Torsion Events Research Articles

Combined Utero-Ovarian and Round Ligament Oophoropexy for Recurrent Torsion of Normal Adnexa: A Case Series

Recurrent torsion of otherwise normal adnexa (not involving adnexal cysts) has been reported in young girls and adolescents. Previous ovarian fixation techniques (oophoropexy) such as plication of the utero-ovarian ligament appear to have limited efficacy in preventing recurrent torsion. A novel technique combining plication of the utero-ovarian ligament and suturing of the ovary to the round ligament has been recently described. In this study, we describe our short-term experience with the combined utero-ovarian and round ligament oophoropexy technique. Patients who underwent combined oophoropexy as a primary fixation technique or as a secondary fixation technique (i.e, after failure of a previous fixation) due to recurrent torsion of otherwise normal adnexa between January 2020 and December 2022 were included in this retrospective cohort study. Follow-up to assess for further torsion events was conducted by telephone interview. Ten patients underwent combined utero-ovarian and round ligament oophoropexy during the study period. In all cases, at least two episodes of torsion of otherwise normal adnexa were surgically diagnosed before oophoropexy (range, 2-4). The median patients' age at time of the combined oophoropexy was 21.8 years (range, 9.1 - 35.7 years), 3 were pre-menarchal and 7 were post-menarchal. After a median follow up of 19.1 months (range, 3.0 - 29.3 months), only one case of recurrent torsion occurred. Combined utero-ovarian and round ligament oophoropexy is novel oophoropexy procedure which may reduce the risk of recurrent torsion. However, longer follow-up is needed to determine its efficacy.

Recurrent torsion of otherwise normal adnexa: oophoropexy does not prevent recurrence.

Recurrence of adnexal torsion involving otherwise normal adnexa is not rare. Various oophoropexy (ovarian fixation) procedures have been suggested to prevent recurrence; however, long-term information of their efficacy is lacking. The aim of this study was to investigate the recurrence rate of adnexal torsion following oophoropexy. Retrospective cohort study, including all consecutive patients who underwent an oophoropexy procedure for the prevention of recurrent torsion of "normal adnexa" in our department from 2008 to 2019 by shortening of the utero-ovarian ligament. Nineteen patients (age range 7-35years) with a mean follow-up of 90.9 ± 57.7months were identified. Fifteen of them (78.9%) were re-operated for recurrent torsion following an oophoropexy procedure, while four (21.1%) did not experience recurrence. Nine torsion recurrences following an oophoropexy occurred within the first 2 postoperative years. There were no differences in mean age and menarcheal status )pre- or post-menarcheal) at the time of the first torsion event, age at the time of oophoropexy, oophoropexy side, number of adnexal torsion events before oophoropexy, and follow-up duration between those with and those without post-oophoropexy recurrences. Oophoropexy procedure by shortening of the utero-ovarian ligament may not prevent recurrent torsion of otherwise normal adnexa. Further studies to determine whether combined fixation (utero-ovarian and round ligament plication) is more efficacious than isolated utero-ovarian plication for the prevention of recurrent torsion are warranted.

A moving target: Multiples occurrences of left lung torsion secondary to adenocarcinoma and pleural effusion

A patient with left upper lobe adenocarcinoma was found to have asymptomatic left lung torsion in the context of a pleural effusion. With drainage of the pleural effusion the mass returned to its original position. Multiple torsion events were documented and found to only occur in presence of a pleural effusion. This case suggests a new possible indication for indwelling pleural catheter (IPC) placement.

