New characteristics of testicular torsion in children during COVID-19

Abstract

Dear editor, we read with great interest an article in your journal about the characteristics of testicular torsion in children during COVID-19 pandemic in your medical center [[1]Pogorelic Z. Milanovic K. Versic A.B. Pasini M. Divkovic D. Pavlovic O. et al.Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic?-A retrospective multicenter study.J Pediatr Urol. 2021; 17: 479.e1-479.e6Abstract Full Text Full Text PDF Scopus (23) Google Scholar]. Indeed, the onset of COVID-19 pandemic poses incalculable risks and challenges to overall health strategies that will affect the condition and prognosis of children with testicular torsion. Our approach to managing testicular torsion was modified recognising the risks of COVID-19 infection. Therefore, our aim was to share the change in our clinical practice of managing children admitted with testicular torsion, and to investigate short-term outcomes after the onset of the pandemic. A total of 25 patients were identified (Table 1). All children received nucleic acid testing negative during the outbreak, and chest CT scans were required until September. All patients were reconfirmed intraoperatively the diagnosis of testicular torsion. No patient had co-morbidities.Table 1Demographic data.Pre-COVID-19 (n = 13)Post-COVID-19 (n = 12)p-valueMedian age, years (range)8y (19h-15y)12y (10m12d-14y)–Gender (male %)111.00Location (right/left, %)3/10, 302/10, 201.00Patients with comorbidities, %001.00Median admission WBC, × 109/L, (range)11.82 (4.86–23.32)10.05 (4.76–16.82)0.12Median admission CRP, mg/L, (range)5.61 (<0.8–15)–Form of hospitalization (outpatient/emergency, %)1/12, 8.32/10, 200.59 Open table in a new tab Post-COVID-19, 66.7% of patients (8/12) had Chest CT scans on admission. No patients were admitted to hospital with chest CT prior to the outbreak in our practice (Table 2). Post-COVID-19, all children (100%, 12/12) were tested for nucleic acid before admission to hospital. Pre-COVID-19, seven (53.8%, 7/13) patients underwent testicular torsion reduction and the remaining 6 (46.2%, 6/13) underwent orchiectomy. Post-COVID-19, seven (58.3%, 7/12) patients underwent testicular torsion reduction and the remaining 6 (41.7%, 5/12) underwent orchiectomy.Table 2Pre and post-COVID-19 management of testicular torsion and outcome.Pre-COVID-19Post-COVID-19p-value(n = 13)(n = 12)Investigation with CT, %00 66.7 (8/12)<0.001Nucleic acid testing0100 (12/12)<0.001Median onset time, (range)12h (2h-12d)2d (3h-12d)0.35Fever001.00Operation method(orchiectomy/torsional reduction, %)6/7, 85.75/7, 71.41.00Median operation time, minutes (range)50 (30–70)45 (30–80)0.66Median hospital stay, days (range)7 (5–9)4 (3–7)<0.001Complication001.00Readmissions over 30-dayfollow-up % (number of patients)001.00 Open table in a new tab The median length of hospital stay pre- and post-COVID-19 was 7 days and 4 days, respectively. In the pre-COVID-19 period, the median operation time was 50 min, but after the outbreak it was significantly reduced to 45 min. The median onset time before the outbreak was 12 h, compared with 2 days in the post-COVID-19 period. Before the outbreak, the median white blood cell was 11.82 × 109/L, compared to 10.05 × 109/L after the outbreak. No complications were recorded in those patients pre- and post-COVID-19. There were no readmissions during either period of follow-up. A conservative approach was adopted in managing a surgical condition recognising the risk of increased nosocomial infection in the midst of COVID-19. Testicular torsion is a clinical diagnosis and is usually not determined by imaging. However, special needs during the outbreak have led to the addition of chest CT, but care should be taken to avoid repeated examinations during hospitalization to reduce possible radiation exposure. Importantly, during the pandemic, we asked patients to minimize the length of hospital stay after surgery, which was completely safe and feasible in the short-term follow-up, suggesting that the length of hospital stay for testicular torsion could be reduced accordingly in the future. In addition, our clinical results suggest that the length of surgery for testicular torsion can also be reduced to minimize the potential medical burden of the surgery. Most of the testicular torsion in our center occurred on the left side before and after the COVID-19 pandemic. This is consistent with most reported incidence rates and it can be explained entirely by anatomical factors [[2]Bayne C.E. Gomella P.T. DiBianco J.M. Davis T.D. Pohl H.G. Rushton H.G. Testicular torsion presentation trends before and after pediatric urology subspecialty certification.J Urol. 2017; 197: 507-515Crossref PubMed Scopus (14) Google Scholar]. The datasets used or analysed during the current study are available from the corresponding author on reasonable request. All authors have agreed to publish this article.