Improving Organ Salvage in Testicular Torsion: Comparative Study of Patients Undergoing vs Not Undergoing Preoperative Manual Detorsion

Purpose We compared surgical outcomes between patients undergoing and those not undergoing preoperative manual detorsion for intravaginal testicular torsion. Materials and Methods We retrospectively analyzed consecutive patients treated surgically for testicular torsion who were examined within 24 h...

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Bibliographic Details
Published in:	The Journal of urology Vol. 197; no. 3; pp. 811 - 817
Main Authors:	Dias Filho, Aderivaldo Cabral, Oliveira Rodrigues, Ruytemberg, Riccetto, Cassio L.Z, Oliveira, Paulo Gonçalves
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-03-2017
Subjects:	ischemia male spermatic cord torsion testis urologic surgical procedures Urology TT spermatic cord torsion US Doppler Doppler enhanced sonography testis testicular torsion urologic surgical procedures male ischemia
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Summary:	Purpose We compared surgical outcomes between patients undergoing and those not undergoing preoperative manual detorsion for intravaginal testicular torsion. Materials and Methods We retrospectively analyzed consecutive patients treated surgically for testicular torsion who were examined within 24 hours of symptoms at our emergency department between January 2012 and September 2015. Explanatory variables were age, presentation delay (time between symptoms and urological examination), surgical wait time (time from examination to surgery), and whether manual detorsion was attempted and, if attempted, was declared successful. End points were surgical outcome (orchiopexy, orchiectomy) and testicular rotation at surgery. Statistical analysis included nonparametric tests and logistic regression. Statistical significance and confidence intervals were set at p <0.05 and 0.95, respectively. Results Detorsion was attempted in 76 of 133 cases (57.1%) and was successful in 72 (95.1%). Patient age (median 15.6 vs 17.4 years, p = 0.115), presentation delay (6.6 vs 6.3 hours, p = 1.0) and surgical wait time (3.5 vs 3.2 hours, p = 0.412) were comparable between patients who underwent manual detorsion attempt and those who did not. Testicular rotation was less among successfully detorsed patients. Orchiectomy was performed in 2 of 72 successfully detorsed patients (2.8%), compared to 15 of 61 patients (24.6%) in whom detorsion was not attempted or was unsuccessful (OR 11.23, p = 0.0002). Logistic regression indicated that surgical wait time (OR 0.95, p = 0.002) and successful detorsion (OR 17.38, p = 0.001) were independently associated with orchiopexy. Conclusions Preoperative manual detorsion was associated with improved surgical salvage in patients with testicular torsion.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-5347 1527-3792
DOI:	10.1016/j.juro.2016.09.087