Oophoropexy for Prevention of Recurrent Torsion of Normal Adnexa

<h3>Study Objective</h3> The conservative management of otherwise normal adnexal torsion by de-torsion may lead to recurrent torsion events. With the aim of reducing recurrent torsion events, various oophoropexy techniques have been suggested. We aimed to investigate the efficacy of oophoropexy in preventing recurrent torsion. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> University affiliated department of Obstetrics and Gynecology. <h3>Patients or Participants</h3> Cases of oophoropexy operated between January 2010 and March 2021. <h3>Interventions</h3> Laparoscopic oophoropexy techniques (plication of the utero-ovarian ligament and/or fixation to the round ligament), using non-absorbable sutures. <h3>Measurements and Main Results</h3> 15 patients with recurrent torsion of otherwise normal adnexa who underwent oophoropexy were identified. At time of the first torsion event, the mean patients' age was 18.3 ± 7.4 years, and 4 (26.7%) were pre-menarchal. The recurrent torsion involved the right adnexa in 9 (60.0%) cases, the left adnexa in 4 (26.7%) cases, and both adnexa in 2 (13.3%) cases. The mean interval between the first and second torsion events was 17.8 ± 20.2 months. In 3 (20.0%) cases, no recurrence occurred following oophoropexy, while in the remaining 12 (80.0%) cases, up to 4 recurrences were diagnosed. <h3>Conclusion</h3> Laparoscopic oophoropexy procedures, although feasible and safe, may not prevent recurrent torsion of otherwise normal adnexa.

69. Retrospective review of outcomes after oophoropexy through the NASPAG Fellows Research Consortium

<h3>Background</h3> Adnexal torsion is a rare pediatric event. Normal ovaries can torse and are more likely to re-torse, especially in premenarchal girls. Oophoropexy (OP) has been proposed to decrease the risk of recurrent torsion, yet there is no consensus to describe appropriate candidates or optimal surgical technique. Our study describes rates of recurrent adnexal torsion with and without OP. Using data from centers across the country, we aim to define if there are circumstances when OP may be beneficial. <h3>Methods</h3> This is an IRB-approved retrospective chart review of all patients aged 18 and under who experienced 2 or more ovarian torsions and/or underwent OP between 1 January 2009 and 30 August 2019. We determined the total number of patients who experienced torsion during the study period and collected data only for those meeting inclusion criteria using CPT, ICD9 and ICD10 codes. We recorded the number of surgically confirmed torsions, if OP was performed and surgical technique. Only data for the pilot site is included in this abstract. <h3>Results</h3> We identified 141 unique patients with at least one surgically-proven torsion and 171 torsion events. There were 44 patients who had at least 2 torsions and/or at least one OP. Mean age at first torsion was 10.6 years with a range of 2 to 18 years. The rate of recurrent torsion was 14.9% (21/141 patients) with 18 of 21 occurring in premenarchal girls. A total of 34 patients had at least one OP (mean age at first torsion 10 years, range 2-18 years). There were 6 patients who had a torsion after OP (17.6%). Of the 7 patients who had three or more torsions, 5 also had two or more OP. <h3>Conclusions</h3> The pilot site data for this ongoing multicenter cohort is the largest series to date. The overall rate of recurrent torsion, as well as the rate of torsion after OP, are comparable to existing literature. The majority of patients with recurrent torsion were premenarchal. All but two patients with three or more torsions also had two or more OP, and at least one torsion after OP. Although this is a limited sample, it suggests that some patients may retain the risk of recurrent torsion even after OP. Collecting data from additional sites will allow for further evaluation of these trends.

Cold weather increases the risk of scrotal torsion events: results of an ecological study of acute scrotal pain in Scotland over 25 years

The role of ambient temperature in the aetiology of acute scrotal pain (ASP) remains uncertain. The most common causes of ASP are torsion of the testis (TT) or its appendages (TA) and epidymo-orchitis (EO). We undertook an ecological study of ASP in Scotland to determine whether a seasonal variation could be observed. Episode reports for TT, TA and EO in Scotland over 25 years were collated monthly. Statistical analyses were performed to determine whether changes in ambient temperature during the year could explain variations in monthly frequency. 7882 episodes of TT and TA (Group A), and 25,973 episodes of EO (Group B) were reported. There was significant variance in the frequency of Group A (p < 0.0001) and B (p = 0.0031) episodes by month, higher frequency of Group A episodes in the colder half of the year (p < 0.0001), and an inverse correlation between the frequency of Group A episodes and ambient temperature (Spearman r = − 0.8757, 95% CI − 0.9661 to − 0.5941, p = 0.0004). Ambient temperature is likely to be playing a role in the aetiology of TT and TA in Scotland but not EO. Further study is warranted to explain underlying mechanisms.

