Predictive Parameters of Testicular Salvage of Pediatric Testicular Torsion: A 6-Year Experience of a Single Center

Seungsoo Lee; Bu Kyung Park; Moon Kee Chung; Jae Min Chung; Sang Don Lee

doi:10.14777/uti.2016.11.1.25

Journal List > Urogenit Tract Infect > v.11(1) > 1084197

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Park, Chung, Chung, and Lee: Predictive Parameters of Testicular Salvage of Pediatric Testicular Torsion: A 6-Year Experience of a Single Center

Original Article

Urogenit Tract Infect 2016;11(1):25-29.

Published online: 20 April 2016

DOI: https://doi.org/10.14777/uti.2016.11.1.25

Predictive Parameters of Testicular Salvage of Pediatric Testicular Torsion: A 6-Year Experience of a Single Center

Seungsoo Lee^1,^2,^∗, Bu Kyung Park^1,^∗, Moon Kee Chung^1,², Jae Min Chung^1,², Sang Don Lee^1,²

¹Department of Urology, Pusan National University School of Medicine, Yangsan, Korea

²Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

Correspondence to: Sang Don Lee http://orcid.org/0000-0001-9459-3887 Department of Urology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-55-360-2134, Fax: +82-55-360-2164 E-mail: lsd@pusan.ac.kr

^∗ These authors contributed equally to this study and should be considered co-first authors.

Received 30 March 2016 Revised 8 April 2016 Accepted 8 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We evaluated parameters associated with testicular salvage in boys with testicular torsion.

Materials and Methods

During 2009–2014, 19 boys younger than 18 years old underwent emergency surgery for testicular torsion in our hospital. Age, chief complaint, laterality of the torsion, physical appearance, ultrasonographic results, duration between the onset of symptoms and hospital visit, duration between the onset of symptoms and start of surgery, intraoperative appearance, surgical method (orchiopexy or orchiectomy), and any postoperative complications were analyzed retrospectively. Cases were categorized according to salvageable testes (n=14) or unsalvageable testes (n=5) groups based on testes viability.

Results

The mean age was not significantly different between the two groups. All patients were diagnosed using color Doppler ultrasonography of the scrotum. Six (42.9%) boys in the salvageable testes group and all five in the unsalvageable testes group were transferred from other clinics or hospitals (p=0.026). The mean duration between the onset of symptoms and hospital visit was 925 minutes in the salvageable testes group and 3,488 minutes in the unsalvageable testes group (p=0.042), and the mean duration between the onset of symptoms and start of surgery was 1,131 minutes in the salvageable testes group and 3,777 minutes in the unsalvageable testes group (p=0.042).

Conclusions

There was a high possibility that orchiectomy was required if surgery was delayed. However, even when a boy is admitted to the hospital more than 24 hours after the onset of symptoms, the testis can still be viable provided the surgery is performed as quickly as possible.

Keywords: Testis, Spermatic cord torsion, Orchiectomy, Orchiopexy

References

1. McAndrew HF, Pemberton R, Kikiros CS, Gollow I. The incidence and investigation of acute scrotal problems in children. Pediatr Surg Int. 2002; 18:435–7.

2. Nelson CP, Williams JF, Bloom DA. The cremasteric reflex: a useful but imperfect sign in testicular torsion. J Pediatr Surg. 2003; 38:1248–9.

3. Sidler D, Brown RA, Millar AJ, Rode H, Cywes S. A 25-year review of the acute scrotum in children. S Afr Med J. 1997; 87:1696–8.

4. Kadish HA, Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics. 1998; 102:73–6.

5. Lewis AG, Bukowski TP, Jarvis PD, Wacksman J, Sheldon CA. Evaluation of acute scrotum in the emergency department. J Pediatr Surg. 1995; 30:277–81. ; discussion 281–2.

6. Bae TH, Jung DY, Kim W, Cho JP. Differential diagnostic method of acute scrotum. J Korean Soc Emerg Med. 1997; 8:385–9.

7. Mansbach JM, Forbes P, Peters C. Testicular torsion and risk factors for orchiectomy. Arch Pediatr Adolesc Med. 2005; 159:1167–71.

8. Makela E, Lahdes-Vasama T, Rajakorpi H, Wikstrom S. A 19-year review of paediatric patients with acute scrotum. Scand J Surg. 2007; 96:62–6.

9. Saxena AK, Castellani C, Ruttenstock EM, Hollwarth ME. Testicular torsion: a 15-year single-centre clinical and histological analysis. Acta Paediatr. 2012; 101:e282–6.

10. Mestrovic J, Biocic M, Pogorelic Z, Furlan D, Druzijanic N, Todoric D, et al. Differentiation of inflammatory from noninflammatory causes of acute scrotum using relatively simple laboratory tests: prospective study. J Pediatr Urol. 2013; 9:313–7.

