Surgical management of testicular torsion

Authors

  • Ashok Suryabhanji Gajbhiye Department of Surgery, IGGMC and Hospital, Nagpur, Maharashtra, India
  • Ambrish Shamkuwar Department of Surgery, IGGMC and Hospital, Nagpur, Maharashtra, India
  • Kuntal Surana Department of Surgery, IGGMC and Hospital, Nagpur, Maharashtra, India
  • Kishor Jivghale Department of Surgery, IGGMC and Hospital, Nagpur, Maharashtra, India
  • Mahesh Kumar Soni Department of Surgery, IGGMC and Hospital, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20160225

Keywords:

Testicular torsion, Orchidectomy

Abstract

Background: Testicular torsion is a correctable true surgical emergency and early diagnosis forms the basis for salvaging this catastrophe. Hence the aim of this study is to identify factors and discuss the management of torsion of testes.

Methods: A prospective study was carried out from 2005 to 2015 at our institute and total 60 cases diagnosed as testicular torsion were studied. The clinical features, radiological investigations and treatment measures were evaluated in details.

Results: Of total 60 cases of testicular torsion the mean age of presentation was 20±5.5 years. The patients presented 12 hours after onset of pain. Pain was present in all 60 (100%) patients. Left testes involved in 38 (63.33%) patients and right in 22 (36.67%) patients. With only the facilities of ultrasound it was found that it was useful in 56 (93.33%) patients. All patients were explored and only 12 (20%) patients had a successful detorsion while 48 (80%) cases underwent orchidectomy. No post-operative complications were noted.

Conclusions: According to our results nearly 80% cases presented late and hence testes could not be salvaged. Left testicular torsion is more common in our region and ultrasonography is a reliable diagnostic tool. Proper awareness, health education and prompt surgical intervention, forms the key to prevent removal of an organ which signifies masculinity.    

 

References

Mushtaq I, Fung M, Glasson MJ. Retrospective review of pediatric patients with acute

scrotum. ANZ Journal of Surgery. 2003;73:55-8.

Selbst SM, Friedman MJ, Singh SB. Epidemiology and etiology of malpractice lawsuits

involving children in US emergency departments and urgent care centers. Pediatric Emergency Care. 2005;21:165-9.

Van Glabeke E, Khairouni A, Larroquet M, Audry G, Gruner M. Acute scrotal pain in children:

results of 543 surgical explorations. Pediatric Surgery International. 1999;15:353-7.

Waldert M, Klatte T, Schmidbauer J, Remzi M, Lackner J, Marberger M. Color Doppler

sonography reliably identifies testicular torsion in boys. Urology. 2010;75:1170-4.

Boettcher M, Bergholz R, Krebs TF. Differentiation of epididymitis and appendix testis

torsion by clinical and ultrasound signs in children. Urology. 2013;82:899-904.

Celik A, Ergun O, Ozcan C, Ozok G. Acute communicating hematocoele: unusual presentation

after blunt abdominal trauma without solid organ injury. European Journal of Emergency Medicine.

;10:342-3.

Soreide K. Surgical management of nonrenal genitourinary manifestations in children with

Henoch-Schonlein purpura. Journal of Pediatric Surgery. 2005;40:1243-7.

Watkin NA, Reiger NA, Moisey CU. Is the conservative management of the acute scrotum

justified on clinical grounds? British Journal of Urology. 1996;78:623-7.

Sessions AE, Rabinowitz R, Hulbert WC, Goldstein MM, Mevorach RA. Testicular torsion:

direction, degree, duration and disinformation. Journal of Urology. 2003;169:663-5.

Jefferson RH, Perez LM, Joseph DB. Critical analysis of the clinical presentation of acute

scrotum: a 9-year experience at a single institution. Journal of Urology. 1997;158:1198-200.

Williamson RC. Torsion of the testis and allied conditions. British Journal of Surgery.

;63:465-76.

Caesar RE, Kaplan GW. Incidence of the bell-clapper deformity in an autopsy series. Urology. 1994;44:114-6.