Adnexal torsion: is there a familial tendency?

Objective: To investigate whether patients diagnosed with adnexal torsion report a family history of adnexal torsion in a first degree relative. Materials and Methods: All women with a surgical diagnosis of adnexal torsion operated from 2008 to 2016 were contacted for participation in the study. The study was conducted by a telephone questionnaire. In addition, the medical records were retrospectively reviewed and information on demographic characteristics, surgical findings at time of torsion, and history of recurrent torsion events were collected. Results: Two hundred thirty women with a surgical diagnosis of adnexal torsion were identified. Of these, 147 women were reached and agreed to participate in the study. A history of adnexal torsion in a first degree relative was reported by seven (4.8%) patients: three cases involved an adnexal torsion event in a sister, and four cases involved an adnexal torsion event in a mother or daughter. Patients with a positive family history of adnexal torsion were more likely to experience torsion of otherwise normal adnexa without adnexal cysts compared to those with a negative family history (71.4% vs. 27.1%, p = 0.01) and to report recurrent torsion events (57.1% vs. 17.1%, p = 0.009). Conclusion: A family history of adnexal torsion in a first degree relative is found in a minority of cases and is significantly associated with torsion of otherwise normal adnexa and with recurrent torsion events. Thus, patients with a family history of torsion may be considered a high-risk subgroup of patients.

EDITORIAL COMMENT

The authors have described 2 cases of “witnessed” torsion with subsequent testicular salvage. Technically, these were not witnessed torsion events. More accurately, the sequelae of the torsion where rapidly identified by the astute nursing care.

561 COLD WEATHER CAUSING TESTICULAR TORSION IS AN URBAN LEGEND

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia1 Apr 2011561 COLD WEATHER CAUSING TESTICULAR TORSION IS AN URBAN LEGEND Jessica T. Casey, Timothy B. Lautz, Lee C. Zhao, and Max Maizels Jessica T. CaseyJessica T. Casey Chicago, IL More articles by this author , Timothy B. LautzTimothy B. Lautz Chicago, IL More articles by this author , Lee C. ZhaoLee C. Zhao Chicago, IL More articles by this author , and Max MaizelsMax Maizels Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1286AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The etiology of testicular torsion is not well described. It has been hypothesized that colder temperatures cause asymmetric contraction of the cremaster muscle leading to asymmetric rotation with consequent twisting and elevation of the spermatic cord in susceptible patients. Consequently, testis torsion has come to be regarded as more common in colder months as an “urban legend” without evidence. Prior single institution studies on seasonal or temperature variation in the incidence of testicular torsion have not definitively answered this hypothesis. Our objective was to determine whether testicular torsion is more common in colder weather using a national pediatric dataset. METHODS Using the 2000, 2003 and 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID), testicular torsion events were identified using a diagnosis of torsion combined with a procedure for orchiopexy or orchiectomy. The percentage of cases occurring each month on a national and regional level was determined using both unweighted and weighted data. As some states do not have sufficient temperature variation to plausibly lead to testicular torsion, subgroup analysis was performed using only “cold states,” those having an average temperature <5° Celsius for ≥4 months per year. The hypothesis that the incidence of testicular torsion is higher in colder seasons than expected was tested with χ2 goodness of fit analysis. RESULTS There were 2413 episodes of testicular torsion among boys ≤18 years reported in the 2000, 2003 and 2006 KID: winter (26.9%), spring (25.7%), summer (23.5%) and fall (23.8%). This was not significantly different from the null hypothesis of equivalent distribution among the different seasons (p=0.06). At a regional level, the seasonal distribution of cases (winter, spring, summer, fall, respectively) was: Northeast (27.5%, 25.7%, 23.4%, 23.4%), Midwest (25.5%, 25.7%, 26.8%, 22.0%), South (26.8%, 25.7%, 23.2%, 24.3%) and West (27.2%, 25.8%, 22.1%, 24.9%). Limiting analysis to cold states, the distribution was winter 26.9%, spring 26.0%, summer 23.6%, and fall 23.5% (p=0.25). There was not significant variation in the monthly distribution of torsion events for all states and for cold states only. These data observations were unchanged when weighted national estimates were calculated for each month accounting for hospital strata, clustering and discharge weight. CONCLUSIONS Testicular torsion is evenly distributed across all seasons. The hypothesis that cold weather is related to the incidence of testicular torsion is not supported by data from a large representative national dataset. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e226-e227 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica T. Casey Chicago, IL More articles by this author Timothy B. Lautz Chicago, IL More articles by this author Lee C. Zhao Chicago, IL More articles by this author Max Maizels Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

