orchiectomy increased compared to a retrospective period. STUDY DESIGN Patients were prospectively enrolled in a multicenter study from seven institutions in the United States and Canada. Inclusion criteria were patients two months to 18 years of age with acute testicular torsion from March through July 2020. The retrospective group included patients from January 2019 through February 2020. Statistical analysis was performed using Kruskal-Wallis tests, Chi-square tests, and logistic regression. RESULTS A total of 221 patients were included: 84 patients in the COVID-19 cohort and 137 in the retrospective cohort. Median times from symptom onset to emergency department presentation during COVID-19 compared to the retrospective period were 17.9 h (IQR 5.5-48.0) and 7.5 h (IQR 4.0-28.0) respectively (p = 0.04). In the COVID-19 cohort, 42% of patients underwent orchiectomy compared to 29% of pre-pandemic controls (p = 0.06). During COVID-19, 46% of patients endorsed delay in presentation compared to 33% in the retrospective group (p = 0.04). DISCUSSION We found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a higher proportion of patients reported delaying care. Strengths of the study include the number of included patients and the multicenter prospective design during the pandemic. Limitations include a retrospective pre-pandemic comparison group. CONCLUSIONS In a large multicenter study we found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a significantly higher proportion of patients reported delaying care. Based on the findings of this study, more patient education is needed on the management of testicular torsion during a pandemic.
Collapse
Affiliation(s)
- Sarah A Holzman
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.
| | - Jennifer J Ahn
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Zoe Baker
- Children's Hospital Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Kai-Wen Chuang
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Hillary L Copp
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
| | - Jacob Davidson
- Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada
| | - Carol A Davis-Dao
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Emily Ewing
- Western University, Department of Urology, London, Ontario, Canada
| | - Joan Ko
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Victoria Lee
- University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Amanda Macaraeg
- University of California, Irvine, Department of Urology, Irvine, CA, USA
| | - Lauren Nicassio
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Michael Sadighian
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
| | - Heidi A Stephany
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Renea Sturm
- University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Kelly Swords
- University of California, San Diego, Department of Urology, La Jolla, CA, USA; Rady Children's Hospital, Division of Pediatric Urology, San Diego, CA, USA
| | - Peter Wang
- Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada
| | - Elias J Wehbi
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Antoine E Khoury
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| |
Collapse
|
21
|
Kwenda EP, Locke RA, DeMarco RT, Bayne CE. Impact of hospital transfer on testicular torsion outcomes: A systematic review and meta-analysis. J Pediatr Urol 2021; 17:293.e1-293.e8. [PMID: 33610457 DOI: 10.1016/j.jpurol.2021.01.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Testicular torsion is an emergent condition requiring prompt treatment. Previous studies have suggested transfer of pediatric testicular torsion cases may be detrimental to patient outcomes. Findings have not reached statistical significance. No study has quantitatively analyzed all literature reporting outcomes for transferred torsion patients. The aim of this study was to elucidate the impact of hospital transfer on pediatric testicular torsion outcomes through a systematic review and meta-analysis. METHODS A predefined study protocol registered with PROSPERO was developed according to PRISMA. A comprehensive literature review of articles investigating outcomes for pediatric testicular torsion for transferred and non-transferred (treated "directly" at presentation institution) patients with orchiectomy as the primary outcome was conducted by systematically searching PubMed and Embase. Potential studies were screened against a predefined study protocol. Meta-analysis using a random effects model with transferred status as the "intervention" was performed using Review Manager 5.3. RESULTS Of 18 eligible studies, 9 retrospective studies comprised of 2564 patients (532 transferred and 2032 direct) were suitable for quantitative analysis. Main analysis showed transfer status does not have a significant effect on torsion outcomes (RR 0.96 [95% CI 0.78-1.17]; I2 = 44%). Subgroup analysis for torsion patients presenting within 24 h of symptom onset shows patients who are transferred to another facility for management are more likely to undergo orchiectomy than those treated at their presenting institution (RR 0.35 [95% CI 0.24-0.51]; I2 = 4%). CONCLUSIONS In this meta-analysis, hospital transfer does not affect orchiectomy rate in pediatric patients with testicular torsion when pooling data from all presentation timeframes. Subgroup analysis of patients presenting with testicular torsion in an acute setting (<24 h of symptom onset) suggests the delay associated with hospital transfer has a deleterious effect on testicular viability.
