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Huang S, Zeng Y, Xu R, Fan Y, Gu X, Miao Q, Wang Y, Chen P, Li S. Clinical features of neonatal testicular torsion: A retrospective analysis of 24 cases. Am J Emerg Med 2024; 85:86-89. [PMID: 39243593 DOI: 10.1016/j.ajem.2024.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/04/2024] [Accepted: 08/26/2024] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVES To analyze the clinical characteristics, surgical management decisions, and outcomes of Neonatal testicular torsion (NTT) in order to offer guidance for future clinical practice. METHODS Retrospectively analyzed the clinical data of patients with NTT who were admitted and underwent surgery from January 2008 to October 2023. RESULTS A total of 24 neonates were enrolled in this study, all of whom were unilateral cases. Age of onset was 0 d (IQR: 0-1.8), while the median duration of symptoms was 73 h (IQR: 26-199). Clinical manifestation included enlarged scrotum (75 %), changes in scrotal color (79 %), and crying upon palpation (17 %). All patients underwent urgent bilateral exploration and performed by orchiectomy and contralateral orchiopexy. CONCLUSION NTT primarily occurs prenatally with insidious manifestations, often leading to omission or misdiagnosis. The testicular salvage rate is extremely low. Physicians need to attach importance to neonatal testicular examination, improve the vigilance of NTT. Early bilateral exploration does not necessarily save the affected testes, but it is more important to prevent damage to the contralateral one.
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Affiliation(s)
- Shaogang Huang
- Department of Urology, Shenzhen Children's Hospital, Futian District, Shenzhen 518000, Guangdong, People's Republic of China; Shenzhen Pediatrics Institute of Shantou University Medical College, Futian District, Shenzhen 518000, Guangdong, People's Republic of China
| | - Yefeng Zeng
- Department of Urology, Shenzhen Children's Hospital, Futian District, Shenzhen 518000, Guangdong, People's Republic of China; Department of Urology, Shenzhen Children's Hospital, China Medical University, Futian District, Shenzhen 518000, Guangdong, People's Republic of China
| | - Rui Xu
- Department of Urology, Shenzhen Children's Hospital, Futian District, Shenzhen 518000, Guangdong, People's Republic of China; Department of Urology, Shenzhen Children's Hospital, China Medical University, Futian District, Shenzhen 518000, Guangdong, People's Republic of China
| | - Yibin Fan
- Department of Urology, Shenzhen Children's Hospital, Futian District, Shenzhen 518000, Guangdong, People's Republic of China
| | - Xianbin Gu
- Department of Urology, Shenzhen Children's Hospital, Futian District, Shenzhen 518000, Guangdong, People's Republic of China; Shenzhen Pediatrics Institute of Shantou University Medical College, Futian District, Shenzhen 518000, Guangdong, People's Republic of China
| | - Qiuling Miao
- Department of Pathology, Shenzhen Children's Hospital, Futian District, Shenzhen 518000, Guangdong, People's Republic of China
| | - Yue Wang
- Department of Pathology, Shenzhen Children's Hospital, Futian District, Shenzhen 518000, Guangdong, People's Republic of China
| | - Pengyu Chen
- Department of Urology, Shenzhen Children's Hospital, Futian District, Shenzhen 518000, Guangdong, People's Republic of China.
| | - Shoulin Li
- Department of Urology, Shenzhen Children's Hospital, Futian District, Shenzhen 518000, Guangdong, People's Republic of China
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Boscaini V, Camoglio FS, Dando I, Pietrobelli A, Zampieri N. Long time follow-up for patients with testicular torsion: new findings. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2024; 12:216-225. [PMID: 39308591 PMCID: PMC11411180 DOI: 10.62347/ygaq8968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 08/21/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Testicular torsion is the major urologic emergency. If not treated promptly, this condition can result in testicular necrosis or long-term functional impairment. At present, there are few paper about long time follow-up of these patients. The primary objective of our study is to report the long-term clinical-instrumental data (mean follow-up 12 years) of patients treated for testicular torsion. METHODS We considered patients treated for testicular torsion during the period between 1997 and 2017. Inclusion and exclusion criteria were created. Patients were contacted by phone between December 2021 and January 2022. Each patient underwent clinical and ultrasonographic evaluation, and in addition, some subjects were offered additional tests (hormonal assays and semen analysis). RESULTS During the study period, 22 patients were treated for testicular torsion. From the ultrasonographic study, it was found that the volume of the affected testis is reduced and it is associated with microcalcifications and heterogeneous echogenicity. Morphovolumetric recovery seems to be more related to age of onset than to the degree of torsion. CONCLUSIONS Based on our results we can state that affected testes, if preserved, grow less and have altered ultrasonographic morphology. Clinically, the age of onset of torsion seems more important than the degree of torsion.
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Affiliation(s)
- Vittoria Boscaini
- Pediatric Surgery Unit, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Department of Engineering for Innovation Medicine, Pediatric Fertility Lab, University of VeronaPiazzale A. Stefani n.1, 37134 Verona, Italy
| | - Francesco Saverio Camoglio
- Pediatric Surgery Unit, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Department of Engineering for Innovation Medicine, Pediatric Fertility Lab, University of VeronaPiazzale A. Stefani n.1, 37134 Verona, Italy
| | - Ilaria Dando
- Department of Neurosciences, Biomedicine and Movement Sciences, Biochemistry Section University of Verona37134 Verona, Italy
| | - Angelo Pietrobelli
- Pediatric Unit, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Department of Surgery, Dentistry, Pediatrics and Gynaecology, University of VeronaPiazzale A. Stefani n.1, 37134 Verona, Italy
| | - Nicola Zampieri
- Pediatric Surgery Unit, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Department of Engineering for Innovation Medicine, Pediatric Fertility Lab, University of VeronaPiazzale A. Stefani n.1, 37134 Verona, Italy
- Unicamillus International Medical UniversityVia Di Sant’Alessandro 8, 00131 Roma, Italy
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Braga I, Martinho S, Barroso C, Correia-Pinto J, Lamas-Pinheiro R. Orchiectomy after torsion testis: Simultaneous prosthesis placement versus staged procedures. J Pediatr Urol 2024:S1477-5131(24)00429-7. [PMID: 39289126 DOI: 10.1016/j.jpurol.2024.08.003] [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: 05/25/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND/PURPOSE Testicular torsion(TT) with unsalvageable testis has a significant psychosocial impact. Orchiectomy can be performed with optional testicular prosthesis(TP) placement, commonly deferred(dTP). Orchiectomy and simultaneous testicular prosthesis placement(sTP) may be a feasible and safe option and has been implemented in our department since 2018. AIM The authors aim to perform a reflective analysis of the patient's experience and assess the feasibility, safety, and satisfaction of the sTP, by comparing it with the dTP. METHODS All patients with TT and unsalvageable testis submitted to orchiectomy were included in the study. An anonymous questionnaire assessed the patients' experience. Those submitted to orchiectomy and TP placement were divided in sTP and dTP groups and their clinical details, satisfaction and quality-of-life were analyzed and compared. RESULTS Scrotal exploration due to TT was performed in 185 patients, 54 were submitted to orchiectomy and 37 placed a TP(17 sTP, 20 dTP). All dTP patients and 66.7% of those without TP, would prefer having a prosthesis placed at the time of the orchiectomy. No significant differences in clinical details and outcomes were found, except prosthesis position (higher in dTP, p = 0.011) and operative time (13 min longer in sTP, p = 0.015). Both groups reported being satisfied with the prosthesis. Only one patient regretted placing a prosthesis(in dTP). CONCLUSION The sTP approach is as safe and effective as dTP. The patients preferred the sTP, as it avoids a second operation and possibly by having a lower psychological impact. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Inês Braga
- Pediatric Surgery Department, Hospital de Braga, Braga, Portugal.
