Testicular Salvage Research Articles

Editorial comment for Protective effect of tunica albuginea incision with tunica vaginalis flap coverage on tissue damage and oxidative stress following testicular torsion: Role of duration of ischemia

The authors presented their experimental study investigating the effects of testicular torsion in a rat model. Not surprisingly they found that there is a linear increase in parameters of testicular distress with increasing duration of torsion (1, 5 and 9 h). A tunica vaginalis flap (TVF) placed in the incised tunica albuginea of an experimentally torsed testes reduced testicular histologic damage and reduced a serum marker of injury (MDA) only in testes torsed for 9 h. The authors found no measurable benefit in those testes torsed for lesser time intervals (1 and 5 h); indeed, there was worse injury in those animals subjected to the TVF intervention. While the authors stated in the Introduction that testicular torsion must be differentiated from other causes of scrotal pain so as to prevent the loss of the testicle in those with torsion, the real issue at hand is what to do with the ischemiclooking testes at the time of surgery. Few would want to leave necrotic testes, but how clinically are irrevocable changes discerned? Which testes can be helped with TVF? The duration of scrotal pain, as indicated by the patient’s history, is a poor indicator of testicular viability given the vagaries of adolescent male perceptions, the occasional but real occurrence of intermittent torsion and the anatomic variability (i.e. the number of twists) of spermatic cord torsion. There is literature [1] directly relating necrosis to duration of symptoms, but experience demonstrates many outliers to the general rules governing the relationship between testicular viability and duration of symptoms. Indeed, Sessions et al. [2] found that 40% of patients presenting with symptoms of >20 h duration had testicular salvage with standard detorsion and fixation. Would these patients be harmed with the TVF techniques, as were those rats

Testicular torsion in undescended testis: A persistent challenge

ObjectiveTo evaluate the management and outcomes of patients who presented with torsion of an undescended testis and review the reported series in the literature. MethodsThe case records of 13 patients operated for testicular torsion involving undescended testis were retrospectively reviewed. The medical records included age at presentation, medical history, physical examination, operative findings and the results of follow-up. The diagnosis of torsion of undescended testis was made clinically and confirmed by inguinal exploration. ResultsIn six cases the testis was preserved and orchiopexy was performed, while in seven cases orchidectomy was performed due to testicular gangrene in six patients and testicular tumor discovered peroperatively in one case. Mean duration of symptoms at time of surgery in the orchiopexy group was 6.5 h and in the orchidectomy group was 21.2 h. From six patients treated by orchiopexy, two patients suffered from testicular atrophy at a mean of 24 months. ConclusionTesticular torsion in undescended testis is still diagnosed with delay which may affect testicular salvage. The importance of examination of external genital organs is highlighted which should be routinely included by emergency physicians in physical examination for abdominal or groin pain.

Ultrasound assessment of perinatal testicular torsion.

The goal of this study was to elucidate the different sonographic features of prenatal and postnatal testicular torsion (TT) using high-frequency colour Doppler ultrasound (HCDU) in an effort to increase diagnostic accuracy. 29 patients (average age, 7.5 days) with perinatal TT were divided into patients with postnatal (acute) TT vs patients with prenatal (chronic) TT and their clinical characteristics, imaging features on HCDU and surgical pathology results were retrospectively analyzed. Significant differences were observed between prenatal and postnatal TT cases with regard to testicular size (p = 0.01) and echogenicity (p = 0.007). All 17 prenatal cases had non-homogeneous testicular parenchymal echo patterns compared with only 9 (64.3%) postnatal TT cases. Five postnatal TT cases presented with homogeneous echo patterns compared with none of the prenatal TT cases. Testicular blood supply was absent in 25 (80.7%) of 31 testes on colour Doppler flow imaging, with the majority occurring in the prenatal TT cases [i.e. 16 (94.1%) cases]. 1 affected testis out of a total 17 testes from 16 patients with prenatal TT was salvaged, with a salvage rate of 1/17 or 0.06%. 7 affected testes out of a total 16 testes from 13 patients with postnatal neonatal TT were salvaged, with a salvage rate of 7/16 or 43.8%. In neonates with acute scrotal symptoms, the possibility of perinatal TT should be considered and HCDU examination should be performed in a timely manner. HCDU examination could aid in testicular salvage by prompting quick surgical intervention. This study underlined the clinical contribution of HCDU in evaluating postnatal (acute) vs prenatal (chronic) TT. The sonographic features of postnatal TT with salvageable testes were compared with prenatal torsion and the relative salvage rates in both cases were discussed.

