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Eur J Pediatr Surg
DOI: 10.1055/s-0044-1790244
Original Article

A Survey of Preoperative, Perioperative, and Postoperative Management Practices for Testicular Torsion in Pediatric Patients among European Surgeons

Amit Beher
1   Department of Pediatric Surgery, Pediatric Urology and Center for Severely Burned Children, Klinikum Kassel GmbH, Kassel, Hessen, Germany
,
Julio César Moreno-Alfonso 
2   Department of Pediatric Surgery, Navarre Hospital Complex, Pamplona, Navarre, Spain
,
Hanna Garnier
3   Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
,
Dogus Darici
4   Department of Anatomy and Molecular Neurobiology, Institute of Anatomy and Molecular Neurobiology, Westfälische-Wilhelms-University, Muenster, Westfalen, Germany
,
Martin Jonathan Salö
5   Department of Pediatric Surgery, Skåne University Hospital, Lund, Skåne, Sweden
6   Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
,
Ophelia Aubert 
7   Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
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Abstract

Introduction Management of testicular torsion varies between specialties resulting in lack of standardization. The aim of this survey was to assess pre-, peri-, and postoperative differences.

Methods An online questionnaire was distributed in 2023 to general and pediatric surgeons, pediatric urologists, and urologists by the Trainees of European Pediatric Surgery.

Main Results Among 88 respondents (92% tertiary referral hospital), 38% always or usually perform sonography in case of suspected torsion respectively. In addition, 15% always attempt manual detorsion and 44% depending on the clinical presentation. Most surgeons (93%) favor a scrotal approach. Interestingly, pediatric surgeons choose a transscrotal while other specialties opt for a midline incision (p = 0.002). The majority (57%) employ a three-point fixation, while 42% opt for a two-point fixation. In case of necrotic testis, 61% puncture the testis with 52% opting for surgical removal, while 33% perform orchiectomy and 6% leave it in situ. Regarding necrotic or borderline-appearing testis, 54% take a biopsy. Furthermore, 82% perform prophylactic orchidopexy of the contralateral side during the same session. Postoperative antibiotics are always administered by 12%, while 52% do so sometimes. Most perform sonographic (58%) or clinical (57%) follow-up 3 months postoperatively. Notably, pediatric surgeons and urologists perform follow-up more frequently themselves, while general surgeons/urologists recommend follow-up by pediatricians (p = 0.002). In addition, 76% of responders affirm adhering to European Association of Urology guidelines. Unawareness of guidelines and institutional practices are reasons most commonly cited for nonadherence.

Conclusion Our study reveals significant disparities in the pre-, peri-, and postoperative management of testicular torsion underscoring the need for establishing standardized practices.