| | - Sofia Martinho
- Pediatric Surgery Department, Hospital de Braga, Braga, Portugal
| | - Catarina Barroso
- Pediatric Surgery Department, Hospital de Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Jorge Correia-Pinto
- Pediatric Surgery Department, Hospital de Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Ruben Lamas-Pinheiro
- Pediatric Surgery Department, Hospital de Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
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Komatsu S, Terui K, Takenouchi A, Kawaguchi Y, Nishimura K, Oita S, Yoshizawa H, Takiguchi S, Hishiki T. Indocyanine green fluorescence imaging as a predictor of long-term testicular atrophy in testicular torsion: a pilot study. Surg Today 2024:10.1007/s00595-024-02908-9. [PMID: 39085699 DOI: 10.1007/s00595-024-02908-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE This pilot study evaluated indocyanine green-guided near-infrared fluorescence (ICG-NIRF) imaging of testicular blood flow to predict long-term testicular atrophy after testicular torsion (TT) surgery. METHODS The subjects of this retrospective study were patients who underwent surgery for TT at our hospital between December, 2020 and July, 2022. After detorsion, testicular blood flow was evaluated by ICG-NIRF imaging and classified into three categories: fluorescence detected, no fluorescence detected, and fluorescence detected only in the tunica albuginea vessels. Testicular volume was measured by ultrasonography up to 12 months after surgery to evaluate long-term outcomes. RESULTS Twelve patients were included in this analysis. We found a 100% correlation between the absence of ICG-NIRF signals and subsequent testicular atrophy. In three patients without an ICG-NIRF signal, the median testis size 12 months postoperatively was significantly smaller (16.5% of the contralateral testis; range 13-20%) than that in six patients with an ICG-NIRF signal (96%; 89-115%) (p = 0.013). Mild atrophy (74.5%; 73-76%) was also observed in the three patients for whom an ICG-NIRF signal was detected only in the tunica albuginea vessels. CONCLUSIONS Our pilot study highlights the potential of ICG-NIRF imaging as a prognostic tool for guiding surgical decision-making for patients with TT, by predicting postoperative testicular atrophy.
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Affiliation(s)
- Shugo Komatsu
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan.
| | - Keita Terui
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Ayako Takenouchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Yunosuke Kawaguchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Katsuhiro Nishimura
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Satoru Oita
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Hiroko Yoshizawa
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Shota Takiguchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
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Lee WG, Ourshalimian S, Keane OA, O'Guinn M, Odegard MN, Sparks SS, Kelley-Quon LI. Sex-based Disparities in the Management of Pediatric Gonadal Torsion. J Pediatr Surg 2024; 59:1355-1361. [PMID: 38599909 DOI: 10.1016/j.jpedsurg.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/01/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION In 2015, the U.S. News and World Report (USNWR) implemented a quality metric to expedite surgery for testicular torsion (TT), but not ovarian torsion (OT). This study examined OR timing among children with suspected TT and OT before and after this metric. METHODS A single-center retrospective cohort study of children (1-18yr) who underwent surgery for suspected gonadal torsion was performed. Time to OR (TTOR) from hospital presentation to surgery start was calculated. An interrupted time series analysis identified changes in TTOR for suspected TT versus OT after the 2015 USNWR quality metric. RESULTS Overall, 216 patients presented with TT and 120 with OT. Median TTOR for TT was 147 min (IQR:99-198) versus 462 min (IQR:308-606) for OT. Post-quality metric, children with TT experienced a 27.8 min decrease (95% CI:-51.7,-3.9, p = 0.05) in annual median TTOR. No significant decrease was observed for children with OT (p = 0.22). Children with history of a known ovarian mass (N = 62) experienced a shorter TTOR compared to those without (422 vs 499min; p = 0.04). CONCLUSION Implementation of a national quality metric for TT expedited surgical care for children with TT, but not children with OT. These findings highlight the need for equitable quality metrics for children presenting with suspected gonadal torsion. LEVEL OF EVIDENCE III. TYPE OF STUDY Retrospective Comparative Study, Observational Cohort Study.
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Affiliation(s)
- William G Lee
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.
| | - Shadassa Ourshalimian
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Olivia A Keane
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Makayla O'Guinn
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Marjorie N Odegard
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Stephen S Sparks
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA; Department of Surgery, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA; Department of Population and Public Health Sciences, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
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Alberti P, Bytyci J, Jindal J, Stephanou M, Thompson L, Tilahun Y, Ying Y, Killen A, Manirambona E, Niyukuri A, Lakhoo K, Ford K. Paediatric testicular torsion in low- and middle-income countries: an OxPLORE scoping study. Pediatr Surg Int 2024; 40:117. [PMID: 38695917 DOI: 10.1007/s00383-024-05704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Literature on paediatric surgical conditions in low- and middle-income countries (LMICs) remains limited. As a common emergency, timely treatment of testicular torsion acts as a benchmark of adequate emergency service delivery in paediatric surgery. This scoping study aims to synthesise all existing literature on paediatric testicular torsion in LMICs. METHODS A database search was conducted by the OxPLORE global paediatric surgery research group to identify studies containing the terms 'testicular torsion' or 'acute scrotum' originating from LMICs. A thematic analysis was applied to the results of the search and the quality of evidence was appraised for all included articles. RESULTS This review included 17 studies with 1798 patients. All studies originated from middle-income countries and the majority (76%) had sample sizes smaller than 100 patients. All studies were appraised as providing less than adequate evidence. Included studies identified long delays to treatment and highlighted ongoing debates on the value of scoring systems and Doppler ultrasonography in diagnosing torsion. Major heterogeneity in surgical approaches to treatment of testicular torsion in children was also observed. CONCLUSIONS Literature on paediatric testicular torsion in LMICs is scarce and heterogeneous. Prospective, multi-centre research on the management of this common paediatric surgical emergency is urgently required.
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Affiliation(s)
- Piero Alberti
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jola Bytyci
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jessy Jindal
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Michael Stephanou
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lucy Thompson
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Yedidiah Tilahun
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Yuxin Ying
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Annabel Killen
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Kokila Lakhoo
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Kathryn Ford
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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Hiramatsu A, Den H, Morita M, Ogawa Y, Fukagai T, Kokaze A. A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database. PLoS One 2024; 19:e0297888. [PMID: 38457468 PMCID: PMC10923415 DOI: 10.1371/journal.pone.0297888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/03/2024] [Indexed: 03/10/2024] Open
Abstract
Testicular torsion is a severe urological emergency caused by the twisting of the spermatic cord. The nationwide incidence of testicular torsion in Japan has not been previously reported. Accordingly, we aimed to estimate the nationwide incidence of testicular torsion using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and examine the orchiectomy rate. This cross-sectional study was based on data from the NDB. We extracted data of patients aged < 21 years with documented testicular torsion and relevant treatment from January 2018 to December 2020. Testicular torsion was identified based on the Japanese standardized disease codes. The national incidence rate between 2018 and 2020 was calculated and assessed according to age and region of origin. Orchiectomy rates were evaluated according to age. The nationwide incidence rates of testicular torsion were 14.46, 15.09, and 15.88 per 100,000 males aged < 21 years in 2018, 2019, and 2020, respectively. The orchiectomy rate was 7.1%. Testicular torsion was most frequently observed during winter. A similar trend was observed nationwide. To the best of our knowledge, this study is the first to report the nationwide incidence of testicular torsion in Japan.