Gatti JM, Murphy PJ. Current management of the acute scrotum. Seminars in Pediatric

Surgery. 2007;16:58-63.

Hawtrey CE. Assessment of acute scrotal symptoms and findings. A clinician's dilemma.

Urologic Clinics of North America. 2005;25:715-23.

Chan JL, Knoll JM, Depowski PL, Williams RA, Schober JM. Mesorchial testicular torsion: case

report and a review of the literature. Urology. 2009;73:83-6.

Ransler CW, 3rd, Allen TD. Torsion of the spermatic cord. Urologic Clinics of North America.

;9:245-50.

Sakurai H, Ogawa H, Higaki Y, Yoshida H, Imamura K. Torsion of appendix of testis and

epididymis: a report of 4 cases. Hinyokika Kiyo - Acta Urologica Japonica. 1983;29:1657-68.

Yang C, Song B, Liu X, Wei G-h, Lin T, He D-w. Acute scrotum in children: an 18-year

retrospective study. Pediatric Emergency Care. 2011;27:270-4.

Ciftci AO, Senocak ME, Tanyel FC, Buyukpamukcu N. Clinical predictors for differential diagnosis of acute scrotum. European Journal of Pediatric Surgery. 2004;14:333-8.

Seng YJ, Moissinac K. Trauma induced testicular torsion: a reminder for the unwary. Journal

of Accident & Emergency Medicine. 2000;17:381-2.

Rabinowitz R. The importance of the cremasteric reflex in acute scrotal swelling in children.

Journal of Urology. 1984;132:89-90.

Hughes ME, Currier SJ, Della-Giustina D. Normal cremasteric reflex in a case of testicular

torsion. American Journal of Emergency Medicine. 2001;19:241-2.

Nelson CP, Williams JF, Bloom DA. The cremasteric reflex: a useful but imperfect sign in

testicular torsion. Journal of Pediatric Surgery. 2003;38:1248-9.

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 International.

;112:1201-6.

Wright S, Hoffmann B. Emergency ultrasound of acute scrotal pain. Eur J Emerg Med.

;6:6.

Pepe P, Panella P, Pennisi M, Aragona F. Does color Doppler sonography improve the clinical

assessment of patients with acute scrotum? European Journal of Radiology. 2006;60:120-4.

Gunther P, Schenk JP, Wunsch R. Acute testicular torsion in children: the role of

sonography in the diagnostic workup. European Radiology. 2006;16:2527-32.

Lam WW-C, Yap T-L, Jacobsen AS, Teo HJE-L. Color Doppler ultrasonography replacing

surgical exploration for acute scrotum: myth or reality? Pediatric Radiology. 2005;35:597-600.

Arce JD, Cortes M, Vargas JC. Sonographic diagnosis of acute spermatic cord torsion.

Rotation of the cord: a key to the diagnosis. Pediatric Radiology. 2002;32:485-91.

Baud C, Veyrac C, Couture A, Ferran JL. Spiral twist of the spermatic cord: a reliable sign of

testicular torsion. Pediatric Radiology. 1998;28:950-4.

Kalfa N, Veyrac C, Baud C, Couture A, Averous M, Galifer RB. Ultrasonography of the

spermatic cord in children with testicular torsion: impact on the surgical strategy. Journal of Urology. 2004;172:1692-5.

Kalfa N, Veyrac C, Lopez M. Multicenter assessment of ultrasound of the spermatic

cord in children with acute scrotum. Journal of Urology. 2007;177:297-301.

Soccorso G, Ninan GK, Rajimwale A, Nour S. Acute scrotum: is scrotal exploration the best

management? European Journal of Pediatric Surgery. 2010;20:312-5.

Dunne PJ, O'Loughlin BS. Testicular torsion: time is the enemy. Australian & New Zealand

Journal of Surgery. 2000;70:441-2.

Davenport M. ABC of general surgery in children. Acute problems of the scrotum. BMJ.

;312:435-7.

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Published

2016-12-13

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Original Research Articles