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Evaluating Testicular Torsion Outcomes and Frequency of Manual Detorsion Attempts Across Tertiary and Community Hospitals
Jonathan A. Gerber, MD1, Adithya Balasubramanian, MS2, Jake S. Jacob, MS2, Mihir A. Shukla, MS2, Huirong Zhu, PhD1, Carolina J. Jorgez, PhD1, Angela G. Mittal, MD1, Duong D. Tu, MD1, Chester J. Koh, MD1, Nicolette K. Janzen, MD1, Ming-Hsien Wang, MD1, Paul F. Austin, MD1, Edmond T. Gonzales, MD1, David R. Roth, MD1, Abhishek Seth, MD1.
1Texas Children's Hospital, Houston, TX, USA, 2Baylor College of Medicine, Houston, TX, USA.

BACKGROUND: Prior studies demonstrating the efficacy and benefit of manual detorsion (MD) for resolving testicular torsion (TT) were conducted in tertiary pediatric centers under controlled, protocoled settings. In this study, we investigate the frequency at which MD is attempted at both a tertiary pediatric facility and multiple community hospitals without MD protocols. Additionally, testicular salvage rates were reviewed. We hypothesized that MD is common practice and without improved outcomes when utilized
METHODS: We retrospectively reviewed all emergent scrotal explorations undertaken for TT at a large, tertiary pediatric care facility from 2015-2018. Variables included age, laterality, symptom duration, attempt at MD, scrotal ultrasound characteristics, and transfer status. Clinical endpoints included orchiectomy, orchidopexy and degree of torsion at time of surgery. Statistical analysis included nonparametric tests and logistic regression.
RESULTS: 294 patients were included. 174 patients presented directly to a tertiary pediatric facility while 120 presented to outside institutions. MD was attempted in 15% (43/294). Of these, 56% (24/43) of MD were first attempted at a referring hospital while 44% (19/43) were at the tertiary hospital. Orchiectomy was performed in 32% (94/294). Univariate analysis showed presence of hydrocele (p=0.0008), abnormal testicular echotexture (p<0.0001), MD attempt (p=0.0015), time to operating room (OR) (p<0.0001), testicular size differential (p<0.001) and age (p<0.0001) were associated with orchiectomy. On multivariate logistic regression, MD attempt was no longer statistically significant. Abnormal echotexture (p=0.0018), time to OR (p=0.0013) and degree of torsion (p=0.0105), however, were associated with orchiectomy. Additionally, MD was not statistically associated with decreased odds of orchiectomy.
CONCLUSIONS: We identified comparable attempts at MD between a tertiary pediatric referral center and local referring hospitals, suggesting this is pursued across levels of care, expertise and specialization. Although MD attempt did not influence testicular salvage rates, time to OR and certain sonographic findings did predict outcomes following TT. The frequency of MD attempts across facility types supports efforts to develop MD protocols for urologic and non-urologic providers.



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