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Affiliation(s)
- Aya Hiramatsu
- Department of Hygiene, Public Health, and Preventative Medicine Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan, Japan
- Department of Urology Showa University Koto Toyosu Hospital, Koto-ku, Tokyo, Japan
| | - Hiroki Den
- Department of Hygiene, Public Health, and Preventative Medicine Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan, Japan
| | - Masashi Morita
- Department of Urology Showa University Koto Toyosu Hospital, Koto-ku, Tokyo, Japan
| | - Yoshio Ogawa
- Department of Urology Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Takashi Fukagai
- Department of Urology Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Akatsuki Kokaze
- Department of Hygiene, Public Health, and Preventative Medicine Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan, Japan
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Barbosa RG, Favorito LA, Sampaio FJB. Morphometric study applied to testicular and epididymis hydatids torsion. Sci Rep 2024; 14:3249. [PMID: 38332206 PMCID: PMC10853171 DOI: 10.1038/s41598-024-52734-9] [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: 10/01/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
Twisted testicular appendages had difficult differential diagnosis with testicular torsion. The objective of this paper is to evaluate the number, shape, size and determine the laterality pattern of the testicular and epididymal hydatids and evaluate the correlations between the length and width of the testicular and epididymal hydatids with testicular measurements. We analyzed 60 fixed cadavers and 16 patients with prostate cancer without previous hormonal treatment undergoing bilateral orchiectomy, totalizing 76 units and 152 testicles. In relation to the testicular appendices, we analyzed the following situations: absence of testicular and epididymis appendages, presence of a testicular appendix, presence of epididymis appendix, and presence of testicular and epididymis appendix. We measured the length, width and thickness of the testis and classified the appendages as sessile or pedicled. Chi-square test was used to verify associations between categorical variables. McNemar Test was used to verify differences between the percentages of right and left appendages. Correlations between quantitative measures were evaluated using the Pearson Correlation Coefficient (p < 0.05). In 50 cases (65.78%) we observed the presence of some type of appendices, in 34 cases (44.72%) we observed the presence of testicular appendices and in 19 cases (25%) the presence of epididymal appendices. We observed the presence of pedicled appendices in 39 cases (51.32%), with 25 of the cases (32.89%) of pedicled testicular appendices and 14 of the cases (18.42%) of pedicled epididymal appendages, with a significant association between the occurrence of appendices on the right and left sides (p < 0.001). Testicular hydatids were present in around two thirds of our sample being pedunculated in almost half of the cases with bilateral similarity. There is a significant chance in cases of twisted appendices that the same anatomical characteristics are present on the opposite side, which is a factor that tends to indicate the need for contralateral surgical exploration in cases of torsion, however studies with larger samples are needed to confirm these findings.
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Affiliation(s)
- Renato G Barbosa
- Urogenital Research Unit, Department of Anatomy, State University of Rio de Janeiro - UERJ, Rua Professor Gabizo, 104/201, Tijuca, Rio de Janeiro, RJ, CEP: 20271-320, Brazil
| | - Luciano Alves Favorito
- Urogenital Research Unit, Department of Anatomy, State University of Rio de Janeiro - UERJ, Rua Professor Gabizo, 104/201, Tijuca, Rio de Janeiro, RJ, CEP: 20271-320, Brazil.
| | - Francisco J B Sampaio
- Urogenital Research Unit, Department of Anatomy, State University of Rio de Janeiro - UERJ, Rua Professor Gabizo, 104/201, Tijuca, Rio de Janeiro, RJ, CEP: 20271-320, Brazil
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Park JS, Kim D, Chun MK, Choi SJ, Lee JS, Ryu JM, Lee JY. Implementing Point-of-Care Ultrasound for Acute Scrotal Pain in the Pediatric Emergency Department: Screening Testicular Torsion and Patient Flow Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2757-2764. [PMID: 37555776 DOI: 10.1002/jum.16312] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES Testicular torsion (TT) is a pediatric surgical emergency that requires prompt treatment. This study investigated the feasibility of point-of-care ultrasound (POCUS) for diagnosing TT in the pediatric emergency department (ED). METHODS We retrospectively reviewed the medical records of patients, aged 18 years or younger, who visited a university-affiliated hospital pediatric ED with acute scrotal pain without trauma history and underwent diagnostic ultrasounds between January 2010 and October 2022. RESULTS This study included 731 patients (median age: 9 years), Of these, 315 (43%) were in the POCUS-performed group: 188 in the POCUS-only group, and 127 in the POCUS-and-RADUS group. The other 416 patients (56.9%) were in the RADUS-only group. In total, 45 patients (6.2%) were diagnosed with TT (19 in the POCUS-performed group and 26 in the RADUS-only group). The sensitivity, specificity, and positive and negative predictive values of POCUS for diagnosing TT were 94.7%, 92.9%, 46.2%, and 99.6%, respectively. The median time to perform POCUS was shorter than RADUS (23 versus 61 minutes, P < .001). The POCUS-performed group had a shorter ED length of stay than the RADUS-only group (93 versus 170 minutes, P < .001). Among the patients diagnosed with TT, performing POCUS first did not significantly delay the ED process, including time to operation (250 versus 205 minutes, P = .142). CONCLUSIONS For patients with acute scrotal pain, evaluation performed by pediatric emergency physicians using POCUS performs well in screening TT, and can decrease length of stay in the ED.
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Affiliation(s)
- Jun Sung Park
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dahyun Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Kyo Chun
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Jun Choi
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Seung Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Min Ryu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Yong Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Liu X, Xu Y, Li L, Bai D. Evaluation of testicular blood flow during testicular torsion surgery in children using the indocyanine green-guided near-infrared fluorescence imaging technique. Front Pediatr 2023; 11:1272659. [PMID: 37964816 PMCID: PMC10642505 DOI: 10.3389/fped.2023.1272659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023] Open
Abstract
Objective This study investigates the feasibility of the indocyanine green-guided near-infrared fluorescence (ICG-NIRF) imaging technique in evaluating testicular blood flow during testicular torsion (TT) surgery in pediatric cases. Methods We retrospectively analyzed the eight pediatric patients with TT who underwent surgery in our hospital between February and July 2023. The intraoperative two-step method of ICG-NIRF imaging and testicular incision was used to evaluate the testicular blood flow, followed by a selection of different surgical methods. The removed testes were pathologically examined after surgery, and all patients were followed up 1 month after surgery to evaluate testicular blood flow using gray-scale ultrasound and color Doppler flow imaging (CDFI). Results Eight pediatric TT patients aged 1-16 years, with a median age of 11.5 years, were enrolled. Time from the onset ranged from 4 to 72 h (mean 26.13 ± 25.09 h). A total of eight testes were twisted, including four on the left side and four on the right side. The twisting direction of the testes was clockwise in four cases and counterclockwise in four cases. The rotation of torsion was 180°-1,080° (mean 472.5° ± 396°). There was no statistically significant difference in the imaging time between the four patients with testicular blood vessel imaging on both the torsional and normal sides (P > 0.05). The postoperative recovery was uneventful, with no complications during the follow-up period of 1 month. The postoperative histopathological results of three patients who underwent orchiectomy showed extensive hemorrhage, degeneration, and necrosis of the testicular tissue. Among the five patients who underwent orchiopexy, a gray-scale ultrasound and CDFI examinations showed uniform internal echo of the testes and normal blood flow signals in four patients. One patient with no testicular blood vessel imaging on the torsional side showed uneven internal echo of the testis and no blood flow signals. Conclusion ICG-NIRF imaging is a feasible method to evaluate testicular blood flow during TT surgery. Testicular blood vessel imaging within 5 minutes after ICG injection might be the basis for testicular retention during TT surgery.
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Affiliation(s)
- Xiaomeng Liu
- Department of Urology, Children’s Hospital of Capital Institute of Pediatrics, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Xu
- Department of Urology, Children’s Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Long Li
- Department of Urology, Children’s Hospital of Capital Institute of Pediatrics, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongsheng Bai
- Department of Urology, Children’s Hospital of Capital Institute of Pediatrics, Beijing, China
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11
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Şencan A, Tanrıverdi Hİ, Şimşek FB, Usta İB, Üçöz M, Özbilgin K. Intraoperative evaluation of testicular vascularization and perfusion in rat testicles with indocyanine green (ICG)/near-infrared (NIR) fluorescent imaging after torsion-detorsion and reperfusion. Pediatr Surg Int 2022; 38:1625-1633. [PMID: 36087144 DOI: 10.1007/s00383-022-05211-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate testicular perfusion and vascularization with intraoperative ICG/NIR imaging in a testicular ischemia-reperfusion model and to investigate the effects of ICG on testicular tissue. MATERIALS AND METHODS 24 male rats were divided into four groups. In the ICG group, only ICG was given and images of the testicles were recorded with NIR camera. In the torsion group, the testicles were left in torsion for 4 h. ICG/NIR images were obtained after torsion and detorsion. In the reperfusion group, ICG/NIR images of the testicles were obtained at the 4th hour of reperfusion. After the procedures, testicles were collected and evaluated with histological, immunohistochemical examination and qRT-PCR. RESULTS There was no histologically negative effect of ICG on testicular tissue. There was no testicular perfusion in the torsion group, but perfusion started after detorsion. At the 4th hour of reperfusion, testicular perfusion continued. TNF-a, IL-6, MCP-1 and caspase-3 immunoreactivity were found to be at low levels in the control and ICG groups, while high in the torsion and reperfusion groups (p < 0.05). In qRT-PCR, TNF-a, IL-6, MCP-1 and caspase-3 expressions were lower in the control and ICG groups, but higher in the torsion and reperfusion groups. CONCLUSION There was no histologically negative effect of ICG on testicles. The ICG/NIR imaging technique seems to be a feasible method in testicular torsion and may contribute to the surgeon in the intraoperative management of testicular torsion. In testicles that started to be perfused after detorsion, perfusion still continued at the 4th hour of reperfusion. Our next goal is to test whether testicles showing ICG fluorescence in during reperfusion maintain their viability for long term.
