Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children

Overview

Journal Urology

Specialty Urology

Date 2018 Mar 25

PMID 29572055

Citations 13

Authors

Gwen M Grimsby

Bruce J Schlomer

Vani S Menon

Lauren Ostrov

Melise Keays

Kunj R Sheth

Carlos Villanueva

Candace Granberg

Daniel DaJusta

Martinez Hill

Emma Sanchez

Clanton B Harrison

Micah A Jacobs

Berk Burgu

Halim Hennes

Linda A Baker

Affiliations

Soon will be listed here.

Abstract

Objective: To prospectively correlate pain duration, red scrotal skin, ultrasound appearance of testis, and intraoperative testis color to future testis atrophy after acute testicular torsion.

Methods: Patients 2 months-18 years old with unilateral acute scrotum were consecutively enrolled in a National Institutes of Health transcutaneous near-infrared spectroscopy study, with a subgroup analysis of the true torsion group. Presence or absence of red scrotal skin, pain duration, testicular heterogeneity on preoperative ultrasound, and intraoperative testis color based on a novel visual chart 5 minutes after detorsion were recorded. All testes underwent orchiopexy regardless of appearance. Percent volume difference between normal and torsed testicles on follow-up ultrasound was compared between patients with and without risk factors.

Results: Thirty of 56 patients who had surgical detorsion underwent scrotal ultrasound at a mean of 117 days after surgery. A color of black or hemorrhagic 5 minutes after detorsion, pain duration >12 hours, and heterogeneous parenchyma on preoperative ultrasound were associated with significant testis volume loss in follow-up compared with normal testis. All patients with a black or hemorrhagic testis had >80% volume loss. Erythematous scrotal skin was not significantly associated with smaller affected testis volume in follow-up.

Conclusion: Based on the high atrophy rate, orchiectomy can be considered for testes that are black or hemorrhagic 5 minutes after detorsion. Pain duration >12 hours and parenchymal heterogeneity on preoperative ultrasound were also associated with testis atrophy. Red scrotal skin was not a reliable predictor of atrophy and should not delay exploration.

Citing Articles

Indocyanine green fluorescence imaging as a predictor of long-term testicular atrophy in testicular torsion: a pilot study.

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Factors Determining Testicular Torsion and Consequent Orchiectomy in Pediatric Patients Presenting With Scrotal Pain.

Yen C, Chang Y, Ming Y, Gau C, Wu C, Lee J Pediatr Emerg Care. 2023; 39(10):744-750.

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Situation of Pediatric Patients with Testicular Torsion in Times of COVID-19.

Komarowska M, Kowalska M, Grubczak K, Pawelczyk A, Hermanowicz A, Debek W Emerg Med Int. 2023; 2023:9960452.

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Testicular salvage: using machine learning algorithm to develop a predictive model in testicular torsion.

Eksi M, Yavuzsan A, Evren I, Ayten A, Fakir A, Akkas F Pediatr Surg Int. 2022; 38(10):1481-1486.

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