Erişkin Testis Torsiyonu Hastalarında Manuel Detorsiyonun Testis Kurtarma Oranlarına Etkisi: Tek Merkez Deneyimi

Abstract

Amaç: Bu çalışmanın amacı erişkin testis torsiyonunda manuel detorsiyonun testis kurtarma oranlarına etkisini ve manuel detorsiyonun başarısını etkileyen faktörleri ortaya koymaktır. Gereç ve Yöntemler: Akut skrotum ön tanısı ile acil servise başvuru yapan hastaların kayıtları incelendi. Testis torsiyonu tanısı konulan 62 erişkin hasta çalışmaya dahil edildi. Hastaların tamamına cerrahi öncesinde manuel detorsiyon denendi. Hastaların demografik özellikleri, skrotal ağrının başlangıcından hastaneye başvuruya kadar geçen süreleri (<24 saat/>24 saat), fizik muayene ve ultrasonografi bulguları, uygulanan cerrahinin tipi ve uzun dönem sonuçları değerlendirildi. Elde edilen veriler manuel detorsiyonu başarılı ve başarısız kabul edilen hastalar arasında istatistiksel olarak karşılaştırıldı. Bulgular: Manuel detorsiyon 36 (%58,1) hastada başarılı, 26 (%41,9) hastada ise başarısız olarak kabul edildi. Başarılı olan hastaların 35’inde (%97,2) ve başarısız olan hastaların ise 11’inde (%42,3) orşiopeksi uygulandı (p<0,001). Alt grup analizi yapıldığında, ağrı süresi 24 saatten daha kısa olan hastalarda, manuel detorsiyonu başarılı olan ve olmayan hastalar arasında ağrı süresi açısından anlamlı bir farklılık olmamasına rağmen (p=0,648), testis kurtarma oranları arasında istatistiksel olarak anlamlı bir farklılık mevcuttu. Başarılı manuel detorsiyon uygulanan hastalarda orşiektomi oranı 1/35 (%2,9) iken, başarısız olan hastalarda bu oran 8/19 (%42,1) olarak bulundu (p<0,001). Sonuç: Testis torsiyonu tanısı alan erişkin hastalarda manuel detorsiyon testis kurtarma oranlarını artırmaktadır, özellikle 24 saatten az ağrı süresi olan hastaların tamamında denenmelidir.

Keywords

• Testküler torsiyon
• Manuel detorsiyon
• Orşiopeksi
• Orşiektomi

The Effect of Manual Detorsion on Testicular Salvage Rates in Adult Testicular Torsion Patients: Single Center Experience

Abstract

Aim: The aim of this study was to reveal the effect of manual detorsion on testicular salvage rates and the factors affecting the success of manual detorsion in adult testicular torsion. Material and Methods: The records of patients who applied to the emergency department with pre-diagnosis of acute scrotum were examined. A total of 62 adult patients diagnosed with testicular torsion were included in the study. Manual detorsion was attempted in all patients before surgery. Demographic characteristics of the patients, time from onset of scrotal pain to hospital admission (<24 hours/>24 hours), physical examination and ultrasonography findings, type of surgery performed, and long-term results were evaluated. The data were statistically compared between patients with manual detorsion considered successful and unsuccessful. Results: Manual detorsion was considered successful in 36 (58.1%) patients and unsuccessful in 26 (41.9%) patients. Orchiopexy was performed in 35 (97.2%) of the successful patients and in 11 (42.3%) of the unsuccessful patients (p<0.001). When subgroup analysis was performed, although there was no significant difference in pain duration between patients with and without successful manual detorsion for patients with pain duration of less than 24 hours (p=0.648), there was a statistically significant difference in testicular salvage rates. While the rate of orchiectomy was 1/35 (2.9%) in patients with successful manual detorsion, this rate was 8/19 (42.1%) in unsuccessful patients (p<0.001). Conclusion: Manual detorsion increases testicular salvage rates in adult patients diagnosed with testicular torsion, and it should be attempted especially in patients with pain duration less than 24 hours.

Keywords

• Testicular torsion
• Manual detorsion
• Orchiopexy
• Orchiectomy

References

1. Moore SL, Chebbout R, Cumberbatch M, Bondad J, Forster L, Hendry J, et al. Orchidopexy for testicular torsion: a systematic review of surgical technique. Eur Urol Focus. 2021;7(6):1493-503.
2. McLaren PSM. A systematic review on the utility of ultrasonography in the diagnosis of testicular torsion in acute scrotum patients. Radiography (Lond). 2021;27(3):943-9.
3. Syed MK, Al Faqeeh AA, Othman A, Hussein AA, Hussain S, Almas T, et al. The spectrum of testicular pathologies upon scrotal exploration for acute scrotum: a retrospective analysis. Cureus. 2020;12(10):e10984.
4. Visser AJ, Heyns CF. Testicular function after torsion of the spermatic cord. BJU Int. 2003;92(3):200-3.
5. Cost NG, Bush NC, Barber TD, Huang R, Baker LA. Pediatric testicular torsion: demographics of national orchiopexy versus orchiectomy rates. J Urol. 2011;185(6 Suppl):2459-63.
6. Jefferies MT, Cox AC, Gupta A, Proctor A. The management of acute testicular pain in children and adolescents. BMJ. 2015;350:h1563.
7. Vasconcelos-Castro S, Flor-de-Lima B, Campos JM, Soares-Oliveira M. Manual detorsion in testicular torsion: 5 years of experience at a single center. J Pediatr Surg. 2020;55(12):2728-31.
8. Cornel EB, Karthaus HF. Manual derotation of the twisted spermatic cord. BJU Int. 1999;83(6):672-4.

9. Demirbas A, Demir DO, Ersoy E, Kabar M, Ozcan S, Karagoz MA, et al. Should manual detorsion be a routine part of treatment in testicular torsion? BMC Urol. 2017;17(1):84.
10. Dias Filho AC, Oliveira Rodrigues R, Riccetto CL, Oliveira PG. Improving organ salvage in testicular torsion: comparative study of patients undergoing vs not undergoing preoperative manual detorsion. J Urol. 2017;197(3 Pt 1):811-7.
11. Tryfonas G, Violaki A, Tsikopoulos G, Avtzoglou P, Zioutis J, Limas C, et al. Late postoperative results in males treated for testicular torsion during childhood. J Pediatr Surg. 1994;29(4):553-6.
12. Drlík M, Kočvara R. Torsion of spermatic cord in children: a review. J Pediatr Urol. 2013;9(3):259-66.
13. Sessions AE, Rabinowitz R, Hulbert WC, Goldstein MM, Mevorach RA. Testicular torsion: direction, degree, duration and disinformation. J Urol. 2003;169(2):663-5.
14. Cummings JM, Boullier JA, Sekhon D, Bose K. Adult testicular torsion. J Urol. 2002;167(5):2109-10.
15. Lian BS, Ong CC, Chiang LW, Rai R, Nah SA. Factors predicting testicular atrophy after testicular salvage following torsion. Eur J Pediatr Surg. 2016;26(1):17-21.
16. Kalfa N, Veyrac C, Lopez M, Lopez C, Maurel A, Kaselas C, et al. Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. J Urol. 2007;177(1):297-301.
17. Nussbaum Blask AR, Rushton HG. Sonographic appearance of the epididymis in pediatric testicular torsion. AJR Am J Roentgenol. 2006;187(6):1627-35.
18. Nash WG. Acute torsion of spermatic cord: reduction: immediate relief. BMJ. 1893;1(1684):742-3.
19. Ringdahl E, Teague L. Testicular torsion. Am Fam Physician. 2006;74(10):1739-43.