562 OUTCOMES IN THE EVALUATION AND MANAGEMENT OF THE PERSISTENT/RECURRENT VARICOCELE

of the spermatic cord in susceptible patients. Consequently, testis torsion has come to be regarded as more common in colder months as an “urban legend” without evidence. Prior single institution studies on seasonal or temperature variation in the incidence of testicular torsion have not definitively answered this hypothesis. Our objective was to determine whether testicular torsion is more common in colder weather using a national pediatric dataset. METHODS: Using the 2000, 2003 and 2006 Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID), testicular torsion events were identified using a diagnosis of torsion combined with a procedure for orchiopexy or orchiectomy. The percentage of cases occurring each month on a national and regional level was determined using both unweighted and weighted data. As some states do not have sufficient temperature variation to plausibly lead to testicular torsion, subgroup analysis was performed using only “cold states,” those having an average temperature 5° Celsius for 4 months per year. The hypothesis that the incidence of testicular torsion is higher in colder seasons than expected was tested with 2 goodness of fit analysis. RESULTS: There were 2413 episodes of testicular torsion among boys 18 years reported in the 2000, 2003 and 2006 KID: winter (26.9%), spring (25.7%), summer (23.5%) and fall (23.8%). This was not significantly different from the null hypothesis of equivalent distribution among the different seasons (p 0.06). At a regional level, the seasonal distribution of cases (winter, spring, summer, fall, respectively) was: Northeast (27.5%, 25.7%, 23.4%, 23.4%), Midwest (25.5%, 25.7%, 26.8%, 22.0%), South (26.8%, 25.7%, 23.2%, 24.3%) and West (27.2%, 25.8%, 22.1%, 24.9%). Limiting analysis to cold states, the distribution was winter 26.9%, spring 26.0%, summer 23.6%, and fall 23.5% (p 0.25). There was not significant variation in the monthly distribution of torsion events for all states and for cold states only. These data observations were unchanged when weighted national estimates were calculated for each month accounting for hospital strata, clustering and discharge weight. CONCLUSIONS: Testicular torsion is evenly distributed across all seasons. The hypothesis that cold weather is related to the incidence of testicular torsion is not supported by data from a large representative national dataset.

Congenital left ventricular aneurysm: a cause of impaired myocardial torsion and peripheral thrombo-embolic events

Congenital aneurysms of the left ventricle (LV) are rare cardiac abnormalities and in most instances, are asymptomatic. However, some patients may present cardiac rupture, tamponade, ventricular arrhythmias, and eventually sudden death. Herein, we describe a case of a 64-year-old male patient who was hospitalized for critical limb ischaemia because of an acute embolic event. Transthoracic contrast echocardiography revealed a congenital aneurysm of the LV apex with a small thrombus and a reduced LV ejection fraction. Speckle tracking imaging showed an impaired myocardial torsion. Diagnosis was confirmed after surgical resection of the aneurysm. LV torsion and ejection fraction were normalized after surgery.