Collapse
Affiliation(s)
- Elizabeth P Kwenda
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Rachel A Locke
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Romano T DeMarco
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christopher E Bayne
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA.
| |
Collapse
|
22
|
Dupond-Athénor A, Peycelon M, Abbo O, Rod J, Haraux E, Scalabre A, Arnaud A, Guérin F, Irtan S. A multicenter review of undescended testis torsion: A plea for early management. J Pediatr Urol 2021; 17:191.e1-191.e6. [PMID: 33388261 DOI: 10.1016/j.jpurol.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Torsion of an undescended testis (UT) is a surgical emergency, difficult to diagnose, whose prognosis depends on a quick management. AIM OF THE STUDY To evaluate the management and outcome of these patients. STUDY DESIGN We retrospectively analyzed all cases of UT torsion operated in nine French hospitals between 1997 and 2017. We divided patients in two groups: patients referred less than 6 h after the onset of symptoms (group A) or more than 6 h (group B). MAIN RESULTS We collected 60 cases (17 in group A and 43 in group B). Median age was 2.2 years [IQR = 0.7-7.8] (2.3 y in group A and 2 y in group B, p = 0.76). Eleven patients (10 in group B) had neurological disorders (p = 0.15). The main reason for absence of UT treatment was the absence of surgical consultation in a normal delay (n = 44, 73%). Symptoms were pain (n = 58, 97%), inguinal mass (n = 55, 92%) and vomiting (n = 16, 27%). An inguinal mass with no palpable testis in the ipsilateral hemiscrotum was seen in 55 patients (92%). An ultrasound scan performed in 27 patients led to the diagnosis in 16 patients (59%). At surgery, an orchiectomy was performed in 4 patients (23%) of group A and 24 patients (56%) of group B (p = 0.04). After a median follow-up of 11 months [IQR = 4-23], 11 patients of group A (65%) and 7 patients of group B (16%) had a clinically normal testis (p = 0.03). The salvage rate among patients with conservative treatment was 85% for group A and 37% for group B (p = 0.01). DISCUSSION Our study reveals that although UT torsion is an emergency, 72% of patients are referred more than 6 h after the onset of symptoms. We mostly found classic clinical presentation of UT torsion: a painful inguinal mass with an empty ipsilateral scrotum. Ultrasound was performed in half cases, and even if the result was not significant, it still seemed to be associated with a higher rate of orchiectomy especially in group B because of the delay in care. However, when ultrasound was realized early, it led to diagnosis in all cases. This dilemma poses the problem of the role of imaging in diagnostic management. CONCLUSIONS Early clinical diagnosis in front of a painful inguinal mass with an empty scrotum is essential to improve the salvage rate of testis in UT torsion. Early management of UT should have avoided 68% of testis loss.
Collapse
Affiliation(s)
- Adrien Dupond-Athénor
- Sorbonne Université, Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, APHP Hôpital Universitaire Robert-Debré, Centres de Référence Maladies Rares, Maladies Endocriniennes Rares de la Croissance (CRMERC), Université de Paris, 48 Bd Sérurier, 75019, Paris, France; Sorbonne Université, INSERM UMR_S933, Maladies Génétiques d'expression Pédiatrique, APHP, Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - Olivier Abbo
- Department of Pediatric Surgery, Hôpital des Enfants de Toulouse, CHU Toulouse, 330 Avenue de Grande Bretagne, 31300, Toulouse, France.
| | - Julien Rod
- Department of Pediatric Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14000, Caen, France.
| | - Elodie Haraux
- Department of Pediatric Surgery, University Hospital, 1 Rue Du Professeur Christian Cabrol, 80054, Amiens, France.
| | - Aurélien Scalabre
- Department of Pediatric Surgery, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - Alexis Arnaud
- Department of Pediatric Surgery, Hôpital Sud, University Hospital, 16 Boulevard de Bulgarie, 35200 Rennes, France.
| | - Florent Guérin
- Department of Pediatric Surgery, Hôpital Bicêtre, AP-HP Paris Saclay, 78 Rue Du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
| | - Sabine Irtan
- Sorbonne Université, Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| |
Collapse
|
23
|
Menzies-Wilson R, Folkard SS, Sevdalis N, Green JSA. Serious incidents in testicular torsion management in England, 2007-2019: optimizing individual and training factors are the key to improved outcomes. BJU Int 2021; 129:249-257. [PMID: 33783942 DOI: 10.1111/bju.15414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To establish the healthcare factors that contribute to testicular torsion adverse events (orchidectomies) and 'near misses'. The secondary objective was to identify areas suitable for impactful quality improvement initiatives to be undertaken by National Health Service (NHS) healthcare providers nationally. MATERIALS AND METHODS This was a retrospective record review and analysis, carried out in four phases. We applied the well-validated London Protocol patient safety incident analysis framework to all eligible serious incidents related to testicular torsion submitted by English NHS Trusts over a 12-year period to the Strategic Executive Information System database. Clinical reviewers established the incident population (Phase 1), were trained and piloted the feasibility of using the London Protocol (Phase 2), applied the protocol and themed the identified contributing factors linked to adverse events (orchidectomies) and near-misses (Phase 3), and reviewed the evidence for improvement interventions (Phase 4). RESULTS Our search returned 992 serious incidents, of which 732 were eligible for study inclusion and analysis. Of those, 137 resulted in orchidectomies, equivalent to one serious incident resulting in orchidectomy per month, and 595 were near misses. Factors contributing to all incidents were: individual staff/training (38%); team (18%); work environment (16%); task and technology (14%); and institutional context (13%). Subgroup analysis of incidents resulting in orchidectomies vs near misses demonstrated a different pattern of factors, with individual staff/training factors significantly more prominent: individual/training (88%); work environment (8%); and task and technology (1%). No evidenced improvement interventions were found in the literature. CONCLUSION This is the first study to our knowledge to systematically analyse and classify factors that are associated with loss of a testicle and related near-miss incidents in patients presenting with testicular torsion. In England, a significant number of orchidectomies occur annually as a consequence of healthcare serious incidents. In order to improve outcomes, we propose clinical support to aid the diagnosis of torsion, improved national clinical guidelines, development of specific standard operating procedures and (in the longer term) more exposure of trainees and medical students to urology to improve the testicular salvage rate.