Standardized process to improve patient flow from the Emergency Room to the Operating Room for pediatric patients with testicular torsion

Testicular torsion (TT) remains one of the most common urological emergencies. The length of time from onset of symptoms to detorsion and degree of spermatic cord twisting are usually the most important factors for testicular damage. Therefore early presentation, accurate diagnosis, and prompt treatment are important factors for optimizing the testicular salvage rate. While delay in seeking medical attention is a common cause of testicular loss in pediatric patients with testicular torsion, delays in diagnosis and treatment can be preventable causes of testicular loss. In this study, we aimed to develop a standardized process to improve the patient flow from the Emergency Room (ER) to Operating Room (OR) for TT patients in an academic children's hospital. Thirty consecutive pediatric patients with acute testicular torsion between November 2013 and July 2014 served as the control group. A scrotal pain checklist was implemented in July 2014, and 30 consecutive patients from July 2014 until April 2015 served as the study group. Perioperative parameters including times, ultrasound (US) findings, and surgical results were reviewed. The mean ages of the control group and the study group were similar (12.3±4.9 years and 11.5±5 years, respectively) (p=0.575). ER arrival to OR time, triage completion to OR time, and scrotal US to OR time were significantly decreased in the study group (p<0.001) (Table). Although triage time and ER arrival to scrotal US times were decreased in the study group, the differences were not significant (p=0.071, p=0.112, respectively). Utilizing scoring tools during the triage of patients with scrotal pain can help identify high-risk patients earlier and prevent unnecessary use of resources in an ER serving a large pediatric population. Limitations of this pilot study include the limited number of patients and the potential for the Hawthorne effect (staff awareness of the study). Additionally, we did not examine scrotal pain checklist scores for other acute scrotal diseases. This study focused on a quality improvement process for TT patients, in order to reduce ER to OR times. A standardized process with use of a scrotal pain checklist and prompt communication between the ER, Urology, and Radiology teams led to significantly reduced times from the ER to the OR. Standardized processes for pediatric patients with testicular torsion may help to improve testicular survival rates.

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

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 ...

Predictive Parameters of Testicular Salvage of Pediatric Testicular Torsion: A 6-Year Experience of a Single Center

Purpose: We evaluated parameters associated with testicular salvage in boys with testicular torsion. Materials and Methods: During 2009-2014, 19 boys younger than 18 years old underwent emergency surgery for testicular torsion in our hospital. Age, chief complaint, laterality of the torsion, physical appearance, ultrasonographic results, duration between the onset of symptoms and hospital visit, duration between the onset of symptoms and start of surgery, intraoperative appearance, surgical method (orchiopexy or orchiectomy), and any postoperative complications were analyzed retrospectively. Cases were categorized according to salvageable testes (n=14) or unsalvageable testes (n=5) groups based on testes viability. Results: The mean age was not significantly different between the two groups. All patients were diagnosed using color Doppler ultrasonography of the scrotum. Six (42.9%) boys in the salvageable testes group and all five in the unsalvageable testes group were transferred from other clinics or hospitals (p=0.026). The mean duration between the onset of symptoms and hospital visit was 925 minutes in the salvageable testes group and 3,488 minutes in the unsalvageable testes group (p=0.042), and the mean duration between the onset of symptoms and start of surgery was 1,131 minutes in the salvageable testes group and 3,777 minutes in the unsalvageable testes group (p=0.042). Conclusions: There was a high possibility that orchiectomy was required if surgery was delayed. However, even when a boy is admitted to the hospital more than 24 hours after the onset of symptoms, the testis can still be viable provided the surgery is performed as quickly as possible.

Acute and intermittent testicular torsion: Analysis of presentation, management, and outcome in South East, Nigeria.

