A Ten-Year Study on Risk Factors of Orchiectomy in Testicular Torsion

Rulianov Rulianov, Kuncoro Adi, Ferry Safriadi

Abstract


Testicular torsion is a common urological emergency among children, peaking in neonates and pubertal age with an incidence rate of 3.8 in 100.000 (0.004%) annually. This study aimed to explore the characteristics of testicular torsion cases and risk factors for orchiectomy in testicular torsion patients. This was a retrospective study on medical records of patients diagnosed with testicular torsion underwent surgery at the urology department of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from January 2009 to August 2019. Patient characteristics including age, duration of symptom, location, etiology, and degree of torsion were analyzed. A total of 86 cases of testicular torsion were identified, with most cases (54 cases, 62.8%) occured at the mean age 14.67 ± 2.4 years old. Most patients (69 patients, 80.2 %) arrived more than six hours after the onset, and 65 (75.5%) and 4 (4.6%) of them underwent orchiectomy and orchidopexy, respectively. The remaining patients (17 patients, 19.8%) came less than 6 hours after the onset and only 8 (9.3%) and 9 (10.4%) underwent orchiectomy and orchidopexy, respectively. Both duration of torsion (p = 0.000, P<0.05) and degree of torsion (p = 0.006 , P<0.05) were significantly correlated with orchiectomy. In conclusion,  the risk factor for orchiectomy is strongly related to duration and degree of torsion. The chance for testis salvation increases if torsion happens before 4.5 hours and the degree of torsion is below 180 degrees. Prompt diagnosis and treatment is the only key to testicular salvation.

Keywords


Degree of torsion; torsion duration; testicular torsion

Full Text:

PDF

References


  1. Sharp VJ, Kieran K, Arlen AM. Testicular torsion: diagnosis, evaluation, and management. Am Fam Physician. 2013;88(12):835–40.
  2. Howe AS, Vasudevan V, Kongnyuy M, Rychik K, Thomas LA, Matuskova M, et al. Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion. Transl Androl Urol. 2017;6(6):1159–66.
  3. Ali MA, Oyortey M, Maalman RS, Donkor OY, Quarshie H. Testicular torsion in a catheterized geriatric 73-year-old patient, making an early diagnosis: a case report. J Surg Case Rep. 2021;2021(5):rjab191.
  4. Filho ACD, Alves JR, Filho HB, de Oliveira PG. The amount of spermatic cord rotation magnifies the timerelated orchidectomy risk in Intravaginal testicular torsion. Int Braz J Urol. 2016;42(6):1210–9.
  5. Kargl S, Haid B. Torsion of an undescended testis-a surgical pediatric emergency. J Pediatr Surg. 2020;55(4):660–4.
  6. Karaguzel E, Kadihasanoglu M, Kutlu O. Mechanisms of testicular torsion and potential protective agents. Nat Rev Urol. 2014;11(7):391–9.
  7. Reyes JG, Farias JG, Henríquez-Olavarrieta S, Madrid E, Parraga M, Zepeda AB, et al. The hypoxic testicle: physiology and pathophysiology. Oxid Med Cell Longev. 2012;2012.
  8. Liguori G, Bucci S, Zordani A, Benvenuto S, Ollandini G, Mazzon G, et al. Role of US in acute scrotal pain. World J Urol. 2011;29(5):639–43.
  9. Fehér ÁM, Bajory Z. A review of main controversial aspects of acute testicular torsion. J Acute Dis. 2016;5(1):1–8.
  10. Tanaka K, Ogasawara Y, Nikai K, Yamada S, Fujiwara K, Okazaki T. Acute scrotum and testicular torsion in children: a retrospective study in a single institution. J Pediatr Urol. 2020;16(1):55–60.
  11. Boettcher M, Bergholz R, Krebs TF, Wenke K, Aronson DC. Clinical predictors of testicular torsion in children. Urology. 2012;79(3):670–4.
  12. Datta V, Dhillon G, Voci S. Testicular torsion/detorsion. Ultrasound Q. 2011;27(2):127–8.
  13. Riaz-Ul-haq M, Mahdi DEA, Elhassan EU. Neonatal testicular torsion; a review article. Iran J Pediatr. 2012;22(3):281–9.
  14. Kapoor S. Testicular torsion: a race against time. Int J Clin Pract. 2008;62(5):821–7.
  15. Wang F, Mo Z. Clinical evaluation of testicular torsion presenting with acute abdominal pain in young males. Asian J Urol. 2019;6(4):368–72.
  16. Bayne CE, Villanueva J, Davis TD, Pohl HG, Rushton HG. Factors associated with delayed presentation and misdiagnosis of testicular torsion: a case-control study. J Pediatr. 2017;186:200–4.
  17. Dias Filho AC, Oliveira Rodrigues R, Riccetto CLZ, Oliveira PG. Improving organ salvage in testicular torsion: comparative study of patients undergoing vs not undergoing preoperative manual detorsion. J Urol. 2017;197(3):811–7.
  18. Sharp VJ, Kieran K, Arlen AM, Barton FJ, Filho ACD, Alves JR, et al. Testicular torsion: orchiectomy or orchiopexy?. J Pediatr Urol. 2013;88(6):210–3.
  19. Yiee JH, Lynne Chang A, Kaplan A, Kwan L, Chung PJ, Litwin MS. Patterns of care in testicular torsion: influence of hospital transfer on testicular outcomes. J Pediatr Urol. 2013;9(6 0 0):713–20.
  20. MacDonald C, Kronfli R, Carachi R, O’Toole S. A systematic review and meta-analysis revealing realistic outcomes following paediatric torsion of testes. J Pediatr Urol. 2018;14(6):503–9.




DOI: https://doi.org/10.15395/mkb.v54n2.2514

Article Metrics

Abstract view : 524 times
PDF - 433 times

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


 


Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 


View My Stats