Collapse
Affiliation(s)
| | - Samuel S Folkard
- Department of Urology, Kent and Canterbury Hospital, Canterbury, UK
| | - Nick Sevdalis
- Health Service and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James S A Green
- Health Service and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Urology, Whipps Cross University Hospital, London, UK
| |
Collapse
|
24
|
Zhong H, Bi Y. Pediatric Trauma-Induced Testicular Torsion: A Surgical Emergency. Urol Int 2020; 105:221-224. [PMID: 33378756 DOI: 10.1159/000511747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the features of testicular torsion (TT) resulting from minor groin trauma and to raise the awareness of trauma-induced testicular torsion (TITT). METHODS This is a retrospective chart review of patients presenting with TT resulting from minor genital trauma that was performed from January 2010 to December 2018 at a single tertiary care institution. The demographic, clinical, and perioperative characteristics, as well as data on follow-up and complications, were analyzed. RESULTS Of the 155 patients treated for TT, 15 were included in this study. The average age of the patients was 10.3 years (range: 3.2-13.3 years). All patients experienced a direct scrotal trauma and subsequently presented with an ipsilateral scrotal or testicular pain secondary to the twisted testicle. Six patients were misdiagnosed as having scrotal inflammation or hematoma, and all were initially treated at local hospitals. The mean duration of symptoms before hospitalization was 138 h (range: 5-504 h). The mean degree of torsion was 390° (range: 180-720°). The testicular salvation rate, at 33%, was poor. No serious postoperative complications or recurrences of TT was observed. CONCLUSIONS TITT is a rare entity and still has delayed diagnosis. This may subsequently lead to a low testicular salvation rate. Emergency surgeons, especially in local hospitals, should be aware of the possibility of TT following testicular trauma in pediatric patients. Improving the parents' awareness regarding TT is also important.
Collapse
Affiliation(s)
- Haijun Zhong
- Department of Pediatric Urology, Children's Hospital of Fudan University, Shanghai, China
| | - Yunli Bi
- Department of Pediatric Urology, Children's Hospital of Fudan University, Shanghai, China,
| |
Collapse
|
25
|
Ryan KA, Folkard SS, Bastianpillai C, Green JSA. The management of testicular torsion in the UK: How can we do better? A national quantitative and qualitative analysis of the factors affecting successful testicular salvage. J Pediatr Urol 2020; 16:815.e1-815.e8. [PMID: 32933873 DOI: 10.1016/j.jpurol.2020.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/30/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Testicular torsion is a surgical emergency, requiring time-critical surgery to avoid potential organ loss. This study collates national data on paediatric testicular torsion, offering a comprehensive insight into the current standard of care in England for paediatric patients with suspected testicular torsion. METHODS National data collection using Freedom of Information requests. Of 134 acute secondary care NHS trusts in England that treat paediatric patients, responses were received from 121 trusts - representing 140 hospitals - providing a picture of the current standard of care in England. FINDINGS Less than two thirds of hospitals have a paediatric A&E department. One third of hospitals use inter-hospital transfer for paediatric patients with suspected torsion, with variable age restrictions. Mean transfer distance was 19·4 miles (range 2·2 to 61·6 miles). No statistically significant relationship between transfer arrangements and the number of non-viable testicle incidents was found (P = 0·15, ns). There was no correlation demonstrated nationally between size of population served and number of scrotal explorations completed (Pearson's r = 0·20 (CI -0·0·8-0·46), p = 0·16, ns). Qualitative thematic content analysis of serious incident reports identified common themes leading to missed diagnosis and delayed time to theatre: Education and Training, Communication, Transfer Complications, On-site Resources and Cross-site Working. INTERPRETATION We found variability in resource provision across England, as well as the number of explorations, and the number of unviable testicles found at exploration nationally. We received variable and incomplete data on emergency scrotal explorations and subsequent orchidectomies, very low levels of local audit and limited disclosure of incident reports. A mandatory national audit would allow more comprehensive data collection to accurately identify trends and make informed recommendations. To improve outcomes, we recommend continued education of ED and surgical teams, with mandatory testicular examination for young males presenting with abdominal pain. Whilst streamlining inpatient services is important, the time lost between symptom onset and seeking medical attention is crucial, and raising awareness in the community for young boys and parents may be imperative to improve rates of testicular salvage.