Testicular torsion compromises the blood supply to the testes and may result in testicular loss or damage if not dealt with promptly. It can occur either as acute testicular torsion (ATT) or intermittent testicular torsion (ITT). This study examines the presentation, management, and outcome of adult testicular torsion. During the period January 1999 and December 2009, 34 out of 59 patients treated for testicular torsion, who had complete records, were evaluated. Operating theater and urology ward admission registers were used to identify patients. Age range was 16-50 years. Of the 34 patients, 11 (32.4%) were between 26 and 30 years old, while 16 (47.1%) were between 16 and 25 years old. Mean age was 27 years. Scrotal pain of varying severity was noted in all patients; there was associated vomiting in 21% of cases and abdominal pain in 38% of cases. Clinical diagnosis was ATT in 12 (35.3%) patients and ITT in 22 (64.7%) patients. In the ATT group, only one patient (8.3%) presented within 6 h of onset of symptoms. In the ITT group, 3 patients (13.6%) presented within 1 month of onset of symptoms while 7 (31.8%) of patients presented between 1 and 6 months after the onset of symptoms. Testicular salvage rate was 58.3% for ATT. Surgical intervention occurred within 3 h in the ATT group in 7 patients (58.3%) and in 5 patients (41.7%) within 3-6 h of onset of symptoms. In the patients with ITT, 12 patients (54.5%) were operated upon within 1 month of presentation. Preoperative external manual detorsion was performed in 1 patient. Late presentation was observed, especially in the intermittent variety. Delay occurred both at pre- and intra-hospital phases. Testicular salvage rate may be improved by physician/health worker and community enlightenment. Adoption of local anesthetic may reduce intrahospital delay.

Factors Predicting Testicular Atrophy after Testicular Salvage following Torsion.

Testicular atrophy (TA) is a significant complication in patients who undergo salvage procedures for testicular torsion. Studies on outcome focus on factors predicting testicular viability during scrotal exploration but few assess factors predicting TA in patients who undergo salvage procedures. We assess the incidence of TA after salvage and identify associated factors. With ethical approval, we reviewed patients who underwent salvage for testicular torsion in our institution from 2001 to 2013. Data was collected on patient demographics, duration of pain, sonographic findings, postoperative complications, and follow-up assessment of TA (defined as difference in testicular volume > 50% compared with the contralateral testis, based on measurement by Prader orchidometer or by ultrasound). We excluded patients with torted undescended testis, those under 1 month, and those with follow-up < 6 months. Chi-square or Mann-Whitney U tests were used as appropriate with significance level < 0.05. Of 85 patients who had scrotal exploration for testicular torsion, 53 had testicular salvage. Overall, 16 patients defaulted or had < 6 months follow-up, leaving 37 patients who were studied, median age 12 years (range, 0.5-16.0 years) at presentation. Median follow-up was 12.5 months (range, 6-88 months). A total of 20 patients (54%) developed TA. Median duration to TA was 12.5 months (range, 2-88 months). All had clinical evidence of atrophy by 14 months, except two who initially defaulted follow-up, but were diagnosed with TA at 35 and 88 months postoperatively when presenting with unrelated complaints. Factors associated with TA were duration of pain > 1 day (p = 0.004) and heterogeneous echogenicity on ultrasound (p = 0.001). Sonographic evidence of reduced vascularity was not predictive. Of 11 that had pain > 1 day, 10 (91%) had TA. No testes survived when pain ≥ 3 days. Half of patients with testicular torsion undergoing salvage surgery will develop testicular atrophy, even when intraoperatively assessed as viable, and should be counseled accordingly. Duration of pain > 1 day and sonographic heterogeneous echogenicity are predictive. Salvage rates are dismal when duration of symptoms exceeds 1 day.

Clinical analysis of 49 cases with testicular torsion

To improve the diagnosis and treatment of testicular torsion. The clinical features of 49 testicular torsion patients admitted to Department of Urology Nanjing Drum Tower Hospital from April 2008 to March 2014 were retrospectively analyzed, the average age was (21 ± 6) years (range 13-52 years).Forty-four cases underwent the color Doppler flow imaging of scrotum, demonstrated reduction of the testicular blood supply in 9 cases and loss of the testicular blood supply in 35 cases. Orchiectomy or orchiopexy was performed according to the testicular blood supply, the contralateral testis fixation was performed in all patients. A two-tailed Student's t-test was used to compare the data between two groups, Pearson correlation analysis was used to analyze the correlation of diurnal temperature and number of cases. All the patients with testicular torsion were Tunica-reversed, 38 (77.5%) cases occurred from November to April. The monthly incidence of testicular torsion was positively correlated with diurnal temperature (r = 0.6434, P = 0.024). Forty-four cases underwent the color Doppler flow imaging, demonstrated the reduction or loss of the testicular blood supply, and these patients were confirmed to be testicular torsion by surgical exploration. The salvage rates of testis in patients with testicular torsion were 2/2, 5/15, 2/9 and 4.2% (1/24) in those seeking medical attention within 6, 12, 24 hours and over 24 hours after the onset of pain. All the patients were followed up for 3 to 75 months, and no one experienced recurrent torsion. The incidence of testicular torsion is higher during the spring and winter, diurnal temperature change is associated with testicular torsion. The diagnostic rate of color Doppler flow imaging is high, which can be chosen as the primary method. Prompt recognition and treatment are necessary for testicular salvage.