Oophoropexy to Prevent Adnexal Torsion: How, When, and for Whom?

Study Objective To assess the efficacy of oophoropexy in obviating recurrent torsion and its possible long-term effects. Design Case series and review of the literature (Canadian Task Force classification III). Setting University hospital. Patients Women who underwent oophoropexy for recurrent torsion of normal adnexa between 2003 and 2008. Measurements and Main Results Retrieved information included the indication for oophoropexy, surgical methods, recurrence, and follow-up. Seven women underwent oophoropexy during the study period because of recurrent torsion of normal adnexa. One additional patient had experienced 3 torsion events of cystic adnexa. Surgical methods included suturing of the ovary to the pelvic sidewall or to the round ligament and plication of the utero-ovarian ligaments. Recurrence occurred in 1 of 6 patients for whom follow-up was available. All 6 patients reported spontaneous menstruation, and 2 conceived spontaneously and gave birth. Ultrasound at long-term follow-up (9–58 months) demonstrated normal ovaries. Conclusion Oophoropexy seems to be efficacious in preventing recurrent torsion. It is our impression that plication of the utero-ovarian ligaments has advantages over other approaches insofar as surgical feasibility and anatomical conservation.

The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy

To investigate the incidence, risk factors, and sonographic findings of maternal ovarian torsion in pregnancy. Retrospective study. Department of Obstetrics/Gynecology of a tertiary referral center. Thirty-three pregnant women with 38 episodes of surgically proven torsion between the years 1993 to 2007. Surgical confirmation and treatment of torsion. Clinical and sonographic findings of ovarian torsion in pregnancy. Sixteen (48.5%) pregnancies were conceived by ovulation induction or in vitro fertilization. Twenty-one torsion events occurred in the first trimester (55.3%) versus 13 (34.2%) and 4 (10.5%) in the second and third trimester, respectively. All patients were admitted with abdominal pain, whereas 22 (57.9%) reported nausea/vomiting. The preoperative ultrasound examination showed unilocular ovarian cysts in 15 (39.5%) cases, multicystic ovaries in 14 (36.8%), and normally appearing ovaries in 9 (23.7%) cases. The multicystic ovary was more common in the first trimester torsion, whereas the "normal" appearing ovary was more common in the second and third trimester torsion (47.6% vs. 23.5% and 14.3% vs. 35.3%, respectively). The median duration from admission to surgery was 6 hours (range, 1 hour to 3.7 days), being significantly shorter in the first trimester. Ovarian torsion in pregnancy is more common in the first trimester, and induction of ovulation is a major risk factor.

Parenchymal Echo Texture Predicts Testicular Salvage After Torsion: Potential Impact on the Need for Emergent Exploration