Collapse
Affiliation(s)
- Kate A Ryan
- Department of Urology, Whipps Cross University Hospital, Barts Health, Whipps Cross Road, Leytonstone, London, E11 1NR, UK.
| | - Samuel S Folkard
- Department of Urology, Whipps Cross University Hospital, Barts Health, Whipps Cross Road, Leytonstone, London, E11 1NR, UK
| | - Christopher Bastianpillai
- Department of Urology, Whipps Cross University Hospital, Barts Health, Whipps Cross Road, Leytonstone, London, E11 1NR, UK
| | - James S A Green
- Department of Urology, Whipps Cross University Hospital, Barts Health, Whipps Cross Road, Leytonstone, London, E11 1NR, UK
| |
Collapse
|
26
|
Göger YE, Özkent MS, Ünlü MZ, Kocaoğlu C, Madenci H, Pişkin MM. Evaluation of parental sociocultural background and education level in response to pediatric testis torsion. J Pediatr Urol 2020; 16:820.e1-820.e6. [PMID: 33077390 DOI: 10.1016/j.jpurol.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Acute scrotal pain (ASP) remains one of the most common male urologic emergencies in the pediatric age group. The most concerning outcome of testicular torsion (TT) is the need for orchiectomy, which has a negative impact on the child's development in general and on sexual development and psychology in particular. Time is the most important factor in the treatment of TT. Parental awareness of ASP indicating the possibility of TT is a significant factor in children's hospital admission time. Sociocultural background may be an indicator in parental awareness. OBJECTIVE This study sought to determine if parental sociocultural and education level is associated with delayed treatment for TT. STUDY DESIGN This retrospective study evaluated data for patients with scrotal or abdominal pain and TT at two hospitals in Konya, Turkey from 2012 to 2020. Study participants were the parents of the patients treated for TT. Participants were contacted by telephone and asked about their educational background. The study population was divided into 2 groups based on parent characteristics. Group 1 parents had an education level less than high school, had no health insurance, were in need of state aid, and had a low sociocultural background. Group 2 parents had an education level of at least high school or higher and had health insurance. Symptom duration (time between symptom onset and hospital admission) and surgical procedures for the patients were compared between the 2 parent groups. RESULTS Of the 140 patients who received a diagnosis of TT, 77 were in Group 1 and 63 in Group 2. Mean patient age was 12.7 ± 2.7 (5-16) years Median symptom duration was 7 (1-120) hours. Symptom duration was higher in Group 1, but no statistically significant differences were noted between groups (Group 1 duration was 8h vs. Group 2 duration of 6h; p = 0.331). Orchiectomy was performed for 62 (44.3%) patients and testicular-sparing surgery for 78 (55.7%). Orchiectomy rates between groups were statistically significant and higher in Group 1 with 41 (53.2%) versus 21 (33.3%) in Group 2. CONCLUSION Factors such as low sociocultural family background and low parental education level increase the risk of orchiectomy for their children. Awareness of the symptoms of TT may minimize the possibility of testicular loss.
Collapse
Affiliation(s)
- Yunus Emre Göger
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey.
| | - Mehmet Serkan Özkent
- Department of Urology, Konya Education and Research Hospital, Health Sciences University, Konya, Turkey.
| | - Mahmud Zahid Ünlü
- Department of Urology, Konya Education and Research Hospital, Health Sciences University, Konya, Turkey.
| | - Canan Kocaoğlu
- Department of Pediatric Surgery, Konya Education and Research Hospital, Health Sciences University, Konya, Turkey.
| | - Hasan Madenci
- Department of Pediatric Surgery, Konya Education and Research Hospital, Health Sciences University, Konya, Turkey.
| | - Mehmet Mesut Pişkin
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey.