Lower genitourinary tract trauma

Lower genitourinary tract trauma comprises a substantial portion of the trauma burden in the USA. Some key trends and findings are described. Mortality is relatively high in patients with bladder trauma due to associated injuries. Urethral injuries should be suspected in patients presenting with the triad of blood at the urethral meatus, suprapubic fullness indicative of a full bladder, and urinary retention. Urethral injury is common in penetrating penile trauma, and stab wounds to the penis are more likely to involve the urethra than gunshot wounds. Penile fracture is largely a clinical diagnosis and suspicion of fracture requires urgent surgical exploration. Zipper injuries are the most common cause of presentation to the emergency department for penile trauma in adults. Toilet seat injuries are the leading cause of penile pediatric trauma presenting to the emergency department. In the setting of testicular trauma, rates of testicular salvage are excellent when exploration is prompt. Trauma in the form of animal or human bites requires treatment with broad-spectrum antibiotics in addition to repair of the injury. Military trauma has seen an increase in explosive injuries to the lower urinary tracts due to evolution of warfare tactics. Increasing awareness of presentation and context of lower genitourinary tract trauma can reduce delay of diagnosis and morbidity associated with such injuries.

Testicular loss following bacterial epididymo-orchitis: Case report and literature review.

Epididymo-orchitis rarely leads to abscess formation and global testicular infarction/loss, particularly in the setting of appropriate antibiotic therapy. The imaging modality used when monitoring for testicular ischemia is ultrasonography. However, as described in the literature, testicular pathology may not be evident on routine imaging. We describe two cases of recurrent bacterial epididymo-orchitis, complicated by testicular abscess resulting in testicular infarction. This rare, nevertheless significant, complication occurred in both patients despite receiving appropriate extended antibiotic therapy. Both cases demonstrate the limitations of ultrasonography alone, suggesting that a high level of clinical suspicion must be maintained when ultrasound evaluation proves to be inconsistent with the clinical presentation. These cases demonstrate the importance of monitoring for warning signs of ischemia, as early recognition may lead to reperfusion interventions and ultimately testicular salvage.

Scrotal Exploration for Testicular Torsion and Testicular Appendage Torsion: Emergency and Reality

Background:Scrotal exploration is considered the procedure of choice for acute scrotum.Objectives:We evaluated the importance of early diagnosis and testicular salvage on the therapeutic outcomes of patients with pediatric testicular torsion (TT) and testicular appendage torsion (TAT) in our geographic area. Patients and Methods:We performed a retrospective database analysis of patients who underwent emergency surgery for TT or TAT between January 1996 and June 2009. Patient history, physical examination findings, laboratory test results, color Doppler sonography (CDS) results, and surgical findings were reviewed.Results:A total of 65 cases were included in our analysis. Forty-two cases were followed up for at least 3 months. Testicular tenderness was identified as the major clinical manifestation of TT, while only a few patients with TAT presented with swelling. CDS was an important diagnostic modality. The orchiectomy rate was 71% in the TT group.Conclusions:Cases of acute scrotum require attention in our area. Early diagnosis and scrotal exploration could salvage the testis or preserve normal function without the need for surgery.

Is it possible to distinguish testicular torsion from other causes of acute scrotum in patients who underwent scrotal exploration? A multi-center clinical trial.

IntroductionTo assess the clinical presentation of patients who underwent surgical exploration for acute scrotum and to investigate the potentially related factors for differential dignosis.Material and methodsWe retrospectively analyzed the medical records of 97 patients who underwent surgical exploration for acute scrotum between May 2007 and July 2013. The patients were divided into two groups as follows: Group1 included patients with testicular torsion (TT) and Group 2 contained patients with acute scrotal pathologies other than TT, including torsion of the testicular appendage, epididymo-orchitis, trauma and Henoch-Schönlein purpura. The physical examination findings, colour Doppler ultrasound (CDUS) and laboratory findings for the groups were compared.ResultsIn total, 97 scrotal explorations were carried out for acute scrotum. Group 1 included 72 patients (74.2%) and Group 2 included 25 patients (25.8%). Group 2 was comprised of patients with torsion of the testicular appendage (n = 13), epididymo-orchitis (n = 8), testicular trauma (n = 2) and Henoch-Schönlein purpura (n = 2). In Group 1, 32 cases (44.4%) presented to a hospital less than 6 hours after onset of pain. More than half (64%) of Group 2's cases presented more than 24 hours after pain onset. Fever and pyuria appeared more frequently in Group 2 than in Group 1 and the results reached statistical significance (p = 0.001 and p = 0.044, respectively). Group 1 had more testicular tenderness than Group 2 (p <0.001). Our testicular salvage rate was 59.7%, and 40.3% of patients underwent orchiectomy.ConclusionsCDUS predicted the diagnosis of TT (sensitivity 98.6%). Furthermore, clinical findings may also play a substantial role in the differential diagnosis of acute scrotum.

