Study details outcomes of scrotal exploration for acute testicular pain
London, UK: Surgical exploration <6 hours from the onset of acute testicular pain is the threshold for salvage in testicular torsion (TT), concludes a study published in the Journal of Clinical Urology. To aid diagnosis, clinical findings should with combined with patient time to presentation and age.
The researchers note, patients between the age of 13 and 16 years carries the highest risk of testicular torsion and frequently present early after the onset of pain. They suggest that speciality organisations should produce definitive guidance on the management of TT given the heterogenicity of surgical management and the highest risk of TT to the paediatric population.
The stud was conducted by William Maynard, Urology Department, Charing Cross Hospital, Fulham Palace Road, London, and colleagues with the objective to assess the evaluation and operative outcomes of patients attending a single urology centre with acute testicular pain (ATP) who underwent scrotal exploration.
The team sought to determine adherence to the Royal College of Surgeons England (RCS) commissioning guide on testicular torsion, clinical and radiological features predictive of torsion, time-dependent salvage rates and surgical technique in a contemporary cohort.
For this purpose, the researchers carried out a single-centre retrospective review from 2015 to 2020. All patients presenting with acute testicular pain undergoing surgical exploration were included.
Key findings of the study include:
- 140 patients were identified, median age 16 years, 40 had testicular torsion (TT) (30%) where nausea (positive predictive value (PPV) 51.7%) and abnormal testis lie (PPV 50%) were more frequent.
- TT was the most common diagnosis if presenting <4 hours (44%), and in patients 13–16 years (62%).
- Time-to-surgery from the assessment was <3 hours in 109 of 128 (85.2%).
- The overall salvage rate was 74.4%, with salvage rates of 100% at 6 hours from the onset of pain.
- Viable tissue was seen on histology in 30% of orchidectomies, up to 25 hours from the onset of pain.
"Surgical exploration <6 hours from the onset of pain is the threshold for salvage in TT," the authors conclude. "Given the heterogenicity of surgical management and the highest risk of TT to the paediatric population, speciality organisations should produce definitive guidance on the management of TT."
Reference:
Maynard W, Shanmugathas N, Mundell A, et al. Scrotal exploration for acute testicular pain: A contemporary UK series from a tertiary centre. Journal of Clinical Urology. June 2022. doi:10.1177/20514158221099390
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