| |
Collapse
|
27
|
Vasconcelos-Castro S, Soares-Oliveira M. Abdominal pain in teenagers: Beware of testicular torsion. J Pediatr Surg 2020; 55:1933-1935. [PMID: 31515114 DOI: 10.1016/j.jpedsurg.2019.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE Testicular torsion (TT) remains an important cause of testicular loss. Subtle presentations, such as abdominal pain, may be responsible for late diagnosis and increased testicular loss. This study assesses the influence of pain onset location over testicular outcome. METHODS Data of children 17 years and younger submitted to surgical treatment for TT by our department from January 2017 to December 2018 were collected. Demographics, clinical presentation and outcome were reviewed. RESULTS 73 patients (median age of 15.3 years old) were included in the study. 22% (16/73) patients presented with abdominal pain. When compared to patients with initial testicular pain, patients with abdominal pain showed a significant delay in TT diagnosis/treatment (median pain duration of 36 h vs 5 h) and a significantly higher rate of testicular loss [81% (13/16) vs 4% (2/57), p < 0.001]. The majority of testicular losses (68%, 13/19) occurred in patients with abdominal pain. In patients with abdominal pain, TT was initially overlooked in 69% (11/16) of cases, resulting in 81% (9/11) gonadal loss; none of these 11 patients were initially evaluated by a surgeon. All patients with testicular pain were evaluated in order to exclude TT. CONCLUSIONS Abdominal pain is a frequent presentation of TT, being an important cause of delayed diagnosis/treatment and associated higher testicular loss rate. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Sofia Vasconcelos-Castro
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Miguel Soares-Oliveira
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| |
Collapse
|
28
|
Sweet DE, Feldman MK, Remer EM. Imaging of the acute scrotum: keys to a rapid diagnosis of acute scrotal disorders. Abdom Radiol (NY) 2020; 45:2063-2081. [PMID: 31748822 DOI: 10.1007/s00261-019-02333-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Imaging of the scrotum in the setting of acute symptoms such as pain or swelling is commonly performed emergently to differentiate between patients who require immediate surgery and those that do not. Acute scrotal symptoms are generally caused by infectious, traumatic or vascular etiologies. Rapid diagnosis and initiation of treatment is vital for testicular salvage in cases of acute testicular torsion, testicular rupture, and Fournier gangrene. Epididymitis, epididymo-orchitis, torsed testicular appendage, segmental testicular infarction, scrotal hematomas, testicular neoplasms, and acute idiopathic scrotal edema can have similar clinical presentations, but these conditions do not require immediate surgery. Ultrasound is the well-established first-line imaging modality for the acute scrotum. Contrast-enhanced ultrasound and magnetic resonance imaging can be useful as problem-solving tools when ultrasound studies are inconclusive or equivocal. This review describes normal scrotal anatomy and a wide range acute scrotal disorders, with emphasis on the imaging and clinical features that can minimize the risk of misdiagnosis.
Collapse
Affiliation(s)
- David E Sweet
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Myra K Feldman
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Erick M Remer
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| |
Collapse
|
29
|
Tanaka K, Ogasawara Y, Nikai K, Yamada S, Fujiwara K, Okazaki T. Acute scrotum and testicular torsion in children: a retrospective study in a single institution. J Pediatr Urol 2020; 16:55-60. [PMID: 31874735 DOI: 10.1016/j.jpurol.2019.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/20/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Testicular torsion (TT), as per the reported incidences in children and preadolescents, is an emergency medical condition that requires prompt surgical treatment. In cases of TT, early and accurate diagnosis of acute scrotum (AS) is important to preserve testicular fertility. In this study, the authors aimed to determine the incidence, clinical examination, etiology, clinical predictors, and treatment of patients with AS and TT. MATERIAL AND METHODS The authors retrospectively reviewed all children (age, ≤15 years) with AS who visited their hospital between January 2012 and June 2019. Data on age and diagnosis, clinical findings, mode of treatment, and blood examination results were collected. RESULTS The authors examined 165 children aged between 0 days and 15 years (mean age, 9.4 years). Final diagnosis identified 72 patients with torsion of the appendix testis, 44 patients with epididymitis, and 38 patients with TT. Testes were salvaged in 23 of the 38 patients with TT (60.5%). Statistically significant variables revealed that the risk factors of TT were age (older than 12 years), white blood cell (WBC) count (>12,000 cells/mm3), and laterality (left side). The level of C-reactive protein (CRP), duration of symptoms, and degree of torsion were significantly higher in the non-salvageable testis group than in the salvageable testis group. Furthermore, the significant predictive factor for non-salvageable testis was the level of CRP >1.0 mg/dl. CONCLUSION The study results indicates that age, WBC count, and laterality are key factors to distinguish TT from AS. Salvageability largely depended on the duration of symptoms and the degree of TT. The salvage rate of the testis can be improved by educating pediatricians, parents, patients, and medical staff about the early diagnosis and treatment of torsion.
Collapse
Affiliation(s)
- Keiichiro Tanaka
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu-shi, Chiba, 279-0021, Japan.
