Is contralateral orchiopexy safe at the time of urgent scrotal exploration?

France: A recent study in the Journal of Urology has questioned the dogma of routine contralateral fixation in patients with testicular torsion. According to the study,  doing so increases the risk of associated minor postoperative complications (Clavien-Dindo 2) but does not result in a testicular loss (Clavien-Dindo 2). Immediate contralateral orchiopexy (ICLO) was linked to an increased postoperative complication rate, including hematoma and delayed wound healing.

The primary goal of Igor Duquesne and colleagues was to assess the safety of instant contralateral orchiopexy (ICLO) during scrotal examination for testicular torsion suspicion. 

Patient data were obtained from the TORSAFUF cohort project, a multicenter nationwide research undertaken between 2005 and 2019 at 14 academic French institutions. Each patient who had surgical exploration for testicular torsion suspicion was included in the study. The major study goal was to evaluate the safety of ICLO to ipsilateral scrotal exploration alone. The complication rate within 90 days of surgery was the major outcome of interest. Before collecting data, the end point was determined.

ICLO was linked with a higher risk of any complication, with hematoma (3 % versus 1%) and delayed wound healing being the most common (7 % vs 2 %). At a median of 3 to 4 years of follow-up, 7% of patients in both groups had chronic orchalgia, and the risk of future contralateral torsion was comparable, at 0.7 % for ICLO vs 0.3 % without ICLO. However, longer-term monitoring may be necessary to identify the hazards of ICLO performance (or omission).

With the results going against the ICLO intervention and no other strong evidence that suggest otherwise, the authors have concluded to go for the conventional method of treatment of testicular torsion instead of opting for ICLO.

Reference:

Duquesne, I., Pinar, U., Dang, V. T., Mauger de Varennes, A., Benali, N. A., Berchiche, W., Margue, G., Gaillard, C., Bardet, F., Hulin, M., Manuguerra, A., Plassais, C., Wandoren, W., Lannes, F., Khene, Z.-E., & Pradere, B. (2021). Contralateral Orchiopexy at the Time of Urgent Scrotal Exploration—Is It Safe? A Propensity Score Matched Analysis from the TORSAFUF Cohort. Journal of Urology. https://doi.org/10.1097/ju.0000000000002142