MP08-12 IS TRANSFER OF ADOLESCENTS FOR TESTICULAR TORSION APPROPRIATE?

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II1 Apr 2016MP08-12 IS TRANSFER OF ADOLESCENTS FOR TESTICULAR TORSION APPROPRIATE? Amul Bhalodi, Mark Ferretti, Michael Goltzman, Ivan Miller, and Israel Franco Amul BhalodiAmul Bhalodi More articles by this author , Mark FerrettiMark Ferretti More articles by this author , Michael GoltzmanMichael Goltzman More articles by this author , Ivan MillerIvan Miller More articles by this author , and Israel FrancoIsrael Franco More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2257AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Testicular torsion (TT) is defined as a surgical emergency resulting from an abnormally mobile testicle twisting on its vascular pedicle causing obstruction to its blood supply. The testis salvage rate approaches 100% in patients who undergo detorsion within 6 hours of the start of pain. However, acute testicular torsion may cause a loss of testis viability only 4 hours after the appearance of symptoms. The rapid decline of function supports early surgical exploration with high suspicion of TT. The aim of this study was to analyze testis loss and healthcare access parameters together. We critically evaluated the management of the cohort with TT presenting to a tertiary pediatric urology referral center. We hypothesized that factors other than symptom duration, such as transfer from an outside facility, age, time of day of presentation, insurance type or ethnicity, may affect testicular salvage in patients with TT. METHODS A retrospective chart review, from January 2009 to October 2014, revealed 54 cases of TT presenting to a tertiary pediatric referral center. Demographic, presentation, management, ultrasound, and outcome data were recorded. Statistical analysis was performed with Microsoft Office Excel and Statpages statistical software. Analyses of categorical data were performed using chi-squared and Fishers exact test. Logistical regression was used for continuous variables. A p-value of less than 0.05 was considered statistically significant. RESULTS Logistical regression analysis demonstrated a 9% risk of orchiectomy per hour delay in time from onset of symptoms until operating room (OR) start time (p=0.0036) as well as a 9.6% risk of orchiectomy per hour delay in time of first symptoms until initial evaluation (p=0.0024). The average delay to OR secondary to transfer from another facility was 155 minutes (2.59 hours). No statistically significant difference was seen between whether a patient had private vs public insurance (p=0.27). CONCLUSIONS We have shown that any delay in therapy for TT places patients at undue risk of orchiectomy. The practice of transferring adolescent patients from facilities with the ability to treat these patients rapidly increases the risk of orchiectomy in our cohort by almost 30%. This increased risk of loss of testis requires that we consider the first responding urologist be responsible for the immediate surgery and avoid transfer unless the case is considered complex. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e89 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Amul Bhalodi More articles by this author Mark Ferretti More articles by this author Michael Goltzman More articles by this author Ivan Miller More articles by this author Israel Franco More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...