Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy.

Xiao-Mao Tian,Xiao-Hui Tan,Qin-Lin Shi,Xu-Liang Li,Tao Lin,Sheng Wen,Guang-Hui Wei,Peng Lu,Da-Wei He,Xing Liu

doi:10.3389/fped.2020.584796

Abstract

Objective: To analyze the risk factors for testicular atrophy (TA) in children with testicular torsion (TT) following emergent orchiopexy.Methods: Clinical data of patients with TT undergoing orchiopexy were retrospectively reviewed, including age at surgery, affected side, delayed surgery (12–24 h and more than 24 h), echogenicity of testicular parenchyma on ultrasonography (ETPU), testicular blood flow on Color Doppler ultrasonography (CDUS), surgical findings (intraoperative blood supply, the degree of torsion, and surgical approaches), and follow-up. The primary outcome was the rate of TA after orchiopexy. The secondary outcome was the testicular volume loss (TVL) between the affected testis and the contralateral.Results: A total of 113 patients were enrolled in this study with a median age of 11 years. The median follow-up was 21 months. Patients had a median TVL of 51.02% and 44 (38.94%) of them developed severe TA during follow-up. TA was significantly associated with age at surgery (P < 0.0001), delayed surgery (P = 0.0003), ETPU (P = 0.0001), and intraoperative blood supply (P = 0.0005). Multivariate logistic regression analysis showed that school-age children (OR = 0.069, P < 0.001) and puberty (OR = 0.177, P = 0.007) had a decreased risk of TA compared with preschool children, and that heterogeneous ETPU (OR = 14.489, P = 0.0279) and delayed surgery >24 h (OR = 3.921, P = 0.040) increased the risk of TA. Multivariate analysis demonstrated that ETPU (F = 16.349, P < 0.001) and delayed surgery (F = 6.016, P = 0.003) were independent risk factors for TVL.Conclusions: Age at surgery, delayed surgery, and ETPU may play a crucial role in predicting the TA in children with TT following emergent orchiopexy. Moreover, blood flow measured by CDUS could not predict the outcome properly.

Highlights

Testicular torsion (TT) has been considered as a serious surgical emergency that requires prompt diagnosis and surgical intervention
The present study aimed to evaluate the occurrence of testicular atrophy (TA) in children with TT following emergent orchiopexy and to identify risk factors involved in the development of testicular loss
Clinical data were retrieved on age at surgery, affected side of testes, delayed surgery, echogenicity of testicular parenchyma on ultrasonography (ETPU), testicular blood flow on Color Doppler ultrasonography (CDUS), surgical findings, and follow-up

Summary

Introduction

Testicular torsion (TT) has been considered as a serious surgical emergency that requires prompt diagnosis and surgical intervention It is the most common cause of testicle loss in children and may impair fertility and endocrine function of the testis in the future [1]. TT may occur at any age, but the vast majority of cases occur after age 10 years with a peak at 12 to 16 years [3] This disease features a dramatic reduction of testicular blood supply due to the torsion of the spermatic cord, with left-sided predominance, and rare bilaterality. The present study aimed to evaluate the occurrence of TA in children with TT following emergent orchiopexy and to identify risk factors involved in the development of testicular loss

Methods

Results

Conclusion