| | - Yuki Ogasawara
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Koki Nikai
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Shunsuke Yamada
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Kentaro Fujiwara
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Tadaharu Okazaki
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| |
Collapse
|
30
|
Afsarlar CE, Cakmakci E, Demir E, Guney G, Komut E, Elizondo R, Seth A, Koh CJ. Novel prognostic grayscale ultrasonographic findings in the testis from a comprehensive analysis of pediatric patients with testicular torsion. J Pediatr Urol 2019; 15:480.e1-480.e7. [PMID: 31495779 DOI: 10.1016/j.jpurol.2019.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although grayscale and Doppler ultrasound (US) findings of testicular torsion (TT) have previously been described in the literature, other US findings may provide more prognostic information to families. OBJECTIVE The authors hypothesized that a comprehensive analysis of US findings of TT that focused on time-dependent changes would lead to additional ultrasonographic morphologic findings and clinically relevant prognostic information. STUDY DESIGN The authors reviewed the records of pediatric patients with acute TT from 2010 to 2017. The sizes and parenchymal characteristics of the torsed and contralateral testes on US were analyzed in relation to the time duration from the onset of scrotal pain to the time of surgery (0-6 h, 6-12 h, 12-24 h, 24-48 h, and >48 h), torsion degree, and clinical outcomes of the testes. RESULTS Patient demographics, time intervals, and US measurements of the torsed and contralateral testes showed significant differences with respect to testicular viability (Summary Table). The mean volume ratios of torsed to contralateral testis showed significant differences between the 0-6 h and the 12-24 h time groups as well as the 6-12 h and the 12-24 h time groups (P = 0.003 and P = 0.035, respectively), as well as significant differences between the viable and non-viable testes (P = 0.005). Regarding testicular heterogeneity, two novel grayscale sonographic findings were noted: (1) multiple hypoechoic lines that were termed 'testicular fragmentation' and (2) hyperechoic patches that were termed 'testicular patching'. The presence of these two findings were significantly increased as TT time duration increased (P < 0.001), and these findings were significantly associated with testicular non-viability (P < 0.001). Torsion degree was also noted to be significantly higher in the non-viable testes (P < 0.001). Presence of hydrocele or scrotal edema also showed significant differences between the TT time groups (P < 0.001). DISCUSSION The results of this study demonstrated ultrasonographic findings related to time dependent changes in TT and provided prognostic information regarding testicular viability. CONCLUSIONS Specific US grayscale findings in torsed testes (testicular fragmentation and testicular patching) were identified that provide prognostic information regarding time duration of testicular torsion and testicular viability. Testicular fragmentation and testicular patching significantly increased as TT time increased, with increasing risk for testicular non-viability.
Collapse
Affiliation(s)
- Cagatay E Afsarlar
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatric Surgery, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Emin Cakmakci
- Department of Radiology, Dr.Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Emre Demir
- Department of Biostatistics, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Guven Guney
- Department of Pathology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Erdal Komut
- Department of Radiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Rodolfo Elizondo
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Abhishek Seth
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Chester J Koh
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
31
|
Zee RS, Bayne CE, Gomella PT, Pohl HG, Rushton HG, Davis TD. Implementation of the accelerated care of torsion pathway: a quality improvement initiative for testicular torsion. J Pediatr Urol 2019; 15:473-479. [PMID: 31444122 DOI: 10.1016/j.jpurol.2019.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/11/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Timely diagnosis and management of testicular torsion is of paramount importance. Furthermore, time to surgical intervention is a benchmark for the quality of care provided by pediatric urologists included in US News and World Report (USNWR) methodology. OBJECTIVE We sought to optimize management of acute testicular torsion at a single institution by decreasing time from presentation to definitive management through the creation and implementation of a clinical care pathway (accelerated care of torsion or ACT) for acute testicular torsion in a 2-year period. STUDY DESIGN Multidisciplinary process mapping involving the emergency department (ED), radiology, anesthesiology, peri-operative services, and operating room (OR) teams resulted in development of the ACT pathway with the goal of achieving surgical intervention within 4 h of arrival at our institution. The accelerated care of torsion pathway was implemented in April 2016. Thirty-eight consecutive acute torsion cases were then prospectively evaluated from April 2016 to April 2018. For process measures, we recorded triage to OR times and mode of presentation. For outcome measures, we examined orchiectomy rates. We retrospectively reviewed 97 cases of acute torsion from 2004 to 2016 as a control. RESULTS Time from ED triage to OR start decreased from a median 196 min (interquartile range [IQR] 137-249 min) to 127 min (IQR 100-148 min; P < 0.0001) for all cases of acute torsion. In the control group, 72% of cases met the USNWR criteria for acute treatment of torsion. After ACT implementation, 100% of cases reached the OR within the 240 min time frame. Orchiectomy rates were performed in 24% of control cases vs 30% after ACT implementation (P = NS). Survival curve analysis demonstrated no significant difference in probability of testis salvage before or after implementation of the ACT pathway. DISCUSSION In agreement with similar studies, despite a significant reduction in triage to OR times, the orchiectomy rate approached 30%. This outcome did not significantly improve after implementation of the ACT pathway. Overall ischemia time was a more important determinant of testis salvage. Study limitations include limited patient follow-up to assess testis atrophy. CONCLUSIONS The multidisciplinary creation and implementation of a clinical pathway for the care of acute testis torsion has significantly decreased the time from ED to OR in our institution. However, overall orchiectomy rate was not significantly affected.