Keywords

testicular torsion - children - clinical practice - guidelines - surgery

Supplementary Material



Publication History

Received: 08 May 2024

Accepted: 13 August 2024

Article published online:
09 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Yen CW, Chang YJ, Ming YC, Gau CC, Wu CT, Lee J. Factors determining testicular torsion and consequent orchiectomy in pediatric patients presenting with scrotal pain. Pediatr Emerg Care 2023; 39 (10) 744-750
    PubMedGoogle Scholar
  • 2 Pentyala S, Lee J, Yalamanchili P, Vitkun S, Khan SA. Testicular torsion: a review. J Low Genit Tract Dis 2001; 5 (01) 38-47
    PubMedGoogle Scholar
  • 3 Goh EH, Pian PM, Singam P. et al. An unusual cause of acute scrotum in a 65-year-old man. Urotoday Int J 2011; 4 (06) art 71
    PubMedGoogle Scholar
  • 4 Sharp VJ, Kieran K, Arlen AM. Testicular torsion: diagnosis, evaluation, and management. Am Fam Physician 2013; 88 (12) 835-840
    PubMedGoogle Scholar
  • 5 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 (05) 2009-2013
    CrossrefPubMedGoogle Scholar
  • 6 van Doeveren T, Somani BK, , T Hoen LA, Haensel SM. Real-world management of testicular torsion: level of adherence to the EAU Pediatric Urology guidelines. J Pediatr Urol 2023; 19 (01) 117-124
    CrossrefPubMedGoogle Scholar
  • 7 Al-Zahrani FA, Alsulami FA, Alghamdi FA. et al. Success of immediate manual detorsion of testicular torsion. J Pharm Res Int 2021; 33 (53A): 235-240
    PubMedGoogle Scholar
  • 8 Antao B, MacKinnon AE. Axial fixation of testes for prevention of recurrent testicular torsion. Surgeon 2006; 4 (01) 20-21 , 62
    CrossrefPubMedGoogle Scholar
  • 9 Mishriki SF, Winkle DC, Frank JD. Fixation of a single testis: always, sometimes or never. Br J Urol 1992; 69 (03) 311-313
    CrossrefPubMedGoogle Scholar
  • 10 Laher A, Ragavan S, Mehta P, Adam A. Testicular torsion in the emergency room: a review of detection and management strategies. Open Access Emerg Med 2020; 12: 237-246
    CrossrefPubMedGoogle Scholar
  • 11 Weber DM, Rösslein R, Fliegel C. Color Doppler sonography in the diagnosis of acute scrotum in boys. Eur J Pediatr Surg 2000; 10 (04) 235-241
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol 2018; 48 (05) 735-744
    CrossrefPubMedGoogle Scholar
  • 13 Ghazali J. Testicular torsion in an elderly man. J Diagn Med Sonogr 2007; 23: 26-29
    CrossrefPubMedGoogle Scholar
  • 14 Agrawal AM, Tripathi PS, Shankhwar A, Naveen C. Role of ultrasound with color Doppler in acute scrotum management. J Family Med Prim Care 2014; 3 (04) 409-412
    CrossrefPubMedGoogle Scholar
  • 15 Middleton WD, Middleton MA, Dierks M, Keetch D, Dierks S. Sonographic prediction of viability in testicular torsion: preliminary observations. J Ultrasound Med 1997; 16 (01) 23-27 , quiz 29–30
    CrossrefPubMedGoogle Scholar
  • 16 Güneş M, Umul M, Altok M. Atypical testicular torsion: we must be cautious in the course of manual detorsion. Pediatr Emerg Care 2016; 32 (10) 691-692
    CrossrefPubMedGoogle Scholar
  • 17 Hosokawa T, Urushibara A, Tanami Y. et al. Prediction of testicular atrophy based on sonographic findings immediately after successful manual detorsion. Australas J Ultrasound Med 2022; 26 (01) 26-33
    CrossrefPubMedGoogle Scholar
  • 18 Hsu CT, Chiu PW. Successful outcome of manual testicular detorsion using point-of-care ultrasound guidance: a clinical experience. Pediatr Emerg Care 2023; 39 (10) 813-815
    PubMedGoogle Scholar
  • 19 Mukendi AM, Kruger D, Haffejee M. Characteristics and management of testicular torsion in patients admitted to the Urology Department at Chris Hani Baragwanath Academic Hospital. Afr J Urol 2020; 26: 34
    CrossrefPubMedGoogle Scholar
  • 20 Karagöz MA, Doluoğlu ÖG, Ünverdǐ H. et al. The protective effect of papaverine and alprostadil in rat testes after ischemia and reperfusion injury. Int Braz J Urol 2018; 44 (03) 617-622