11. Mellick LB. Torsion of the testicle: it is time to stop tossing the dice. Pediatr Emerg Care. 2012; 28:80–6.

12. Gunther P, Rubben I. The acute scrotum in childhood and adolescence. Dtsch Arztebl Int. 2012; 109:449–57. ; quiz 458.

13. Zhao LC, Lautz TB, Meeks JJ, Maizels M. Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of care. J Urol. 2011; 186:2009–13.

14. Korbel EI. Torsion of the testis. J Urol. 1974; 111:521–2.

15. Kim HS, Lee SW, Yoo TK, Kang JY. Clinical outcomes of scrotal exploration for acute scrotum in children less than 13 years old. Korean J Pediatr Urol. 2009; 1:100–4.

16. Boettcher M, Krebs T, Bergholz R, Wenke K, Aronson D, Reinshagen K. Clinical and sonographic features predict testicular torsion in children: a prospective study. BJU Int. 2013; 112:1201–6.

17. Yazihan N, Ataoglu H, Koku N, Erdemli E, Sargin AK. Protective role of erythropoietin during testicular torsion of the rats. World J Urol. 2007; 25:531–6.

18. Horica CA, Hadziselimovic F, Kreutz G, Bandhauer K. Ultrastructural studies of the contorted and contralateral testicle in unilateral testicular torsion. Eur Urol. 1982; 8:358–62.

19. Thomas WE, Williamson RC. Diagnosis and outcome of testicular torsion. Br J Surg. 1983; 70:213–6.

20. Bartsch G, Frank S, Marberger H, Mikuz G. Testicular torsion: late results with special regard to fertility and endocrine function. J Urol. 1980; 124:375–8.

21. Cattolica EV, Karol JB, Rankin KN, Klein RS. High testicular salvage rate in torsion of the spermatic cord. J Urol. 1982; 128:66–8.

22. Ringdahl E, Teague L. Testicular torsion. Am Fam Physician. 2006; 74:1739–43.

23. Liang T, Metcalfe P, Sevcik W, Noga M. Retrospective review of diagnosis and treatment in children presenting to the pediatric department with acute scrotum. AJR Am J Roentgenol. 2013; 200:W444–9.

24. Nussbaum Blask AR, Rushton HG. Sonographic appearance of the epididymis in pediatric testicular torsion. AJR Am J Roentgenol. 2006; 187:1627–35.

25. Kaye JD, Shapiro EY, Levitt SB, Friedman SC, Gitlin J, Freyle J, et al. Parenchymal echo texture predicts testicular salvage after torsion: potential impact on the need for emergent exploration. J Urol. 2008; 180(4 Suppl):1733–6.

26. Chmelnik M, Schenk JP, Hinz U, Holland-Cunz S, Gunther P. Testicular torsion: sonomorphological appearance as a predictor for testicular viability and outcome in neonates and children. Pediatr Surg Int. 2010; 26:281–6.

27. Lysiak JJ, Turner SD, Nguyen QA, Singbartl K, Ley K, Turner TT. Essential role of neutrophils in germ cell-specific apoptosis following ischemia/reperfusion injury of the mouse testis. Biol Reprod. 2001; 65:718–25.

28. Baccetti B, Collodel G, Piomboni P. Apoptosis in human ejaculated sperm cells (notulae seminologicae 9). J Submicrosc Cytol Pathol. 1996; 28:587–96.

29. Bohring C, Krause W. Immune infertility: towards a better understanding of sperm (auto)-immunity. The value of proteomic analysis. Hum Reprod. 2003; 18:915–24.

Table 1.

Age distribution of boys with testicular torsion under 18-year-old (n=19)

Age (y)	Number (%)
0	1 (5.3)
5	1 (5.3)
7	1 (5.3)
12	3 (15.8)
13	3 (15.8)
14	2 (10.5)
15	2 (10.5)
16	2 (10.5)
17	2 (10.5)
18	2 (10.5)

Table 2.

Patient characteristics in the salvageable testes group and unsalvageable testes group

	Salvageable testesgroup	Unsalvageable testes group	p-value
Total	14 (73.7)	5 (26.3)
Age (mo)	164 (57–212)	134 (2–221)	0.853
Laterality			0.120
Left	9 (64.3)	5 (100.0)
Right	5 (35.7)	0
Diagnosis (%)
Prehn's sign	3 (21.4)	2 (40.0)
Doppler ultrasonography	14 (100.0)	5 (100.0)
Visiting other clinics or hospitals (%)	6 (42.9)	5 (100.0)	0.026
Duration (min)
Symptom onset-visiting center	925 (62–4,710)	3,488 (391–10,348)	0.042
Symptom onset-surgery start	1,131 (225–4,970)	3,777 (675–10,700)	0.042

Values are presented as number (%) or number (range).

TOOLS

Similar articles