Collapse
Affiliation(s)
- R S Zee
- Children's National Medical Center Division of Urology, Washington, D.C, USA.
| | - C E Bayne
- University of Florida Division of Pediatric Urology, Gainesville, FL, USA
| | - P T Gomella
- George Washington University Department of Urology, Washington, D.C, USA
| | - H G Pohl
- Children's National Medical Center Division of Urology, Washington, D.C, USA
| | - H G Rushton
- Children's National Medical Center Division of Urology, Washington, D.C, USA
| | - T D Davis
- Children's National Medical Center Division of Urology, Washington, D.C, USA
| |
Collapse
|
32
|
Saab MM, Landers M, Cooke E, Murphy D, Davoren M, Hegarty J. Enhancing Men's Awareness of Testicular Disorders Using a Virtual Reality Intervention: A Pre-Post Pilot Study. Nurs Res 2019; 67:349-358. [PMID: 30059354 DOI: 10.1097/nnr.0000000000000303] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of benign and malignant testicular disorders is on the rise. Three literature reviews and one qualitative study found that men's awareness of testicular disorders was lacking, and their intentions to seek help for symptoms of testicular disease were low. OBJECTIVES The aim of the study was to enhance men's awareness of testicular disorders, help-seeking intentions for testicular symptoms, and intention and behavior to feel their testes. METHODS Men aged 18-50 years were recruited from a university and asked to engage in a three-level, educational, virtual reality experience. The Medical Research Council framework guided the development and pilot testing of the intervention. Knowledge, awareness, perceived risk, implementation intentions, help-seeking intentions, and behaviors were measured at pretest (T0), immediately posttest (T1), and 1 month posttest (T2). RESULTS Data were available from 49 participants. In comparison to T0, a significant increase in knowledge (mean difference [MD] = 3.5, 95% CI [2.8, 4.26]); testicular awareness (MD = 0.2, 95% CI [0.01, 0.41]); implementation intentions (MD = 0.6, 95% CI [0.33, 0.90]); and help-seeking intentions for testicular swelling (MD = 0.3, 95% CI [0.12, 0.51]), lumpiness (MD = 0.3, 95% CI [0.08, 0.46]), and pain (MD = 0.6, 95% CI [0.25, 1.01]) was noted at T1. This increase was maintained at T2. Participants who expressed an intention to feel their testes at T0 were more likely to report performing this behavior at T2. DISCUSSION The intervention succeeded in promoting knowledge, testicular awareness, implementation intentions, help-seeking intentions, and behaviors. A randomized controlled trial of the Enhancing Men's Awareness of Testicular Disorders intervention with a larger sample size is warranted.
Collapse
Affiliation(s)
- Mohamad M Saab
- Mohamad M. Saab, PhD, MSc, BSc, RGN, is Lecturer, Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland. Margaret Landers, PhD, MSc, BSc, RNT, RGN, is Lecturer, Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland. Josephine Hegarty, PhD, MSc, BSc, RNT, RGN, is Professor, at Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland. Eoghan Cooke, MSc, BA, is Interactive Media Professional, Department of Computer Science, University College Cork, Ireland. David Murphy, BMus, is Lecturer, Department of Computer Science, University College Cork, Ireland. Martin Davoren, PhD, MPH, BSc, is Adjunct Lecturer, School of Public Health, University College Cork, and Chief Executive Officer at The Sexual Health Centre, Cork, Ireland
| | | | | | | | | | | |
Collapse
|
33
|
Saab MM, Davoren MP, Murphy A, Murphy D, Cooke E, Landers M, Fitzgerald S, Richardson N, Rovito MJ, Von Wagner C, Murphy M, Dahly D, Hegarty J. Promoting men's awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions. HRB Open Res 2018; 1:16. [PMID: 32002508 PMCID: PMC6973532 DOI: 10.12688/hrbopenres.12837.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Testicular cancer (TC) is commonly diagnosed among men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders such as testicular torsion and epididymitis can lead to testicular ischemia, sepsis, and infertility if left untreated. This systematic review aims to evaluate the effectiveness of studies promoting men's knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsychINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, Clinicaltrials.gov, Grey Literature Report, and Open Grey were searched for studies published between November 2014 and April 2018. The methodological quality and level of evidence per outcome were assessed. Results: There were five papers included: two were experimental studies, two were systematic reviews, and one was an integrative review. The majority of the reviewed interventions were successful in increasing men's awareness of TC and self-examination. Examples include a television show featuring a celebrity with TC, a university campaign, and interactive educational sessions. The impact of the reviewed interventions on health beliefs (i.e. perceived susceptibility, severity, benefits, barriers, and self-efficacy) varied across the reviewed literature. Studies promoting help-seeking for testicular symptoms and awareness of benign testicular disorders were lacking. Conclusions: This review highlights the importance of evaluating educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.