In the setting of signs and symptoms of testicular torsion the absence of diastolic flow and/or color flow on Doppler ultrasound has traditionally prompted emergent scrotal exploration. This practice emanates largely from the difficulty on ultrasound of distinguishing salvageable torsed testes from those that are not salvageable. We identified ultrasound findings predictive of testicular viability or the lack thereof. We retrospectively reviewed the charts of all boys who underwent scrotal exploration for signs and symptoms of torsion during a 4-year period. In those who underwent preoperative Doppler ultrasound of the scrotum ultrasound findings were reviewed, as were the operative dictations. In patients who underwent orchiectomy the pathology reports were also reviewed. In patients in whom the torsed testis appeared viable and who underwent orchiopexy followup data were reviewed when available. Emergency room charts were also reviewed to ascertain, when documented, the duration of pain before presentation to the emergency room and the interval between ultrasound and operating room. During this period 55 boys underwent exploration after preoperative scrotal Doppler ultrasound revealed absent diastolic flow and/or color flow Doppler in the symptomatic testis. Assessment of parenchymal echogenicity revealed heterogeneity in 37 testes (67%), of which none were deemed viable at exploration. Orchiectomy was performed in 34 of 37 cases. Pathological examination revealed necrosis in all 34 cases, a finding consistent with late torsion. The remaining 3 testes underwent orchiopexy by parental directive despite nonviability, as confirmed by biopsy and subsequent atrophy. Thus, heterogeneity on preoperative ultrasound was universally predictive of organ loss (chi-square p <0.001). Of the 18 symptomatic testes (33%) demonstrating homogeneity and isoechogenicity on ultrasound 16 (89%) were deemed viable at exploration. Boys in whom the torsed testicle was nonviable on exploration experienced an average of 27.5 hours of pain preoperatively (range 5 to 72), whereas boys in whom the torsed testis was salvaged experienced an average of 20.5 hours of pain (range 2 to 96) (p = 0.073). The nonviable group underwent surgery an average of 49 minutes after ultrasound, whereas the viable group underwent surgery 52 minutes after ultrasound (p = 0.92). None of the 55 patients experienced any surgical or anesthetic complications and no pathological condition was noted intraoperatively in the contralateral asymptomatic testis. In the setting of Doppler proven testicular torsion heterogeneous parenchymal echo texture indicates late torsion and testicular nonviability. Therefore, the case may not require emergent scrotal exploration. On the other hand, homogeneous echo texture portends extremely well for testicular viability. Thus, such testes should be explored emergently.

Torsion of Normal Adnexa in Postmenarchal Women and Risk of Recurrence

To compare the incidence of recurrent torsion of normal adnexa to recurrent torsion of abnormal adnexa in postmenarchal women. All cases of surgically confirmed adnexal torsion operated on in our department from January 2002 to April 2006 were retrospectively analyzed. Classification as torsion of pathologic adnexa versus torsion of normal adnexa was based on pre- and postoperative pelvic sonograms, operative findings, and pathologic diagnoses (when available). The torsion recurrence rates were evaluated by a telephone questionnaire, with 90.5% compliance. Twelve women had twisted normal adnexa and 50 women had twisted abnormal adnexa. The women with twisted normal adnexa were younger (25.5+/-7.9 years versus 31.4+/-11.4 years, P=.10) and had a lower median parity (0 versus 1, P=.06). Both groups had similar clinical presentations and a similar mean time from admission to surgery. The torsion recurrence rates were 63.6% (95% confidence interval [CI] 0.3-0.9) in the twisted normal adnexa group and 8.7% (95% CI 0.02-0.2) in the twisted abnormal adnexa group (P<.001). The retorsion risk of the pathologic adnexa was especially low after cystectomy (5.3%, 95% CI 0.001-0.3) or salpingo-oophorectomy (0%). The Kaplan-Meier life table analysis also showed a higher retorsion risk for normal adnexa (P=.008). The current adnexa-sparing laparoscopic management of adnexal torsion by simply untwisting may predispose to recurrent torsion of normal adnexa. The role of ovariopexy procedures in the prevention of recurrent torsion events remains uncertain. III.

Torsion of the Cryptorchid Testis—Can It be Salvaged?