Parental perception of acute scrotal pain in children.

Acute scrotal pain (ASP) remains one of the more common urological emergencies in the paediatric age group. Acute testicular torsion is the only true urological emergency, where delay in presentation or management can lead to loss of the affected testicle. Since prompt presentation, diagnosis and treatment are critical for testicular salvage, multiple patient and hospital specific factors may influence orchidectomy rates. Parental awareness of the sequelae of ASP may be a significant factor in delayed presentation of children to hospital. We examine the awareness among parents of the implications of ASP in this snapshot study. A prospective study was planned, and all boys between the ages of 2 and 16 years presenting to the unit with ASP and undergoing emergency scrotal exploration were considered for inclusion in the study. The accompanying parents/guardians of all these boys were asked to complete a questionnaire assessing their awareness of ASP and its potential consequences. Over a period of 26 months (July 2010 to September 2012), 76 boys were eligible for the study. The response rate was 81.6%. Only a third (30%) presented to hospital within six hours of onset of pain and just under a quarter (22%) of the cohort attended the emergency department directly. Parents overwhelmingly (96%) felt that there ought to be increased public awareness of the condition. The majority of parents questioned (n=41, 66%) did not fully appreciate the implications of ASP. This is a first snapshot study demonstrating the apparent lack of awareness among parents about the implications of ASP, which could influence the rate of testicular salvage.

Reply: To PMID 25307733.

Lost in the aftermath of the exponential growth of testosterone supplementation therapy (TST) are numerous downstream effects dealt with by the male fertility specialist. One previously unappreciated effect of TST is how the suppression of spermatogenesis creates a dilemma for the vasectomy reversal surgeon, potentially affecting the method of reconstruction, and thus, the outcomes. In the present article, preoperative testicular salvage therapy was used to optimize spermatogenesis before reversal. The proposed protocol for salvage therapy after discontinuation of TST routinely recommended included a combination of clomiphene citrate (25 mg daily) with human chorionic gonadotropin (3000 units subcutaneously every other day) for a period of 3 months before reassessment. In this study, because some patients elected to only use clomiphene, the population ultimately studied included men who received clomiphene with or without human chorionic gonadotropin. Editorial CommentUrologyVol. 84Issue 6PreviewIncreased awareness about potential links between hypogonadism and metabolic syndrome, sexual dysfunction, mood disorders, and physical fitness in men leads to dramatic increase in utilization of testosterone replacement therapy (TRT).1 Some of the men treated with TRT either never had children or remarry and decide to have children with their new spouses.2 TRT by lowering serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) can lead to suppression of spermatogenesis. When human chorionic gonadotropin (hCG) was given with TRT, no suppression of spermatogenesis was observed providing convincing evidence that it is not TRT per se causing spermatogenic suppression but decrease in serum LH and FSH levels as a result of TRT. Full-Text PDF

Time delays in presentation and treatment of acute scrotal pain in a provincial hospital.

Acute scrotal pain is a urological emergency due to the possibility of testicular torsion and subsequent testicular loss if correction is not carried out in a timely manner. We conducted a retrospective review of all patients who underwent surgical exploration for acute scrotal pain in a provincial hospital in New Zealand between 1 January 2001 and 31 December 2010. A total of 91 cases were identified. The median delay pre-hospital was 9 h and in-hospital was 2.5 h. Patients who had a non-viable testicular torsion and patients under the age of 14 had longer pre-hospital delays of 24 and 72 h, respectively. In-hospital delays were similar between all pathologies except for non-viable testicular torsions with 7 h and 45 min. Viable testicular torsions had a median in-hospital delay of 2 h and 13 min. Delay from the time of testicular pain until surgical exploration is important for the chances of testicular salvage and is made up mostly of pre-hospital delays. Patients under the age of 14 had longer delays pre-hospital.