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Affiliation(s)
- Aydın Şencan
- Faculty of Medicine, Department of Pediatric Surgery, Manisa Celal Bayar University, Manisa, Turkey.
| | - Halil İbrahim Tanrıverdi
- Faculty of Medicine, Department of Pediatric Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | - Fatma Bilgecan Şimşek
- Faculty of Medicine, Department of Pediatric Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | - İbrahim Berkan Usta
- Faculty of Medicine, Department of Pediatric Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | - Meltem Üçöz
- Faculty of Medicine, Department of Histology-Embryology, Manisa Celal Bayar University, Manisa, Turkey
| | - Kemal Özbilgin
- Faculty of Medicine, Department of Histology-Embryology, Manisa Celal Bayar University, Manisa, Turkey
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Shirasaki Y, Kawashima M, Kimura T, Yamanaka H, Hatta K, Branch J, Matsuda Y. Successful salvage of torsion testis by means of intraoperative indocyanine green fluorescence imaging. Surg Case Rep 2022; 8:152. [PMID: 35951275 PMCID: PMC9372249 DOI: 10.1186/s40792-022-01476-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Testicular torsion (TT) is common surgical emergency that requires early diagnosis and immediate intervention within 6 h since its onset to salvage the testis. However, the decision was made only by the surgeon’s experience whether it has to be resected or not. Recently, indocyanine green (ICG) has become an excellent tool to identify biliary and vascular anatomy, and assess perfusion abnormalities in tissues. In this case report, we successfully salvaged the twisted testis, since the testicular blood perfusion was confirmed by means of intraoperative ICG (IICG) fluorescence imaging. Case presentation A 14-year-old healthy male patient presented due to acute left testicular pain. The patient was diagnosed with TT and had immediate surgery. Macroscopically, the testis had stagnant blood flow and appeared to be dark colored. After manual detorsion, the testis remained cyanotic and with macroscopically poor blood flow. ICG angiography was performed under near-infrared light by laparoscopic camera to assess the perfusion of the affected testicle. An excellent ICG signal appeared after 45 s in the testis, and decision was made to be preserved. Therefore, left orchidopexy was performed to complete the operation. The patient had a good postoperative course and was discharged the day after surgery. Six months later, the testis did not show any shrinkage, and both sides of the testis showed the same size without any consequences. Conclusion The blood flow in the testis was visually confirmed during the IICG fluorescence method. ICG fluorescence imaging may become an effective alternative to evaluate whether a testis can be preserved following TT.
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Peeraully R, John M, Ellis R, Green S, Jancauskaite M, Smart T, Thompson A, Sarmah P, Fraser N. Does decentralisation of surgical management improve outcomes for paediatric testicular torsion? J Pediatr Urol 2022; 18:302.e1-302.e8. [PMID: 35410806 DOI: 10.1016/j.jpurol.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/26/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In testicular torsion (TT), delayed emergency scrotal exploration (ESE) increases the risk of orchidectomy. Transfer of a patient with suspected TT from a district general hospital (DGH) to a paediatric surgical centre (PSC) delays ESE and potentially puts them at increased risk of testicular loss. Prior to 1st January 2017, all boys under aged <16 years presenting to a DGH within the East Midlands Clinical Network (EMCN) would be referred to the PSC. From this date, it was agreed within the EMCN that boys aged ≥5 years with suspected TT presenting to a network DGH would be managed locally, barring exceptional circumstances. Boys aged <5 years would be referred to the PSC for management. AIM This study aimed to assess the impact of decentralisation of ESE for suspected TT on orchidectomy rates in the EMCN. METHODS All patients who underwent ESE under the care of paediatric surgery in the PSC, and all patients <16 years old who underwent ESE in 4 EMCN DGHs between January 2017 and December 2019 were identified. Neonatal cases and inpatient referrals were excluded. Comparison was made with published data on ESE performed in the PSC over the 9 years 2008-2016 prior to decentralisation. RESULTS In the 9 years prior to decentralisation, there were 110 cases of TT in the PSC. In the subsequent 3 years, there were 40 in the PSC and 37 in the DGHs. The orchidectomy rate of boys with TT presenting to DGHs and undergoing exploration locally (16%, 6/37) contrasts with the rate in those transferred from DGHs to the PSC for exploration (58%, 15/26). The difference is highly significant (p = 0.00059, RR 0.28 [95% CI 0.13-0.63]) and indicates that in the EMCN, avoiding hospital transfer and performing ESE at the presenting DGH reduces the risk of orchidectomy by 72%. CONCLUSION Decentralisation of the provision of ESE in boys with TT has resulted in a significantly lower orchidectomy rate in boys undergoing ESE in the presenting hospital than when transferred to the PSC. This study reinforces existing literature that demonstrates the effect of delayed ESE on orchidectomy rate, and supports the recommendations of national guidelines in the UK that transfer of boys to a PSC for ESE should only occur in exceptional circumstances.
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Affiliation(s)
- Riyad Peeraully
- Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
| | - Michael John
- Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom
| | - Ricky Ellis
- King's Mill Hospital, Mansfield, NG17 4JL, United Kingdom
| | - Sophie Green
- Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom
| | | | - Thomas Smart
- Royal Derby Hospital, Derby, DE22 3NE, United Kingdom
| | - Amari Thompson
- Lincoln County Hospital, Lincoln, LN2 5QY, United Kingdom
| | | | - Nia Fraser
- Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom
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Dias AC, Cruz PRCD, Ribeiro PRF, Riccetto CLZ. Testicular volume and Tanner stage: determinant factors for testicular torsion. EINSTEIN-SAO PAULO 2022; 20:eAO6605. [PMID: 35476083 PMCID: PMC9000982 DOI: 10.31744/einstein_journal/2022ao6605] [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] [Received: 03/20/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To assess testicular volumes and sexual maturation in patients with testicular torsion. Methods A retrospective analysis of consecutively treated patients with testicular torsion between 2016 and 2018. Age, pubic hair staging (Tanner), and by ultrasonography, volume of the unaffected testis (in cubic centimeters) were evaluated either immediately before surgery or at the first postoperative visit. Patients with previous testicular disease, such as cryptorchidism, or with no records of testicular volume were excluded. The analysis included descriptive statistics and Bayesian regression. Results We treated 149 patients during the study period, and 141 (94.6%, median age 17.3 years) met the inclusion criteria. Median testicular volume was 13.0cm3 (interquartile range of 10.5-15.2), with similar right and left volumes (12.9cm3versus 13.3cm3; p=0.94). Sixty-five (46.1%) patients were Tanner stage IV, 17 (12.1%) stage III, and 59 (41.8%) stage V. Conclusion In this study, we were able to estimate volumes of testicular torsion, which aggregated around late puberty values (13.0cm3 for the whole dataset, 12.2cm3 for patients <25 years), suggesting that testicular hypermobility, due to congenital anatomical abnormalities, remains quiescent until the organ reaches a critical volume, after which torsion becomes possible. These findings provide a tentative explanation for the disease’s age distribution.
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15
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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.