The literature concerning undescended testis mainly concentrates on the increased risks of infertility and development of germ cell tumors. Yet the UDT also appears to be at higher risk for torsion compared to the normally descended testis, and this issue is relatively poorly addressed. We reviewed all cases of torsion of UDTs operated on at our hospital during the last 20 years in an attempt to characterize better this condition and its salvageability. In this retrospective clinical study we reviewed and analyzed all cases of testicular torsion involving UDT operated on at our hospital between 1984 and 2004. A total of 11 children were operated on at our hospital for torsion of undescended testis between 1984 and 2004. Patient age ranged from 1 month to 18 years (median 7.5 months). In all cases unilateral torsion of undescended testis was diagnosed, with 73% of cases involving the left side. Clinical symptoms included inguinal swelling and erythema associated with a tender, firm mass palpated in the groin area and an empty ipsilateral hemiscrotum. Doppler ultrasound examination was routinely performed in the last 7 patients to confirm the diagnosis. During inguinoscrotal exploration severe ischemia or overt necrosis of the testis was found in 5 of 11 cases. Three of these 5 cases were managed by orchiectomy, while in the other 2 cases the testis subsequently vanished. In the 6 patients who exhibited some improvement following detorsion and warming of the tissue the testes were preserved and orchiopexy was performed. Followup was available in only 5 patients, with vanishing of the torsed testis observed in 4 and a normal testicle detected 21 years postoperatively in 1 patient who was diagnosed early. This series clearly demonstrates poor rates of surgical salvage, which we mainly attribute to delays in parental response and in primary physician referral to the hospital. Parents, who have a pivotal role in early diagnosis, were usually unaware of this urological emergency, and some were surprisingly unaware of the presence of cryptorchidism. By increasing the awareness regarding this entity among members of the medical community and parents, we hope that torsion of the cryptorchid testis (literally, "hidden testis") will no longer necessarily be synonymous with "crypt-torsion" ("hidden torsion").

Testicular Fixation Following Torsion of the Spermatic Cord???Does it Guarantee Prevention of Recurrent Torsion Events?

Testicular Fixation Following Torsion of the Spermatic Cord???Does it Guarantee Prevention of Recurrent Torsion Events?

Testicular Fixation Following Torsion of the Spermatic Cord—Does It Guarantee Prevention of Recurrent Torsion Events?

Testicular Fixation Following Torsion of the Spermatic Cord—Does It Guarantee Prevention of Recurrent Torsion Events?

Testicular Fixation Following Torsion of the Spermatic Cord—Does it Guarantee Prevention of Recurrent Torsion Events?

Patients with history of testicular torsion who have undergone orchiopexy may rarely present with acute scrotum due to recurrent episodes of torsion. Most of the reports in the literature regarding this scenario refer to the era when absorbable sutures were used for testicular fixation. Herein, we review our experience in recent years, focusing upon the surgical technique and sutures' material. Between 1991 and 2003, 179 patients were operated on at our institute with the clinical diagnosis of unilateral testicular torsion. They ranged in age between neonates to 45 years old (average age 18). In a comprehensive retrospective study we managed to locate 8 patients who experienced recurrent intravaginal testicular torsion following previous fixation performed in our institute. The patients who experienced repeat torsion have initially presented at the mean age of 18.5 years old (range 12 to 30) with unilateral twisted testicle (left 3, right 5). Urgent explorations were generally performed, apart from in 2 cases that underwent spontaneous detorsion which was followed by an elective surgery. Testicular fixation was conducted by suturing of the tunica albuginea to the dartos layer by 2 sutures at each side, using chromic 3-zero in the 3 more early cases, followed by the usage of polyglactin 3-zero stitches in 4 subsequent cases and 3 sutures of polypropylene 4-zero for each testicle, thereafter, in the most recent case. The patients presented with repeat torsion, 0.5 to 23 years subsequently (average 7 years), involving either the ipsilateral testicle in 4 cases or the contralateral gonad in 4. Recurrent torsion following previous testicular fixation may appear many years following the primary procedure, even in cases in which either polyglactin or, notwithstanding, polypropylene sutures have been applied, in accordance with the common practice used in the last 2 decades. Increased awareness regarding this possibility is imperative for early diagnosis and prevention of testicular loss.

Laparoscopic oophoropexy for the treatment of recurrent torsion of the adnexa in pregnancy: Case report and review

To introduce a new surgical approach, oophoropexy to prevent recurrent adnexal torsion. Case report and review of the literature. The obstetrics and gynecology department of a university hospital. A 29-year-old pregnant patient who had three events of torsion of the adnexa after stimulation. Laparoscopic oophoropexy. Incidence of torsion. No more torsion events were registered during the ongoing pregnancy. Laparoscopic oophoropexy is recommended in emergency situations to increase adnexal salvage and to prevent a recurrence.