Penetrating Scrotal Trauma: A Case Report and Brief Management with Literature Review

Penetrating scrotal trauma is an uncommon injury that is often secondary to civilian or combat violence. Much of the literature on the topic is from case reports, small retrospective series from civilian trauma centers, and reports from combat zones. In this manuscript, a case report involving self-inflicted penetrating scrotal trauma from our institution is presented. Following the case report, accepted management strategies and recent literature on the topic of penetrating scrotal trauma are reviewed. Briefly, current management strategies for penetrating scrotal injuries involve initial resuscitation and stabilization of the patient, followed by operative exploration, with the primary operative goals of hemostasis, debridement, and testicular salvage. Recent case series of penetrating scrotal trauma have shown rates of testicular salvage that vary between institutions, mechanism of injury, and setting (civilian vs military/combat).

A Rare Case of Testicular Torsion in a 75 Year Old

Background: Testicular torsion occurs when a testicle torts on the spermatic cord resulting in the cutting off of blood supply. The most common symptom is acute testicular pain and the most common underlying cause, a bell-clapper deformity. Testicular torsion implies obstruction of first venous, and later, arterial flow. The extent of testicular ischemia will depend on the degree of twisting (180°-720°) and the duration of the torsion. Testicular salvage is more likely in patients treated within 4-6 hours after the onset of torsion. Case Presentation: We came across an unusual case of testicular torsion in a 75 years old man,who presented to our emergency department with a 7 days history of right-sided testicular pain with no pyrexia,urinary symptoms and negative urine routine ,initially treated with antibiotics elsewhere as torsion amongst the elderly population is rarely described. This case presents the oldest surgically confirmed case of testicular torsion, in a 75-year-old male, documented in a journal so far .There was no pyrexia or urinary symptoms and negative urine routine. In adults above the age of 40, likely diagnoses include epididymo-orchitis, epididymitis, neoplasm or hydrocele. Clinical differentiation with epididymo-orchitis can be difficult in any age range. Clinical signs such as fever, elevated C-reactive protein and positive urine test are suggestive of epididymo-orchitis/orchitis. Conclusion: This case study demonstrates that testicular torsion can occur at any age, and clinical suspicion should always be high in patients presenting with testicular pain and a negative urine tests, regardless of age. Although risk in this subgroup is low, the identification of a potentially reversible testicular abnormality should be of high priority.

Evaluation of acute scrotum in our consecutive operated cases: a one-center study

PurposeThe purpose of the present study was to evaluate the clinical history, demographic data, surgical exploration findings, and final diagnoses in all young males presenting with acute scrotum to our center.Materials and methodsThis was a descriptive–retrospective study in which all consecutive cases of acute scrotum treated in our department from March 2008 to March 2012 were evaluated.ResultsA total of 116 cases were included in the study. Out of these cases, 100 cases underwent surgical exploration, and the remaining 16 cases were managed conservatively. Our eligible cases were divided into three groups: the testicular torsion (TT) group (68%); the torsion of the appendix testis (AT) group (20%); and the epididymo-orchitis (EO) group (9%). Testicular preservation was achieved in 39 cases of the TT group, while due to delayed referral, orchiectomy was performed in 29 cases. Thus, our testicular salvage rate was 57.5% and missed testicular torsion rate was 42.5%.ConclusionIt was observed that our testicular salvage rate was lower than the expected figures published in the literature. This is may be attributed to different causes, including delayed referral or presentation of acute scrotum cases, inadequate knowledge of the general practitioners working in emergency departments, or poor knowledge of parents.

A nationwide epidemiological study of testicular torsion in Korea.

Testicular torsion is a surgical emergency in the field of urology. Knowledge of the epidemiology and pathophysiology is significant to an urologist. However, the epidemiology of testicular torsion in Korea has not been studied. We performed a nationwide epidemiological study to improve knowledge of the epidemiology of testicular torsion. From 2006-2011, the Korean Urologic Association began the patient registry service. The annual number of patients with testicular torsion from 2006 to 2011 were 225, 250, 271, 277, 345, and 210, respectively. The overall incidence of testicular torsion in males was 1.1 per 100,000; However, the incidence in men less than 25 yr old was 2.9 per 100,000. Adolescents showed the highest incidence. Total testicular salvage rate was 75.7% in this survey. There was no geographic difference of testicular salvage rate. Minimizing the possibility of orchiectomy for testicular torsion is important to improve public awareness to expedite presentation and provider education to improve diagnosis and surgery.