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Affiliation(s)
| | | | | | - Kim Entezari
- Urology Department, CHU Saint-Pierre, Brussels, Belgium
| | | | | | - Pierre Mols
- Emergency Department, CHU Saint-Pierre, Brussels, Belgium
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Castle C, Beasley SW, Taghavi K. Access to emergency paediatric surgery for testicular torsion or intestinal volvulus in New Zealand: A system perspective. J Paediatr Child Health 2022; 58:146-151. [PMID: 34375478 DOI: 10.1111/jpc.15684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022]
Abstract
AIM The risk of organ loss is increased in children with testicular torsion or intestinal volvulus if surgical management is not expedient. The current retrospective study aims to review the time-course from first symptom to 'knife to skin' in these conditions, to determine where delays occur and facilitate a systems approach to better manage these children. METHODS One hundred consecutive paediatric cases of scrotal exploration for presumed testicular torsion, and 100 neonatal cases presenting with possible malrotation/volvulus were analysed to evaluate the exact time-course of events from admission to surgery. RESULTS (i) Scrotal exploration: the median time from onset of symptoms to presentation was 12 h (interquartile range (IQR): 5-48 h). In children over 5 years of age, 36% (33/93) were transferred from an external district service area. (ii) Malrotation/volvulus: the median duration of symptoms prior to arrival/assessment was 12 h (IQR: 4-24 h). The median cumulative in-hospital time was over 6 h (368 min, IQR: 247-634 min). CONCLUSIONS Time to presentation contributes significantly to testicular ischaemic time. This delay to timely surgical intervention is multi-factorial, and must be addressed at a public health level. Support and training in the management of testicular torsion should be provided to all adult surgeons/trainees that may care for these children. In general, this condition is best managed at the presenting hospital whenever appropriate expertise is available. Novel pathways that streamline care may improve efficiency at an institutional level. Addressing issues of access to specialised neonatal surgery is more vexed on account of the tyranny of distance, and the pre-requisite level of surgical expertise required.
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Affiliation(s)
- Cameron Castle
- Department of Paediatric Surgery, Child Health Service, Wellington Regional Hospital, Wellington, New Zealand
| | - Spencer W Beasley
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Kiarash Taghavi
- Department of Paediatric Surgery, Child Health Service, Wellington Regional Hospital, Wellington, New Zealand.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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17
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Long-term protective effects of the combination of intermittent reperfusion and hypothermia on reperfusion injury in an experimental testicular torsion model. J Pediatr Surg 2021; 56:2037-2044. [PMID: 33279218 DOI: 10.1016/j.jpedsurg.2020.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/21/2020] [Accepted: 11/21/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION There are many significantfactors in testicular injury which determine the prognosis in testicular torsion. Reperfusion injury following detorsion also has a significant effect on testicular injury.This study was planned considering that with the implementation of intermittent reperfusion and hypothermia, reperfusion injury can be reduced, and such an application might have a positive effect on testicular tissue in the long term. MATERIALS AND METHODS Forty adult male rats were divided into five groups as follows: Sham(Sh)(n = 8), Torsion(T)(n = 8), Intermittent reperfusion(IR)(n = 8), Hypothermia(H)(n = 8), and Intermittent reperfusion+hypothermia(IR+H)(n = 8). Except forGroup Sh, the left testicle was taken out of the scrotum in all groups, rotated three times counterclockwise, fixed back in the scrotum, and left for four hours.After four hours, and just before reperfusion, the testicle's detorsion was performed while holding the vascular structures in the proximal part of the torsed segment with an atraumatic vessel clamp, and thus, not allowing reperfusion in Groups T, IR, H, and IR+H. In Group T, the clamp was released immediately. In Group H, an ice-bag cooling was performed around the testis, and the clamp was released when the tissue temperature was reached and kept constant at 4 °C. In Group IR, the clamp was released, allowing reperfusion of five seconds, followed by reclamping, providing an ischemic status for ten seconds; this procedure was repeated ten times. In Group H+IR,an ice-bag cooling was performed around the testis, and the clamp was released when the tissue temperature was reached and kept constant at 4 °C. Then, reperfusion was applied for 5 s, followed by 10 s ischemia with reclamping. This procedure was repeated ten times.Tissue blood flow was provided for60 days of reperfusion in all groups. After 60 days, both testicles were excised under anesthesia in all living rats, and samples ofthe left testicle werereserved for biochemical and pathological examinations. At the end of the procedure, all animals were sacrificed by a high dose of anesthesia. RESULTS It was biochemically and histopathologically determined that the tissues were preserved in the experimental groups compared to Group T, which was statistically significant (p < 0.05).However, no experimental group's superiority over each other was determined both biochemically and histopathologically (p > 0.05). CONCLUSION Our long-term experimental study revealed that all methods were protective in testicular torsion. The authors believe that these methods can be applied in clinical practice because of their ease of application and no additional cost. On the other hand, the results of our study should further be supported by other experimental studies.
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18
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Sugrue DD, O'Connor E, Davis N. Testicular torsion in Ireland: a 10-year analysis of incidence and risk of orchidectomy. Ir J Med Sci 2021; 191:2267-2274. [PMID: 34671927 DOI: 10.1007/s11845-021-02816-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The estimated incidence of testicular torsion (TT) is 4 per 100,000 males under 25 years [1]. Age, region and health insurance status have been associated with a higher risk of orchidectomy following TT [2]. AIMS This study aimed to establish incidence rates for TT in Ireland for the first time. Sociodemographic characteristics were analysed to assess risk factors for undergoing orchidectomy. METHODS A retrospective analysis of a national database, Hospital In-Patient Enquiry (HIPE), was carried out. Cases of TT treated between 2009 and 2018 were identified. Incidence and age-specific rates were calculated in conjunction with census data. Descriptive statistics, non-parametric tests and logistic regression were used to evaluate risk factors for orchidectomy. RESULTS Between 2009 and 2018, 1746 males under 25 years underwent scrotal exploration for TT. The crude incidence was 21.76 per 100,000 population. The age-standardised rate rose from 16.85 per 100,000 in 2009 to 26.31 per 100,000 in 2018. TT was most common in the 10-14 years age-group (n = 766, 43%) with a normal distribution across age-groups. TT most commonly occurred in spring (27.55%, 95% CI 25.46-29.71%), and was least common in summer (21.65%, 95% CI 19.46-23.36%, p < 0.01). Age, lack of private insurance, province of residence and transfer from another hospital were associated with orchidectomy. CONCLUSIONS The incidence of TT appears to be higher in Ireland than elsewhere. Epidemiological data for TT in Ireland will help inform health policy and clinical guidelines, facilitate comparison with other jurisdictions and improve public awareness. Further research is needed to identify modifiable risk factors that predict treatment outcomes.
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Affiliation(s)
- Diarmuid D Sugrue
- Transplant Urology and Nephrology Directorate, Beaumont Hospital, Beaumont, Dublin 9, Ireland.
- London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, UK.
| | - Eabhann O'Connor
- Transplant Urology and Nephrology Directorate, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Niall Davis
- Transplant Urology and Nephrology Directorate, Beaumont Hospital, Beaumont, Dublin 9, Ireland
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Hampl D, Koifman L, de Almeida R, Ginsberg M, Sampaio FJB, Favorito LA. Testicular torsion: a modified surgical technique for immediate intravaginal testicular prosthesis implant. Int Braz J Urol 2021; 47:1219-1227. [PMID: 34469675 PMCID: PMC8486465 DOI: 10.1590/s1677-5538.ibju.2021.9917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/20/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose: The aim of this paper is to propose a modified surgical technique for immediate intravaginal prosthesis implantation in patients undergoing orchiectomy due to testicular torsion, and to evaluate the wound healing process and patient’s satisfaction. Material and methods: We prospectively analyzed 137 patients with testicular torsion admitted to our facility between April 2018 and May 2020. Twenty-five patients who underwent orchiectomy were included in this study. Fifteen had a testicular prosthesis implanted at the same time as orchiectomy using a modified intravaginal technique (summary figure) and 10 received implants 6 to 12 months after orchiectomy. Wound healing was evaluated at a minimum of four checkpoints (on days 15, 45, 90 and 180 after surgery). At the end of the study, a questionnaire was administered to measure patients’ satisfaction rate. Student’s t test was used for comparison of quantitative data between negative vs. positive cultures (p <0.05). The chi-square test was used to verify associations between categorical variables and immediate vs. late prosthesis implantation (p <0.05). Results: Patient’s ages ranged from 13 to 23 years (mean 16.44 years). Overall time lapse from symptoms to orchiectomy ranged from 10 hours to 25 days (mean 7.92 days). Only one extrusion occurred and it happened in the late implant group. All wounds were healed in 72%, 88%, 95.8% and 100% of the cases on the 15th, 45th, 90th and 180th days after implant, respectively. At the end of the study, all patients stated they would recommend it to a friend or relative. The only patient that had prothesis extrusion asked to have it implanted again. Conclusion: There was no prosthesis extrusion using the modified intravaginal surgical technique for immediate testicular prosthesis implantation, which proved to be an easily performed and safe procedure that can avoid further reconstructive surgery in patients whose testicle was removed due to testicular torsion.
