MP55-09 ALBUGINEOTOMY WITH TUNICA VAGINALIS FLAP COVERAGE IN ACUTE TESTICULAR TORSION: A PROSPECTIVE RANDOMIZED STUDY

Abstract

You have accessJournal of UrologyPediatric Urology V (MP55)1 Sep 2021MP55-09 ALBUGINEOTOMY WITH TUNICA VAGINALIS FLAP COVERAGE IN ACUTE TESTICULAR TORSION: A PROSPECTIVE RANDOMIZED STUDY Rafael Ribeiro Zanotti, Luis Gustavo Morato de Toledo, André Costa Matos, Marcos Broglio, Sergio Paolillo, and Jorge Ricardo Gois e Cunha Rafael Ribeiro ZanottiRafael Ribeiro Zanotti More articles by this author , Luis Gustavo Morato de ToledoLuis Gustavo Morato de Toledo More articles by this author , André Costa MatosAndré Costa Matos More articles by this author , Marcos BroglioMarcos Broglio More articles by this author , Sergio PaolilloSergio Paolillo More articles by this author , and Jorge Ricardo Gois e CunhaJorge Ricardo Gois e Cunha More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002085.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testicular torsion is the most potential harmful cause of acute scrotal pain. To date, the most significant efforts in terms of testicular rescue rates have been based on early detorsion. Compartment syndrome has been increasingly recognized as important in enhancing the ischemic insult of several organs limited by their natural sheaths, such as the testis. Therefore we evaluate the impact of albugineotomy with reconstruction using a vaginal tunica flap in testicular salvage rate and late viability. METHODS: This study was conducted after institutional approval by local Research Ethics Committee. We randomized testicles that appeared to be ischemic even after detorsion and heating (which traditionally would be treated by orchiectomy), in one group for albugineotomy with tunica vaginalis flap coverage and another group for orchiectomy. Testicles with signs of good perfusion were not randomized, and so treated by orchidopexy. The follow-up was maintained for further analysis of testicular viability. Time from pain to surgery was not a variable that would determine the technique. Doppler sonography was performed at 6 postoperative months to assess the symmetry of blood flow and the volume in relation to the contralateral testis. Viable testes were defined as those with detectable flow and more than 50% of contralateral testis volume. RESULTS: From December 2018 to August 2020, a total of 28 patients were treated. Ten patients were randomized to albugineotomy and 7 to orchiectomy. Eleven patients were not randomized because the affected testicle had good perfusion aspect, so they underwent orchidopexy. The median time between the onset of pain and surgery was 48 hours (4 to 140 hours). This late presentation was mainly caused by the transfer of patients from other centers. Upon arriving at our service, the patient was immediately referred to treatment in the operating room. In the group with good reperfusion after detorsion and heating; and therefore, not randomized, only 22% of the testicles did not suffer atrophy after 6 months. Of those who underwent the technique under study, 25% did not atrophy. CONCLUSIONS: The application of albugineotomy with tunica vaginalis flap resulted in decrease of orchiectomy rates and avoids long-term testicular atrophy in a significant percentage of gonads (25%) that would otherwise be considered for orchiectomy, without causing major complications. We can conclude that albugineotomy allows to increase the intraoperative and long-term testicular preservation rate. Only 22% of testicles considered viable in the intraoperative, non-randomized, did not present atrophy after 6 months. The use of albugineotomy for these patients with late presentation but good perfusion aspect has not yet been studied. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e961-e962 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael Ribeiro Zanotti More articles by this author Luis Gustavo Morato de Toledo More articles by this author André Costa Matos More articles by this author Marcos Broglio More articles by this author Sergio Paolillo More articles by this author Jorge Ricardo Gois e Cunha More articles by this author Expand All Advertisement Loading ...