Abstract
Objective: The purpose of the present study is to determine the clinical, radiological and pathological characteristics of testicular torsion patients, the intervention techniques applied according to time to hospital admission of the patient and testis-saving rates in the childhood age group.
Material and Methods: This retrospective study included the patients aged between 0-18 years who applied to pediatric surgery clinic due to the complaint of abdominal pain or scrotal pain between January 2011 to January 2021 and were diagnosed with testicular torsion after evaluation. The patient age, hospital admission complaint, duration of the symptoms, month of hospital admission, lateralization of the affected testicle, preoperative diagnostic studies, type of the implemented intervention (orchiectomy/detorsion) and postoperative diagnosis were determined. Hematoxylin-Eosin-stained archive slides of the materials sent to pathology department for examination were reviewed by two pathologists.
Results: In this period of 10 years; 28 patients aged between 0-18 years admitted to our hospital because of testicular torsion. Scrotal pain and tenderness were present in all the patients (100%). Of the patients; 4 (14.3%) were neonatal and 21 (75%) were between the ages 12-18 years. Testicular parenchyma could not be macroscopically selected in the examination of orchiectomy materials and the materials were hemorrhagic. Hemorrhagic infarction was detected by microscopic examination.
Conclusion: Acute scrotum is a frequently seen surgical emergency in the childhood period. There are many entities that may cause acute scrotum; performing differential diagnosis accurately and timely can protect the patient from unnecessary surgery and testicular loss.
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References
- Jacobsen FM, Rudlang TM, Fode M, Østergren PB, Sønksen J, Ohl DA, et al. The impact of testicular torsion on testicular function. World J Mens Health 2020;38:298-307.
- Hyun GS. Testicular torsion. Rev Urol 2018;20:104-6.
- Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatric radiol 2018;48:735-44.
- Tanaka K, Ogasawara Y, Nikai K, Yamada S, Fujiwara K, Okazaki T. Acute scrotum and testicular torsion in children: a retrospective study in a single institution. J Pediatr Urol 2020;16:55-60.
- Nebot CS, Salvador RL, Aliaga SP, Iñigo EG. Perinatal testicular torsion: ultrasound assessment and differential diagnosis. Radiología 2017;59:391-400.
- Feng S, Yang H, Lou Y, Ru W, Wang A, Liu W. Clinical characteristics of testicular torsion and identification of predictors of testicular salvage in children: a retrospective study in a single institution. Urol Int 2020;104:878-83.
- Kylat RI. Perinatal testicular torsion. Arch Pédiatr 2021;28:75-9.
- Khasawneh, GF. Acute Scrotum in Pediatric: Clinical Presentation and Management in Royal Medical Services Hospitals. Sch J App Med Sci 2021;8:1283-7.
- Kalfa N, Veyrac C, Lopez M, Lopez C, Maurel A, Kaselas C, et al. Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. J Urol 2007;177:297-301.
- Güneş M, Umul M, Altok M, Akyüz M, İşoğlu CS, Uruç F, et al. Is it possible to distinguish testicular torsion from other causes of acute scrotum in patients who underwent scrotal exploration? A multi-center clinical trial. Cent European J Urol 2015;68:252-6.
- Pogorelić Z, Mrklić I, Jurić I. Do not forget to include testicular torsion in differential diagnosis of lower acute abdominal pain in young males. J Pediatr Urol 2013;9:1161-5.
- Pogorelić Z, Mustapić K, Jukić M, Todorić J, Mrklić I, Mešštrović J, et al. Management of acute scrotum in children: a 25-year single center experience on 558 pediatric patients. Can J Urol 2016;23:8594-601.
- Ekici M, Ozgur BC, Senturk AB, Nalbant I. Relationship of low temperature with testicular torsion. J Coll Phys Surg Pak 2018;28:378-80.
- Mundell A, Maynard W, Shanmugathas N, Tanaka MB, Orton T, Patrick J, et al. 1346 A retrospective, five-year review of presentation, investigations and management of acute testicular pain in paediatric patients. Arch Dis Child 2021;106 (Suppl 1): A329-A330.
- Alkhori NA, Barth RA. Pediatric scrotal ultrasound: review and update. Pediatric Radiol 2017;47:1125-33.
- Laher A, Ragavan S, Mehta P, Adam A. Testicular torsion in the emergency room: a review of detection and management strategies. Open Access Emerg Med 2020;12:237-46.
- Pinar U, Duquesne I, Lannes F, Bardet F, Kaulanjan K, Michiels C, et al. The use of Doppler ultrasound for suspected testicular torsion: lessons learned from a 15-year multicentre retrospective study of 2922 patients. Eur Urol Focus 2022;8:105-11.
- Forrest A, Brahmbhatt A, Dogra V. Decreased Blood Flow in the Testis: Is it Testicular Torsion?. Am J Sonogr 2018;13:1-7.
- Huang, A, Delozier S, Lauderdale CJ, Zhao S, Clayton, DB, Pope IV JC, et al. Do repeat ultrasounds affect orchiectomy rate in patients with testicular torsion treated at a pediatric institution?. J Pediatr Urol 2019;15:179.e1-179.e5.
- Dias Filho AC, Maroccolo MVO, Ribeiro HDP, Riccetto CLZ. Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil. Int Braz J Urol 2020;46:972-81.
Abstract
Amaç: Bu çalışmanın amacı çocuk yaş grubunda testis torsiyonlu hastaların klinik, radyolojik ve patolojik özelliklerini, hastaların hastaneye başvuru zamanına göre müdahale yöntemlerini ve testis kurtarma oranlarını belirlemektir.