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Affiliation(s)
- Daniel Hampl
- Serviço de Urologia, Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brasil
| | - Leandro Koifman
- Serviço de Urologia, Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brasil
| | - Ricardo de Almeida
- Serviço de Urologia, Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brasil
| | - Marcio Ginsberg
- Serviço de Urologia, Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brasil
| | - Francisco J B Sampaio
- Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Luciano A Favorito
- Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Hori T, Yasukawa D. Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty. World J Methodol 2021; 11:160-186. [PMID: 34322367 PMCID: PMC8299909 DOI: 10.5662/wjm.v11.i4.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
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21
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Anand S, Kainth D. Fragility Index of Recently Published Meta-Analyses in Pediatric Urology: A Striking Observation. Cureus 2021; 13:e16225. [PMID: 34367825 PMCID: PMC8343562 DOI: 10.7759/cureus.16225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background and objective Fragility Index (FI) of meta-analyses determines their stability in terms of the level of confidence and strength behind the results depicted by them. The present study was conducted to estimate the FI of recently published meta-analyses in the Journal of Pediatric Urology (JPUrol). Method Twenty recently published articles on meta-analyses were screened to identify the eligible ones. The baseline data of each meta-analysis including the details of the author, number of included studies, total sample size, the total number of events, the status of the overall outcome (significant or non-significant), type of effect measure, type of method used for pooling the estimates, and type of effects model were recorded. FI was calculated by doing each single status modification. The 95% CI of the treatment effect was re-calculated until the statistical significance of the meta-analysis was reversed. Results A total of seven articles incorporating 22 meta-analyses were included. Seven (32%) of them had a statistically significant outcome prior to FI estimation. The risk ratio (17/22; 77%) was the most commonly used effect measure. The random-effects model (15/22; 68%) and the Mantel-Haenszel method (20/22; 91%) of pooling the estimates were utilized in the majority of meta-analyses. The median (Q1-Q3; range) FI of statistically significant, non-significant, and total meta-analyses were 5 (3-19.5; 2-39), 5 (3.5-6; 1-17), and 5 (3-13; 1-39) respectively. FI of ≤5 was noticed in four out of seven (57%), 9/15 (60%), and 13/22 (59%) of these meta-analyses respectively. Conclusion Based on our findings, the majority of the recently published meta-analyses in the field of pediatric urology are fragile and depend upon the event status of ≤5 participants.
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Affiliation(s)
- Sachit Anand
- Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND.,Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, IND
| | - Deepika Kainth
- Pediatrics, All India Institute of Medical Sciences, New Delhi, IND
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22
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Unsal V, Kolukcu E, Gevrek F, Firat F. Sinapic acid reduces ischemia/reperfusion injury due to testicular torsion/detorsion in rats. Andrologia 2021; 53:e14117. [PMID: 34081348 DOI: 10.1111/and.14117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 01/28/2023] Open
Abstract
This study aimed to investigate the protective effect of sinapic acid (SA) on biochemical and histopathological changes in an experimental testicular torsion-detorsion rat model. Twenty-four rats were randomised into four groups: sham group, ischemia/reperfusion (IR) group subjected to testicular torsion for 2 hr and then detorsion for 4 hr, and two groups treated with SA1 and SA2 (10 mg/kg and 20 mg/kg, by single intraperitoneal injection, 30 min before reperfusion). Serum testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were measured by an autoanalyzer, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malondialdehyde (MDA), protein carbonyl (PC), and nitric oxide (NO) oxidative stress parameters by spectrophotometric methods, and tumour necrosis factor (TNF-α), interleukin-1 beta (IL-1β), and interleukin 6 (IL-6) parameters by the Elisa method. In addition, immunohistochemical and histopathological examinations were performed on testicular tissues. There was no significant difference between the groups in terms of serum testosterone, FSH and LH levels (p > .05). SA significantly reduced increased testicular damage, oxidative stress, inflammation, cell death and also restored decreased antioxidant enzyme activities (p < .05). Pre-treatment of rats with SA reduced testicular dysfunction and morphological changes IRI. SA's antioxidant, anti-inflammatory, and antiapoptotic properties were found to be protective against testicular IR.
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Affiliation(s)
- Velid Unsal
- Faculty of Health Sciences and Central Research Laboratory, Mardin Artuklu University, Mardin, Turkey
| | - Engin Kolukcu
- Department of Urology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - Fikret Gevrek
- Department of Histology and Embryology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - Fatih Firat
- Department of Urology, Tokat State Hospital, Tokat, Turkey
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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.
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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
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24
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Brooks JP, Brooks JM, Seals T. Smartphone Thermal Imaging in the Detection of Testicular Ischemia. Urology 2021; 157:233-238. [PMID: 33689763 DOI: 10.1016/j.urology.2021.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/13/2021] [Accepted: 02/28/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate smartphone thermal imaging as a point of care test in the detection of testicular ischemia. Thermal imaging detects the infrared (heat) pattern of an object and the technology is now available as an inexpensive attachment to smartphones. MATERIALS AND METHODS Smartphone thermal imaging was studied as a point-of-care diagnostic test for testicular ischemia in an IACUC approved study that prioritized survival of all animal subjects. Thirty canines weighing over 12 kg were observed during elective neuter procedures with consent from owners. Randomization determined ligation of the right vs left spermatic cord. With both testicles remaining in the scrotum, blinded inspection was performed with a FLIR ONE Pro thermal imaging camera for smartphone use. The bilateral orchiectomy procedures were then completed as planned. RESULTS Within 11 minutes of ligation of the randomized spermatic cord, an obvious change in the thermal imaging pattern allowed for the correct diagnosis of the ischemic testicle in 30/30 (100%) of subjects in a blinded fashion. Temperature differences between testicles at the time of ischemia diagnosis ranged from 0.7°C to 3.7°C with an average difference of 1.79°C lower in the ischemic testicle (95% CI: [1.50, 2.08]). A thermal imaging evaluation of the testicles takes 30 seconds to perform. CONCLUSION Smartphone thermal imaging correctly diagnosed testicular ischemia in 100% of animal subjects in a blinded fashion. The clinical utility of this emerging point-of-care technique in the evaluation of testicular torsion is currently unknown.
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Affiliation(s)
| | | | - Tora Seals
- Missouri State University, Springfield, MO
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25
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MacDonald C, Burton M, Carachi R, O'Toole S. Why adolescents delay with presentation to hospital with acute testicular pain: A qualitative study. J Pediatr Surg 2021; 56:614-619. [PMID: 32828543 DOI: 10.1016/j.jpedsurg.2020.06.041] [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: 03/23/2020] [Revised: 05/21/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE Adolescents have poor outcomes following testicular torsion directly attributable to delay from onset of symptoms to presentation to hospital. The aim of this study was to investigate the barriers to urgent presentation in young men. METHODS Semistructured interviews were undertaken with young men (11-19 years), using a topic guide exploring issues surrounding testicular pain and health. Thematic analysis was undertaken using a framework approach. RESULTS Twenty-seven adolescents were recruited, data saturation was reached at sixteen participants, and median age was 13.5 years (range 11-18). The process by which an adolescent gets to hospital with testicular pain is slow. They must recognize the problem and alert their parents, who then use a 'watch and wait' policy to assess need for medical review, often leaving it 'a day' or overnight. Adolescent males do not engage with healthcare services independently of their parents. Additional factors preventing early presentation include: absence of knowledge about testicular pathology from adolescents and their parents; concern from the young people about raising a false alarm and family concerns about burdening healthcare services. CONCLUSIONS Recommendations include designing a testicular health education campaign for young men and educating parents regarding the medical conditions where a 'watch and wait' policy may be harmful to their child. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Caroline MacDonald
- School of MVLS, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland; Royal Hospital for Children, 1345 Govan Rd, Glasgow G51 4TF, Scotland.
| | - Maria Burton
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, S1 1WB, UK
| | - Robert Carachi
- School of MVLS, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland
| | - Stuart O'Toole
- School of MVLS, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland; Royal Hospital for Children, 1345 Govan Rd, Glasgow G51 4TF, Scotland
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26
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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.