Collapse
Affiliation(s)
- Mohamad M. Saab
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Martin P. Davoren
- School of Public Health, University College Cork, Cork, Ireland
- Sexual Health Centre, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, University College Cork, Cork, Ireland
| | - David Murphy
- School of Computer Science & Information Technology, University College Cork, Cork, Ireland
| | - Eoghan Cooke
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
- Health Research Board National Clinical Trials Office, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Margaret Landers
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Serena Fitzgerald
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Noel Richardson
- Department of Science and Health, South East Technological University, Carlow, Ireland
| | - Michael J. Rovito
- College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
| | - Christian Von Wagner
- Behavioural Science and Health, Institute of Epidemiology & Health, University College London, London, UK
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Darren Dahly
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| |
Collapse
|
34
|
Saab MM, Davoren M, Murphy A, Murphy D, Cooke E, Landers M, Fitzgerald S, Richardson N, Rovito M, Von Wagner C, Murphy M, Dahly D, Hegarty J. Promoting men's awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions. HRB Open Res 2018. [PMID: 32002508 DOI: 10.12688/hrbopenres.12837.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Testicular cancer (TC) is commonly diagnosed among men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders such as testicular torsion and epididymitis can lead to testicular ischemia, sepsis, and infertility if left untreated. This systematic review aims to evaluate the effectiveness of studies promoting men's knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsychINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, Clinicaltrials.gov, Grey Literature Report, and Open Grey were searched for studies published between November 2014 and April 2018. The methodological quality and level of evidence per outcome were assessed. Results: There were five papers included: two were experimental studies, two were systematic reviews, and one was an integrative review. The majority of the reviewed interventions were successful in increasing men's awareness of TC and self-examination. Examples include a television show featuring a celebrity with TC, a university campaign, and interactive educational sessions. The impact of the reviewed interventions on health beliefs (i.e. perceived susceptibility, severity, benefits, barriers, and self-efficacy) varied across the reviewed literature. Studies promoting help-seeking for testicular symptoms and awareness of benign testicular disorders were lacking. Conclusions: This review highlights the importance of evaluating educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.
Collapse
Affiliation(s)
- Mohamad M Saab
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Martin Davoren
- School of Public Health, University College Cork, Cork, Ireland.,Sexual Health Centre, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, University College Cork, Cork, Ireland
| | - David Murphy
- Department of Computer Science, University College Cork, Cork, Ireland
| | - Eoghan Cooke
- Department of Computer Science, University College Cork, Cork, Ireland
| | - Margaret Landers
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Serena Fitzgerald
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Noel Richardson
- Department of Science and Health, Institute of Technology Carlow, Carlow, Ireland
| | - Michael Rovito
- College of Health and Public Affairs, University of Central Florida, Orlando, Florida, USA
| | - Christian Von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Darren Dahly
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| |
Collapse
|
35
|
Arevalo MK, Sheth KR, Menon VS, Ostrov L, Hennes H, Singla N, Koral K, Schlomer BJ, Baker LA. Straight to the Operating Room: An Emergent Surgery Track for Acute Testicular Torsion Transfers. J Pediatr 2018; 192:178-183. [PMID: 29246339 PMCID: PMC5737783 DOI: 10.1016/j.jpeds.2017.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/19/2017] [Accepted: 09/07/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effect of implementing an emergency surgery track for testicular torsion transfers. We hypothesized that transferring children from other facilities diagnosed with torsion straight to the operating room (STOR) would decrease ischemia time, lower costs, and reduce testicular loss. STUDY DESIGN Demographics, arrival to incision time, hospital cost in dollars, and testicular outcome (determined by testicular ultrasound) at follow-up were retrospectively compared in all patients transferred to our tertiary care children's hospital with a diagnosis of testicular torsion from 2012 to 2016. Clinical data for STOR and non-STOR patients were compared by Wilcoxon rank-sum, 2-tailed t test, or Fisher exact test as appropriate. RESULTS Sixty-eight patients met inclusion criteria: 35 STOR and 33 non-STOR. Children taken STOR had a shorter median arrival to incision time (STOR: 54 minutes vs non-STOR: 94 minutes, P < .0001) and lower median total hospital costs (STOR: $3882 vs non-STOR: $4419, P < .0001). However, only 46.8% of STOR patients and 48.4% of non-STOR patients achieved surgery within 6 hours of symptom onset. Testicular salvage rates in STOR and non-STOR patients were not significantly different (STOR: 68.4% vs non-STOR: 36.8%, P = .1), but follow-up was poor. CONCLUSIONS STOR decreased arrival to incision time and hospital cost but did not affect testicular loss. The bulk of ischemia time in torsion transfers occurred before arrival at our tertiary care center. Further interventions addressing delays in diagnosis and transfer are needed to truly improve testicular salvage rates in these patients.
Collapse
Affiliation(s)
| | - Kunj R Sheth
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Vani S Menon
- Children’s Health, Dallas, TX,University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Halim Hennes
- Children’s Health, Dallas, TX,University of Texas Southwestern Medical Center, Dallas, TX
| | - Nirmish Singla
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Korgun Koral
- Children’s Health, Dallas, TX,University of Texas Southwestern Medical Center, Dallas, TX
| | - Bruce J Schlomer
- Children’s Health, Dallas, TX,University of Texas Southwestern Medical Center, Dallas, TX
| | - Linda A Baker
- Children’s Health, Dallas, TX,University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|