    CrossrefPubMedGoogle Scholar
  • 21 Hosokawa T, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Oguma E. Role of ultrasound in manual detorsion for testicular torsion. J Clin Ultrasound 2021; 49 (08) 860-869
    CrossrefPubMedGoogle Scholar
  • 22 Vuruşkan E, Erçil H, Karkin K. et al. The Effect of Manual Detorsion on Testicular Salvage Rates in Adult Testicular Torsion Patients: Single Center Experience. Duzce Med J 2022; 24 (02) 101-104
    CrossrefPubMedGoogle Scholar
  • 23 Coughlin MT, Bellinger MF, LaPorte RE, Lee PA. Testicular suture: a significant risk factor for infertility among formerly cryptorchid men. J Pediatr Surg 1998; 33 (12) 1790-1793
    CrossrefPubMedGoogle Scholar
  • 24 van Welie M, Qu LG, Adam A, Lawrentschuk N, Laher AE. Recurrent testicular torsion post orchidopexy - an occult emergency: a systematic review. ANZ J Surg 2022; 92 (09) 2043-2052
    CrossrefPubMedGoogle Scholar
  • 25 Arap MA, Vicentini FC, Cocuzza M. et al. Late hormonal levels, semen parameters, and presence of antisperm antibodies in patients treated for testicular torsion. J Androl 2007; 28 (04) 528-532
    CrossrefPubMedGoogle Scholar
  • 26 Almaramhy HH. Surgical practice among pediatric surgeons and pediatric urologists in the Kingdom of Saudi Arabia for the management of suspected testicular torsion. Saudi Med J 2018; 39 (12) 1232-1237
    CrossrefPubMedGoogle Scholar
  • 27 Sells H, Moretti KL, Burfield GD. Recurrent torsion after previous testicular fixation. ANZ J Surg 2002; 72 (01) 46-48
    CrossrefPubMedGoogle Scholar
  • 28 Loveland KL, Klein B, Pueschl D. et al. Cytokines in male fertility and reproductive pathologies: immunoregulation and beyond. Front Endocrinol (Lausanne) 2017; 8: 307
    CrossrefPubMedGoogle Scholar
  • 29 Payabvash S, Kiumehr S, Tavangar SM, Dehpour AR. Ethyl pyruvate reduces germ cell-specific apoptosis and oxidative stress in rat model of testicular torsion/detorsion. J Pediatr Surg 2008; 43 (04) 705-712
    CrossrefPubMedGoogle Scholar
  • 30 Osemlak P, Jędrzejewski G, Woźniak M, Nachulewicz P. Ultrasound evaluation of long-term outcome in boys operated on due to testicular torsion. Medicine (Baltimore) 2021; 100 (21) e26057
    CrossrefPubMedGoogle Scholar
  • 31 Chen P, Yang Z, Chen N. et al. Diagnosis and treatment of cryptorchid testicular torsion in children: a 12-year retrospective study. Front Pediatr 2022; 10: 968997
    CrossrefPubMedGoogle Scholar
  • 32 Bombiński P, Warchoł S, Brzewski M. et al. Ultrasonography of extravaginal testicular torsion in neonates. Pol J Radiol 2016; 81: 469-472
    CrossrefPubMedGoogle Scholar
  • 33 Ke L, Dong X, Chen T. et al; Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG). Early on-demand drainage or standard management for acute pancreatitis patients with acute necrotic collections and persistent organ failure: a pilot randomized controlled trial. J Hepatobiliary Pancreat Sci 2021; 28 (04) 387-396
    CrossrefPubMedGoogle Scholar
  • 34 Raison N, Warrington J, Alnajjar HM, Muneer A, Ahmed K. The role of partial orchidectomy in the management of small testicular tumours: fertility and endocrine function. Andrology 2020; 8 (05) 988-995
    CrossrefPubMedGoogle Scholar
  • 35 Skoogh J, Steineck G, Cavallin-Ståhl E. et al; SWENOTECA. Feelings of loss and uneasiness or shame after removal of a testicle by orchidectomy: a population-based long-term follow-up of testicular cancer survivors. Int J Androl 2011; 34 (02) 183-192
    CrossrefPubMedGoogle Scholar
  • 36 Lian BS, Ong CCP, Chiang LW, Rai R, Nah SA. Factors predicting testicular atrophy after testicular salvage following torsion. Eur J Pediatr Surg 2016; 26 (01) 17-21
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Dohle GR, Elzanaty S, van Casteren NJ. Testicular biopsy: clinical practice and interpretation. Asian J Androl 2012; 14 (01) 88-93
    CrossrefPubMedGoogle Scholar