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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.
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Data and data illustrations supporting the analysis of transcripts from interviews exploring the views and experiences of young men and their parents/guardians regarding testicular health. Data Brief 2020; 32:106106. [PMID: 32885003 PMCID: PMC7453114 DOI: 10.1016/j.dib.2020.106106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 12/03/2022] Open
Abstract
Evidence shows young men have poor outcomes from testicular torsion directly attributable to delay in presentation to hospital [1]. Only a third to a half of adolescents present within 6 h with testicular pain, [2,3] There is poor understanding of why adolescents delay in presenting with testicular pain. The authors started without an a-priori hypothesis and designed a thematic qualitative research protocol to explore the phenomena is a naturalistic setting [4,5] . Sixteen young men (11–19 years) and their parents or guardians underwent semi-structured interviews, directed by a topic guide which evolved with subsequent interview findings. Young men were recruited from out of school clubs to minimise the bias associated with schools or hospital recruitment, and were naïve to testicular disease. Verbatim transcriptions were coded, categories and themes formed and final concepts derived utilising a framework methodology. The figure included shows the initial topic guide. The data tables presented show the emergent themes and the final code book. The authors have utilised the analysis to explore the factors impeding young men in presenting early to hospital with testicular pain [6]. The authors feel the data tables and raw data will be of interest to other researchers interested in adolescent health, health access, public health, linguistics and healthcare qualitative methodology.
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28
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Taskinen S, Mäkelä E, Raivio T. Effect of Pediatric Testicular Torsion on Testicular Function in the Short Term. J Pediatr Surg 2020; 55:1613-1615. [PMID: 31718871 DOI: 10.1016/j.jpedsurg.2019.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/20/2019] [Accepted: 10/05/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate short-term testicular outcome after torsion in children. METHODS Fifty-four children and adolescents were evaluated after 6 months of the operation for testicular torsion. Testicular volume was measured and circulating Inhibin B, FSH, LH and testosterone levels were checked. RESULTS Delay from the onset of symptoms to surgery was shorter in the orchidopexy group (n = 47), than in the orchiectomy group (n = 7, p = 0.001). In the orchidopexy group, the median volume of the affected testis was 83% (IQR 43-104) of the contralateral testis (p = 0.002). The plasma hormone levels in orchidopexy and orchiectomy groups were: 148 ng/l (IQR 108-208) vs. 129 ng/l (IQR, 123-138, p = 0.269) for Inhibin B; 4.5 IU/L (IQR2.6-6.9) vs. 11.7 IU/L (IQR 4.3-12.8, p = 0.037) for FSH; 2.9 IU/L (IQR 1.3-3.7) vs. 4.8 (IQR 3.0-5.6, p = 0.066) for LH; and 13.6 nM (IQR 6.5-18.0) vs. 14.5 nM (IQR 6.7-15.9, p = 0.834) for testosterone. The association between FSH, LH as well as testosterone levels was most clear with the volume of the contralateral testis (Rho = 0.574, p < 0.001, Rho = 0.621, p = 0.001 and Rho 0.718, p < 0.001 respectively). CONCLUSIONS Testicular function is mainly dependent on the volume of contralateral testicle after testicular torsion. However, testis preserving surgery tends to maintain better function than orchiectomy. TYPE OF STUDY Retrospective review. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Eija Mäkelä
- Department of Pediatric Surgery, Helsinki, Finland
| | - Taneli Raivio
- Pediatric Research Center New Children's Hospital, Helsinki University Hospital, Helsinki, Finland; Department of Physiology, Medicum Unit, and Translational Stem Cell Biology and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Yasukawa D, Aisu Y, Hori T. Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults. World J Gastrointest Surg 2020; 12:307-325. [PMID: 32821340 PMCID: PMC7407845 DOI: 10.4240/wjgs.v12.i7.307] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.
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Affiliation(s)
- Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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30
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Wei SM, Wang RY, Chen YS. Sesamol Protects Testis from Ischemia-Reperfusion Injury through Scavenging Reactive Oxygen Species and Upregulating CREM τ Expression. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:9043806. [PMID: 32655774 PMCID: PMC7320277 DOI: 10.1155/2020/9043806] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023]
Abstract
Testicular torsion/detorsion-induced damage is considered as a typical ischemia-reperfusion injury attributed to excessive reactive oxygen species (ROS) production. ROS may regulate many genes whose expression affects cell-cycle regulation, cell proliferation, and apoptosis. The cAMP-responsive element modulator-τ (CREMτ) gene expression in the testis is essential for normal germ cell differentiation. The present study was aimed at investigating the effect of sesamol, a powerful antioxidant, on testicular ischemia-reperfusion injury and related mechanisms in an experimental testicular torsion-detorsion rat model. The type of our study was a randomized controlled trial. Sixty rats were randomly divided into the following 3 groups: (1) sham-operated control group (n = 20), (2) testicular ischemia-reperfusion group (n = 20), and (3) testicular ischemia-reperfusion+sesamol-treated group (n = 20). Testicular ischemia-reperfusion was induced by left testicular torsion (720° rotation in a counterclockwise direction) for 2 hours, followed by detorsion. Orchiectomy was performed at 4 hours or 3 months after detorsion. The testis was obtained for the analysis of the following parameters, including malondialdehyde level (a sensitive indicator of ROS), CREMτ expression, and spermatogenesis. In the testicular ischemia-reperfusion group, the malondialdehyde level was significantly increased with a concomitant significant decrease in CREMτ expression and spermatogenesis in ipsilateral testis. These results suggest that overproduction of ROS after testicular ischemia-reperfusion may downregulate CREMτ expression, which causes spermatogenic injury. Sesamol treatment resulted in a significant reduction in the malondialdehyde level and significant increase in CREMτ expression and spermatogenesis in ipsilateral testis. These data support the above suggestion. Our study shows that sesamol can attenuate testicular ischemia-reperfusion injury through scavenging ROS and upregulating CREMτ expression.
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Affiliation(s)
- Si-Ming Wei
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou City, Zhejiang Province 310015, China
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province 310053, China
| | - Rong-Yun Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province 310053, China
| | - Yan-Song Chen
- Department of Orthopedics, Zhejiang Xiaoshan Hospital, Hangzhou City, Zhejiang Province 311200, China
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province), Hangzhou City, Zhejiang Province 310005, China
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Song SH, Afşarlar ÇE, Xie HW, Hung AJ, Koh CJ. Estimating the time of onset of testicular torsion using ultrasonography in an experimental rat model. Ultrasonography 2020; 39:152-158. [PMID: 32098458 PMCID: PMC7065987 DOI: 10.14366/usg.19055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/04/2020] [Indexed: 11/05/2022] Open
Abstract
Purpose We aimed to document the time of onset of ultrasonographic and histologic changes in the testes of a rat model following testicular torsion. Methods Twenty-five Sprague-Dawley rats were divided into four groups. All animals underwent preoperative Doppler ultrasonography. Groups 1, 2, and 3 underwent unilateral surgical torsion of the testis lasting for 72, 24, and 6 hours, respectively. Group 4 underwent a sham operation. The animals were followed with Doppler ultrasonography at 6, 24, 48, and 72 hours postoperatively. Histologic examinations were performed at the designated final time point for each group. Results After torsion, enlargement of the epididymal head and thickening of the spermatic cord over time were noted. Based on the ultrasonographic dimensions,
the ratio of the epididymal volume increased with time following torsion (p=0.002). The torsed testes had an average weight gain of 0.27 g at 6 hours compared to the control testes, but an average weight loss of 0.22 g at 72 hours (P=0.006). Changes in testicular echotexture were noted as soon as 6 hours after torsion, but there was no consistent pattern of echotexture change thereafter. Histologically, viable tubules were seen 6 hours after torsion, while extensive hemorrhagic necrosis was found at 72 hours. Conclusion In evaluating testicular torsion, the enlargement ratio of the epididymis and thickening of the spermatic cord on Doppler ultrasonography may be useful for determining the urgency of immediate surgery. Changes in testicular echotexture may not be a reliable indicator of the time of onset.
