Testicular Atrophy Following Torsion in Pediatric Patients
Catherine J. Chen, MD1, John Sung, MS2, Craig A. Peters, MD1.
1University of Texas Southwestern Medical Center, Dallas, TX, USA, 2Texas A&M College of Medicine, Bryan, TX, USA.
Background: Testicular torsion is a surgical emergency as prolonged ischemia is inversely related to testicular salvage. It is thought that when torsion is corrected within 6 hours of pain onset, the testis can be saved. However, there is limited evaluation of torsion outcomes. This study assesses torsion outcomes and evaluates the rate of testicular atrophy.
Methods: Male patients ≤ 19 years old who underwent surgery for torsion at Children’s Medical Center, Dallas, TX from 1/2015 to 12/2017 by 7 surgeons were identified by CPT codes and a retrospective chart review was completed. Any decrease in size of the torsed testicle compared to the contralateral healthy testicle by either palpation or ultrasound measurements was considered atrophied. Given the inability to quantify degree of decrease based on palpation, results were dichotomized into atrophy or no atrophy.
Results: 204 patients, median age 14 years (IQR 12-15 years), were included, with 31 tunica vaginalis flaps, 68 orchiectomies and 105 orchiopexies for a testicular salvage rate of 66%. 89/204 (43.6%) patients had follow-up, median time 101 days (IQR 47-138 days), with 41/89 (46%) patients having atrophy. 24/39 (61.5%) had atrophy on ultrasound and 17/50 (34%) had atrophy on palpation. For patients whose onset of pain was ≤6 hours, >6 and <12 hours, ≥12 and <24 hours, and ≥24 hours before detorsion, the atrophy rate was 27% (9/33), 42% (11/26), 69% (9/13), and 71% (12/17) respectively (Figure 1). In the ≤6 hours group, atrophy was detected by ultrasound in 4 patients and palpation in 5. Out of patients who underwent a tunica vaginalis flap, 20/31 had follow-up with 14/20 (70%) demonstrating atrophy. One patient who underwent an orchiopexy, however, ultimately required orchiectomy due to abscess formation.
Conclusion: This study demonstrates that despite rapid intervention, injury from testicular torsion may still result in testicular atrophy at a higher rate than traditionally thought. This allows clinicians to more accurately inform patients and families of atrophy risk following detorsion. Despite tunica vaginalis flaps, these patients still experience a high rate of atrophy at 70%. Further studies with more consistent follow-up are needed.
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