Gereç ve Yöntemler: Bu retrospektif çalışma Ocak 2011-Haziran 2021 yılları arasında karın ağrısı veya skrotal ağrı ile çocuk cerrahisi kliniğine başvuran ve değerlendirme sonrası testis torsiyonu tanısı alan 0-18 yaş arası hastaları kapsamaktadır. Hastaların yaşı, hastaneye başvuru şikayeti, semptomların süresi, hastaneye başvurduğu ay, etkilenen testisin lateralizasyonu, preoperatif tanı çalışmaları, yapılan müdahalenin tipi (orşiektomi/detorsiyon) ve postoperatif tanı belirlendi. Patoloji birimine inceleme için gönderilen materyallere ait Hematoksilen-Eozin boyalı arşiv preparatları iki patolog tarafından yeniden gözden geçirildi.
Bulgular: Bu 10 yıllık dönemde 0-18 yaş arası 28 hasta testis torsiyonu nedeni ile hastanemize başvurmuştu. Hastaların hepsinde (%100) skrotal ağrı ve hassasiyet mevcuttu. Hastaların 4 tanesi (%14.3) yenidoğandı ve 21 hasta (%75) 12-18 yaşları arasındaydı. Orşiektomi materyallerinin incelenmesinde makroskopik olarak testis parankimi seçilemiyordu ve materyaller hemorajikti. Mikroskopik incelemede hemorajik enfarktüs saptandı.
Sonuç: Akut skrotum çocukluk çağında sık görülen cerrahi acillerdir. Akut skrotuma neden olabilecek çok sayıda antite mevcuttur; ayrıcı tanının doğru ve zamanında yapılması hastayı gereksiz cerrahiden kurtaracak ve testis kaybını önleyecektir.
Keywords
Project Number
-
References
- Jacobsen FM, Rudlang TM, Fode M, Østergren PB, Sønksen J, Ohl DA, et al. The impact of testicular torsion on testicular function. World J Mens Health 2020;38:298-307.
- Hyun GS. Testicular torsion. Rev Urol 2018;20:104-6.
- Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatric radiol 2018;48:735-44.
- Tanaka K, Ogasawara Y, Nikai K, Yamada S, Fujiwara K, Okazaki T. Acute scrotum and testicular torsion in children: a retrospective study in a single institution. J Pediatr Urol 2020;16:55-60.
- Nebot CS, Salvador RL, Aliaga SP, Iñigo EG. Perinatal testicular torsion: ultrasound assessment and differential diagnosis. Radiología 2017;59:391-400.
- Feng S, Yang H, Lou Y, Ru W, Wang A, Liu W. Clinical characteristics of testicular torsion and identification of predictors of testicular salvage in children: a retrospective study in a single institution. Urol Int 2020;104:878-83.
- Kylat RI. Perinatal testicular torsion. Arch Pédiatr 2021;28:75-9.
- Khasawneh, GF. Acute Scrotum in Pediatric: Clinical Presentation and Management in Royal Medical Services Hospitals. Sch J App Med Sci 2021;8:1283-7.
- Kalfa N, Veyrac C, Lopez M, Lopez C, Maurel A, Kaselas C, et al. Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. J Urol 2007;177:297-301.
- Güneş M, Umul M, Altok M, Akyüz M, İşoğlu CS, Uruç F, et al. Is it possible to distinguish testicular torsion from other causes of acute scrotum in patients who underwent scrotal exploration? A multi-center clinical trial. Cent European J Urol 2015;68:252-6.
- Pogorelić Z, Mrklić I, Jurić I. Do not forget to include testicular torsion in differential diagnosis of lower acute abdominal pain in young males. J Pediatr Urol 2013;9:1161-5.
- Pogorelić Z, Mustapić K, Jukić M, Todorić J, Mrklić I, Mešštrović J, et al. Management of acute scrotum in children: a 25-year single center experience on 558 pediatric patients. Can J Urol 2016;23:8594-601.
- Ekici M, Ozgur BC, Senturk AB, Nalbant I. Relationship of low temperature with testicular torsion. J Coll Phys Surg Pak 2018;28:378-80.
- Mundell A, Maynard W, Shanmugathas N, Tanaka MB, Orton T, Patrick J, et al. 1346 A retrospective, five-year review of presentation, investigations and management of acute testicular pain in paediatric patients. Arch Dis Child 2021;106 (Suppl 1): A329-A330.
- Alkhori NA, Barth RA. Pediatric scrotal ultrasound: review and update. Pediatric Radiol 2017;47:1125-33.
- Laher A, Ragavan S, Mehta P, Adam A. Testicular torsion in the emergency room: a review of detection and management strategies. Open Access Emerg Med 2020;12:237-46.
- Pinar U, Duquesne I, Lannes F, Bardet F, Kaulanjan K, Michiels C, et al. The use of Doppler ultrasound for suspected testicular torsion: lessons learned from a 15-year multicentre retrospective study of 2922 patients. Eur Urol Focus 2022;8:105-11.
- Forrest A, Brahmbhatt A, Dogra V. Decreased Blood Flow in the Testis: Is it Testicular Torsion?. Am J Sonogr 2018;13:1-7.
- Huang, A, Delozier S, Lauderdale CJ, Zhao S, Clayton, DB, Pope IV JC, et al. Do repeat ultrasounds affect orchiectomy rate in patients with testicular torsion treated at a pediatric institution?. J Pediatr Urol 2019;15:179.e1-179.e5.
- Dias Filho AC, Maroccolo MVO, Ribeiro HDP, Riccetto CLZ. Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil. Int Braz J Urol 2020;46:972-81.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | ORIGINAL ARTICLES |
| Authors | |
| Project Number | - |
| Publication Date | January 30, 2023 |
| Submission Date | May 20, 2022 |
| Published in Issue | Year 2023 Volume: 17 Issue: 1 |
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