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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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Shi J, Chen Z, Zhang L, Li H. Scrotal small-incision to remove the testicular appendage for the treatment of patients with testicular appendage torsion: An experience of 230 cases. Asian J Surg 2024; 47:2012-2013. [PMID: 38242781 DOI: 10.1016/j.asjsur.2023.12.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/29/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- Jizhou Shi
- Department of Pediatric Surgery, Shengli Oilfield Central Hospital, Dongying, 257034, PR China
| | - Zedong Chen
- Department of Pediatric Surgery, Tengzhou Central People's Hospital, Zaozhuang, 277599, PR China
| | - Lina Zhang
- Department of Emergency, Zhangqiu District People's Hospital, Jinan, 250200, PR China
| | - He Li
- Department of Urology, Children's Hospital Affiliated to Shandong University, Jinan, 250000, PR China; Department of Urology, Jinan Children's Hospital, Jinan, 250000, PR China.
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Maynard W, Shanmugathas N, Mundell A, Yassin M, Bertoncelli-Tanaka M, Morley R, Minhas S. Scrotal exploration for acute testicular pain: A contemporary UK series from a tertiary centre. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221099390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The objective of this study was to assess the evaluation and operative outcomes of patients attending a single urology centre with acute testicular pain (ATP) who underwent scrotal exploration. We sought to determine adherence to the Royal College of Surgeons England (RCS) commissioning guide on testicular torsion, clinical and radiological features predictive of torsion, time-dependent salvage rates and surgical technique in a contemporary cohort. Patients and Methods: A single-centre retrospective review was carried out from 2015 to 2020. All patients presenting with acute testicular pain undergoing surgical exploration were included. Results: 140 patients were identified, median age 16 years, 40 had testicular torsion (TT) (30%) where nausea (positive predictive value (PPV) 51.7%, p = 0.009) and abnormal testis lie (PPV 50%, p = 0.008) were more frequent. TT was the most common diagnosis if presenting <4 hours (44%), and in patients 13–16 years (62%). Time-to-surgery from the assessment was <3 hours in 109 of 128 (85.2%). The overall salvage rate was 74.4%, with salvage rates of 100% at 6 hours from the onset of pain. Viable tissue was seen on histology in 30% of orchidectomies, up to 25 hours from the onset of pain. Discussion: Surgical exploration <6 hours from the onset of pain is the threshold for salvage in TT. Clinical findings should be combined with patient age and time to presentation to aid diagnosis. Patients between 13 and 16 years are at the highest risk of TT and frequently present early following the onset of pain. Given the heterogenicity of surgical management and the highest risk of TT to the paediatric population, speciality organisations should produce definitive guidance on the management of TT. Level of evidence: OCEBM Level 3 evidence
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Affiliation(s)
- William Maynard
- ST4 Urology, North Central and East Thames deanery, London, UK
- Urology Department, Charing Cross Hospital, Fulham Palace Road, London
| | | | | | | | | | | | - Suks Minhas
- Imperial College Healthcare NHS Trust, London, UK
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McLaren PSM. A systematic review on the utility of ultrasonography in the diagnosis of testicular torsion in acute scrotum patients. Radiography (Lond) 2021; 27:943-949. [PMID: 33451883 DOI: 10.1016/j.radi.2020.12.012] [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: 09/26/2020] [Revised: 12/18/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Ultrasound is a valuable tool in establishing the cause of acute scrotum pain. However, its role in testicular torsion (TT) detection remains controversial. This review aims integrate pre-existing data to assess the value of B-mode and colour Doppler ultrasound (CDS) features combined in the detection of TT in acute scrotum pain patients of all ages. METHODS A search through electronic databases, grey literature and hand searching using specific search terms was conducted to identify relevant literature. Search results were subjected to a three-step selection process to ensure the inclusion criteria of this review were met. Statistical data pertaining to the accuracy, sensitivity, and specificity of the B-mode, CDS and combined B-mode CDS features were extracted. These results subsequently underwent a narrative analysis. RESULTS Five studies met the inclusion criteria. A variety of B-mode features were identified. Most studies showed that reliance on CDS alone can be prone to false-negative results. The combination of B-mode and CDS features were found to increase the overall sensitivity of ultrasound towards TT (up to 100% in 3 studies). All studies recommended correlation with clinical examination findings. Several limitations in methodology of the included studies were noted: small sample populations and lack of information on the experience of ultrasound practitioners. This highlighted the need for a primary study with a larger sample population to validate the findings of this review. CONCLUSION The combination of B-mode and CDS ultrasound is a useful and reliable triage tool in the detection of TT, particularly in equivocal or low suspicion cases but its findings should always be adjunct with clinical examination. Nevertheless, it is noted that appropriate service level agreements, pathways, and training are key factors in ensuring effectiveness of the process. IMPLICATIONS FOR PRACTICE Dedicated training and appropriate departmental protocol are key in ensuring accurate diagnosis across all levels of practice.
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Affiliation(s)
- P S M McLaren
- Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, NE1 4LP, Newcastle upon Tyne, United Kingdom.
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Yan Y, Chen S, Chen Z, Pei X, Zhou J, Xiao Y, Wang X. The applied value of medical history, physical examination, colour-Doppler ultrasonography and testis scintigraphy in the differential diagnosis of acute scrotum. Andrologia 2018; 50:e12973. [PMID: 29460432 DOI: 10.1111/and.12973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 11/28/2022] Open
Abstract
Acute scrotum, especially testicular torsion, is a common surgical emergency. A delay in diagnosis or management may lead to permanent testicular ischaemic damage. Thus, it is particularly important to differentiate testicular torsion from other acute scrotum conditions as soon as possible. Our study has retrospectively investigated 358 patients with acute scrotum admitted to our hospital from the year 2007 to 2016. We have collected a thorough history and clinical data and drew the conclusion by comparing clinical features of different acute scrotum cases, medical history, imaging and surgical findings. Therefore, we propose an innovative "Testicular Torsion (TT) Green Channel" concept. Through the combination of a comprehensive medical history, physical examination and auxiliary colour-Doppler ultrasonography, the diagnosis of testicular torsion is definite in most circumstances. Testis scintigraphy is a novel and complementary diagnostic modality that can reduce the negative exploration rate in ambiguous and certain cases. The TT Green Channel is a new concept in the management of testicular torsion.
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Affiliation(s)
- Y Yan
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - S Chen
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Z Chen
- Department of Urology, Jingzhou Central Hospital, The Second Clinical College, Yangtze University, Jingzhou, China
| | - X Pei
- Department of Emergency, Jingzhou Central Hospital, The Second Clinical College, Yangtze University, Jingzhou, China
| | - J Zhou
- Department of Urology, Jingzhou Central Hospital, The Second Clinical College, Yangtze University, Jingzhou, China
| | - Y Xiao
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Laboratory of Precision Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - X Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
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