Testicular torsion: A retrospective investigation of predictors of surgical outcomes and of remaining controversies. Issue 5 (October 2017) - Castañeda-Sánchez, Irene
Summary: Introduction: Testicular torsion (TT), a common surgical emergency worldwide, is typically treated with orchiectomy or orchiopexy. It is widely accepted that the chance of salvaging the testicle declines with time and degree of torsion. The impact of ethnicity on outcome is less well understood, and the association between weather and onset of TT remains a controversy. Objectives: It is important to know the signs of TT so that appropriate treatment can be given quickly. The purpose of this study was to provide a detailed analysis of registered cases of TT in adolescent patients diagnosed at a single institution to better understand the association between clinical indicators and surgical outcomes and to examine some remaining controversies in the literature on TT. Study design: A retrospective chart review was conducted, using medical records from the present institution. Data were collected for 165 patients who met the following inclusion criteria: 1) adolescent males between 10 and 18 years of age at the time of diagnosis, and 2) TT between January 2001 and June 2013. Results: Of the 165 patients, 38% had orchiectomies. Patients with orchiectomies had longer wait times for surgery ( p < 0.0001)—but not greater driving times, driving distances, or degrees of torsion—than those with orchiopexies (Table). Yet, among patients who waited less than the median wait time to surgery (197 min), patients with orchiectomies had greater degrees of torsion than did those with orchiopexies ( p = 0.02). Assuming that patients without reference to presence of bell clapper deformity in their medical notes did not have the deformity, those with orchiectomies were less likely to have bell clapper deformity than were those with orchiopexies ( p < 0.01). Although mean atmospheric temperature was unassociated with onset of TT and with surgical outcome in general, patients without bell clapper deformity had TT on relatively colder days ( p = 0.02). Discussion and conclusion: Wait time to surgery positively correlates with orchiectomy. Early identification and intervention is vital to testicular salvage. As the degree of torsion increases, the blood supply to the affected testis decreases and the time required to inflict testicular vascular damage decreases. Our results showed the presence of the bell clapper deformity moderated the relationship between temperature and TT: Those without the deformity had torsions on colder days than did those with the deformity. A comprehensive multi-centered study could help draw further conclusions regarding temperature correlation and the bell clapper deformity. Table Differences in clinical characteristics by surgical outcome. Variable Orchiopexy Orchiectomy p Triage to provider, minutes 27.55 ± 30.47 31.12 ± 28.27 0.47 Triage to surgery, minutes 216.63 ± 110.23 334.29 ± 250.51 <0.0001 Driving distance, miles 26.37 ± 43.56 39.83 ± 169.37 0.54 Driving time, minutes 31.42 ± 38.93 41.78 ± 141.75 0.57 Degree of torsion, degrees 458.29 ± 179.51 505.10 ± 173.13 0.15 Bell clapper <0.01 Yes 34 (33%) 9 (14%) No 68 (67%) 54 (86%) Temperature, Fahrenheit 64.05 ± 15.62 61.54 ± 18.73 0.36