Testicular Salvage Rate Research Articles

High Testicular Salvage Rate in Torsion of the Spermatic Cord

Acute, nontraumatic scrotal emergency operations were done on 104 patients. The testes were saved in 79 per cent of 67 patients with torsion of the spermatic cord. When the patients who presented late are excluded, aggressive treatment allowed a 93 per cent testicular salvage rate. Spontaneous or manipulative detorsion preoperatively resulted in a 100 per cent testicular salvage rate. If the patient seeks medical advice early a high testicular salvage rate can be obtained by proper diagnosis and prompt, aggressive detorsion either by manipulation when examined initially or at operation. These maneuvers are combined with bilateral orchiopexy to ensure permanent cure.

Elective Orchiopexy for Recurrent Testicular Torsion

The over-all testicular salvage rate with acute torsion is only 20 to 50 per cent. However, up to 50 per cent of the patients with acute torsion have experienced previous episodes of acute testicular pain. The features of resolved acute torsion in 9 patients are described. It is suggested that if an elective orchiopexy is performed after an episode of resolved acute torsion then the over-all rate of testicular salvage should improve by obviating subsequent acute torsion.

Torsion of the Testis: Techniques of Assessment

Results of treatment of torsion of the testicle can be measured only by determining the rate of testicular salvage, which has been low but has improved in recent years. The Doppler instruments and the technique of scrotal imaging with the gamma camera provide noninvasive and rapid diagnostic aids with a high degree of accuracy. There is evidence that these techniques will aid in the differential diagnosis of equivocal cases, and thus lower the incidence of delay in the diagnosis of torsion, a cause of lower than optimal salvage rates in the past. Fluorescein staining can also be used in the operating room if there is a question of testicular viability. The availability of these new modalities, however, is no substitute for early evaluation. Quick referral from primary physicians and a high awareness of torsion as a cause of acute scrotal pain and swelling are extremely important. Reviews clearly indicate that improved salvage rates are achieved with early evaluation and treatment. Therefore the urologist has a continuing responsibility to educate pediatricians, family practitioners, and emergency room physicians in the urgency of diagnosis and treatment in cases of testicular torsion. Although new diagnostic aids are useful, only early surgical exploration can save a torsive testis.