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Affiliation(s)
- Sang Hoon Song
- 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 Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Çağatay E Afşarlar
- Department of Pediatric Surgery, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Hui Wen Xie
- Division of Pediatric Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Andrew J Hung
- University of Southern California (USC) Institute of Urology, Keck School of Medicine, USC, Los Angeles, CA, 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
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Kohler R, Hamdani A, Grämiger M. Use of intraoperative Indocyanine green fluorescence to assess testicular perfusion and viability when managing testicular torsion in a 26-year old man. Urol Case Rep 2019; 28:101063. [PMID: 31754602 PMCID: PMC6854066 DOI: 10.1016/j.eucr.2019.101063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 11/29/2022] Open
Abstract
Testicular torsion is an urological emergency requiring early diagnosis and immediate surgical intervention for successful salvage. Decision for testicular salvage is made during surgery by assessing the color of the testis. We present a case where Indocyanine green fluorescence was used to assess testicular perfusion during surgery as an additional evaluation tool for testicular viability.
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Affiliation(s)
- Rémy Kohler
- Pourtalès Hospital, Department of Surgery, Neuchâtel, Switzerland
| | - Antoine Hamdani
- Pourtalès Hospital, Department of Surgery, Neuchâtel, Switzerland
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Appelbaum R, Azari S, Clement M, Browne M. Testicular torsion: The unexpected terrible twos, a unique case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Laher A, Swart M, Honiball J, Perera M, Lawrentschuk N, Adam A. Near-infrared spectroscopy in the diagnosis of testicular torsion: valuable modality or waste of valuable time? A systematic review. ANZ J Surg 2019; 90:708-714. [PMID: 31512384 DOI: 10.1111/ans.15402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Testicular torsion (TT) is a urological emergency that affects one in 4000 males younger than 25 years. Delays in the management of TT may result in testicular ischaemia, testicular necrosis, orchidectomy and infertility. This review assesses the validity of near-infrared spectroscopy (NIRS) as a diagnostic tool in the assessment and diagnosis of TT. METHODS A systematic search of Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, PubMed, Scopus and Web of Science databases was performed in January 2019 using specific search terms. Selected studies were ranked and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS A total of nine studies that included 253 subjects (88 animals and 165 humans) with a mean sample size of 28.1 (standard deviation 40.8) subjects were included. The mean difference in testicular tissue oxygen saturation between torsed and non-torsed testes (Δ%StO2 ) were 45%, 42% (±5%), 26% and 5-18% in four animal studies and 2.0%, 3.0%, 6.7%, 6.8% and 23.0% in five human studies. The tissue oxygen saturation difference between contralateral healthy testes (controls) ranged from 1% to 10% in the five studies that alluded to this. CONCLUSION The current body of evidence does not support the use of NIRS in the work-up of TT. Well-designed clinical trials with large patient samples are required to determine whether NIRS may have some future role as a diagnostic modality in TT.
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Affiliation(s)
- Abdullah Laher
- Department of Emergency Medicine, Faculty of Health Sciences, The University of the Witwatersrand, Johannesburg, South Africa
| | - Marlize Swart
- Department of Emergency Medicine, Faculty of Health Sciences, The University of the Witwatersrand, Johannesburg, South Africa
| | - John Honiball
- Department of Emergency Medicine, Faculty of Health Sciences, The University of the Witwatersrand, Johannesburg, South Africa
| | - Marlon Perera
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, The University of Queensland, Brisbane, Queensland, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Olivia-Newton John Cancer Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ahmed Adam
- Division of Urology, Faculty of Health Sciences, The University of the Witwatersrand, Johannesburg, South Africa
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Romao RLP, Anderson KH, MacLellan D, Anderson P. Point-of-care influences orchiectomy rates in pediatric patients with testicular torsion. J Pediatr Urol 2019; 15:367.e1-367.e7. [PMID: 31130503 DOI: 10.1016/j.jpurol.2019.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/13/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study was to determine whether point-of-care (community hospitals vs. tertiary centers) or treatment-delaying variables (transfer, emergency room [ER] throughput, and distance traveled) affect orchiectomy rates in minors with testicular torsion (TT) using a national database. STUDY DESIGN This was a retrospective cohort study using prospectively collected data by the Canadian Institute of Health Information (CIHI) between 2010 and 2015. All Canadian male patients in the CIHI database aged <18 years with TT based on International Classification of Diseases (ICD) codes were included, except for those residing in Quebec. Variables collected were age, type of treating institution (community small/medium, community large, or tertiary/academic), transfer for definitive treatment, road distance traveled, and ER throughput. The outcome was testicular loss based on intervention codes for orchiectomy/orchidopexy. Univariable and multivariable analyses were performed using logistic regression. RESULTS A total of 1713 minors with TT were included. Overall orchiectomy rate was 28%. Most patients (52%) were treated at tertiary hospitals. Small/medium community hospitals depicted the lowest odds of orchiectomy on univariable and multivariable analyses (odds ratio [OR] = 0.54, confidence interval [CI]: 0.37-0.79, p < 0.001); academic hospitals were also associated with a lower odds of orchiectomy than large community ones. Transfer and distance traveled were not associated with the outcome. Age >12 and ER throughput less than 1 h were significantly associated with lower orchiectomy rates. In a subgroup analysis of patients aged <12 years (n = 278), transfer was the only factor associated with increased risk of orchiectomy (OR = 2.41 , CI: 1.09-5.33; p = 0.03). DISCUSSION This study showed that small and medium community hospitals had the lowest orchiectomy rates in minors with TT in Canada (Figure). However, on multivariable analysis, they performed similarly to tertiary/academic hospitals, with both being superior to large community hospitals. Transfer and distance traveled did not affect orchiectomy rates. Emergency room throughput had a statistically significant association with orchiectomy rates in every analysis and based on the study data would constitute the best target for policies aimed at reducing orchiectomy rates for TT in minors. The main limitation of this study is the inability to evaluate long-term testicular viability of patients not undergoing orchiectomy (i.e., true testicular salvage). CONCLUSIONS Type of hospital treating facility (point-of-care) affects orchiectomy rates in minors with TT. Small/medium community hospitals depict the lowest orchiectomy rates in Canada. Transfer to another facility for definitive care and distance traveled did not affect orchiectomy rates, except in a subgroup analysis of prepubertal boys. Longer ER throughput and prepubertal age were consistently associated with loss of the testicle.
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Affiliation(s)
- Rodrigo L P Romao
- Division of Pediatric Urology, IWK Health Centre; Department of Urology, Dalhousie University, Halifax, NS, Canada.
| | - Katherine H Anderson
- Division of Pediatric Urology, IWK Health Centre; Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Dawn MacLellan
- Division of Pediatric Urology, IWK Health Centre; Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Peter Anderson
- Division of Pediatric Urology, IWK Health Centre; Department of Urology, Dalhousie University, Halifax, NS, Canada
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Abstract
The term primary gonadal failure encompasses not only testicular insufficiency in 46,XY males and ovarian insufficiency in 46,XX females, but also those disorders of sex development (DSD) which result in gender assignment that is at variance with the genotype and gonadal type. In boys, causes of gonadal failure include Klinefelter and other aneuploidy syndromes, bilateral cryptorchidism, testicular torsion, and forms of 46,XY DSD such as partial androgen insensitivity. Causes in girls include Turner syndrome and other aneuploidies, galactosemia, and autoimmune ovarian failure. Iatrogenic causes in both boys and girls include the late effects of childhood cancer treatment, total body irradiation prior to bone marrow transplantation, and iron overload in transfusion-dependent thalassaemia. In this paper, a brief description of the physiology of testicular and ovarian development is followed by a section on the causes and practical management of gonadal impairment in boys and girls. Protocols for pubertal induction and post-pubertal hormone replacement - intramuscular, oral and transdermal testosterone in boys; oral and transdermal oestrogen in girls - are then given. Finally, current and future strategies for assisted conception and fertility preservation are discussed.
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Affiliation(s)
- Asmahane Ladjouze
- Faculté de Médecine d'Alger, Service de Pédiatrie, Centre Hospitalo-Universitaire Bad El Oued, 1 Boulevard Said Touati, Algiers, Algeria.
| | - Malcolm Donaldson
- Section of Child Health, School of Medicine, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, United Kingdom.
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