Did the COVID-19 pandemic affect the Approach to Testicular Torsion Cases?

Year 2022, Volume: 12 Issue: 2, 141 - 145, 31.08.2022

Mehmet Yılmaz İbrahim Hacibey Ünsal Özkuvancı Ramazan Ömer Yazar Ahmet Yaser Müslümanoğlu

Abstract

Aim: COVID-19 pandemic affects the approach to emergency pathologies as well as in many diseases. Testicular torsion is a scrotal emergency, where the time leading up to diagnosis and treatment is most important in organ protection. We planned to compare the time until diagnosis and treatment and the rate of organ loss between the pre-pandemic period and the pandemic period in our clinic.
Materials and Methods: In our retrospective study, we included patients over the age of 1 who were diagnosed with testicular torsion and treated in our clinic between March2019 and March2021. We divided the patients into 2 groups according to the time of admission. We named the period between March2019- March2020 Group1 and the interval between March2020- March2021 as Group2. We compared the 2 groups in terms of demographic data, ischemic duration and orchiectomy rates.
Results: Of the 55 total cases that met the study inclusion criteria, 26 occurred during the pre-pandemic period and 29 during the COVID-19 crisis. The median age for group 1 was 17 (IQR: 6-32) and 15 (IQR: 6-28) in the group 2 (p=0,019). Incidence of orchiectomy in our center was 31% in the group 2 and 15.4% in the group 1 and it was not statistically significant (p = 0.173). In the evaluation of the whole cohort (n=55) according to early (before 12 hours) and late admission (after 12 hours), the rate of orchiectomy at early admission was found to be significantly lower (50% compared to 3.6 %; p=0,006). The median time from onset of symptoms to first presentation was not significantly different between group1 and 2 (p=0.439).
Conclusion: Time to presentation, ischemic times, and orchiectomy rates for testicular torsion at our center were not significantly different during the COVID-19 period compared to the pre-pandemic period.

Keywords

acute scrotal pathologies, COVID-19 pandemic, testicular torsion

References

• 1. Osumah TS, Jimbo M, Granberg CF, Gargollo PC. Frontiers in pediatric testicular torsion: An integrated review of prevailing trends and management outcomes. J Pediatr Urol 2018; 14(5): 394-01.
• 2. Doğukan M, Duran M, Uludağ Ö, Tepe M, Çelik Z, Çift A. Anesthetic Management of Testicular Torsions and Seasonal Distribution: 5-Year Analysis. Van Tıp Derg 2020; 27(1): 1-4.
• 3. Ta A, D’Arcy FT, Hoag N, D’Arcy JP, Lawrentschuk N. Testicular torsion and the acute scrotum. Eur J Emerg Med 2016; 23(3): 160-5.
• 4. Jefferson RH, Pérez LM, Joseph DB. Critical analysis of the clinical presentation of acute scrotum: a 9-year experience at a single institution. J Urol 1997; 158 (Pt 2): 1198–1200.
• 5. Dunne PJ, O’Loughlin BS. Testicular torsion: time is the enemy. Aust N Z J Surg 2000; 70: 441–2.
• 6. Tanaka K, Ogasawara Y, Nikai K, Yamada S, Fujiwara K, Okazaki T. Acute scrotum and testicular torsion in children: Retrospective study in a single institution. J Pediatr Urol 2019; 16(1): 55-60.
• 7. Zhao LC, Lautz TB, Meeks JJ, Maizels M. Pediatric testicular torsion epidemiology 16 using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of care. J Urol 2011; 186: 2009-13.
• 8. Murphy FL, Fletcher L, Pease P. Early scrotal exploration in all cases is the investigation of choice in the acute paediatric scrotum. Pediatr Surg Int 2006; 22: 413-6.
• 9. Ribal MJ, Cornford P, Briganti A, Knoll T, Gravas S, Babjuk M, et al. EAU Section Offices and the EAU Guidelines Panels. European Association of Urology Guidelines Office Rapid Reaction Group: An Organisation-wide Collaborative Effort to Adapt the European Association of Urology Guidelines Recommendations to the Coronavirus Disease 2019 Era. j eururo 2020; 78(1): 21–28.
• 10. Tankel J, Keinan A, Blich O, Koussa M, Helou B, Shay S et al. The Decreasing Incidence of Acute Appendicitis During COVID-19: A Retrospective Multi-centre Study. World J Surg 2020; 26: 1-6.
• 11. Teo KC, Leung WCY, Wong YK, Liu RKC, Chan AHY, Choi OMY et al. Delays in stroke onset to hospital arrival time during COVID-19. Stroke 2020; 51(7): 2228-31.
• 12. Mafham MM, Spata E, Goldacre R, Gair D, Curnow P, Bray M et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. London, England: Lancet 2020; 396(10248): 381-9.
• 13. Lange SJ, Ritchey MD, Goodman AB, Dias T, Twentyman E, Fuld J et al. Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute lifethreatening conditions - United States, January-May 2020. Am J Transplant 2020; 69(25): 795-800.
• 14. Power BD, Power RF, Twomey J, Afridi Z, Neylonet OM. PANDEMIC: presentation of non-COVID cases—delay in emergencies in children. J Paediatr Child Health 2021 Jun;57(6):929-31.
• 15. Holzman SA, Ahn JJ, Baker Z, Chuang KW, Copp HL, Davidson J et al. A multicenter study of acute testicular torsion in the time of COVID-19. J Pediatr Urol 2021 Aug;17(4): 478.e1-478.e6.
• 16. Place R, Lee J, Howell J. Rate of pediatric appendiceal perforation at a children’s hospital during the COVID-19 pandemic compared with the previous year. JAMA Netw Open 2020; 3: e2027948.
• 17. Wong LE, Hawkins JE, Langness S, Murrell KL, Iris P, Sammann A. Where are all the patients? Addressing COVID-19 fear to encourage sick patients to seek emergency care. NEJM Catal Innov Care Deliv 2020 May 14: 10.1056/CAT.20.0193.
• 18. Fisher JC, Tomita SS, Ginsburg HB, Gordon A, Walker D, Kuenzler KA. Increase in pediatric perforated appendicitis in the New York city metropolitan region at the epicenter of the COVID-19 outbreak. Ann Surg 2021; 273(3): 410e5.
• 19. Bram JT, Johnson MA, Magee LC, Mehta NN, Fazal FZ, Baldwin KD et al. Where have all the fractures gone? The epidemiology of pediatric fractures during the COVID-19 pandemic. J Pediatr Orthop 2020; 40: 373–9.
• 20. Roland D, Harwood R, Bishop N, Hargreaves D, Patel S, Sinhac I. Children's emergency presentations during the COVID-19 pandemic. Lancet Child Adolesc Health 2020; 4(8): e32–e33.
• 21. Offenbacher R, Knoll MA, Loeb DM. Delayed presentations of pediatric solid tumors at a tertiary care hospital in the Bronx due to COVID-19. Pediatr Blood Cancer 2020; e28615.
• 22. Nelson CP, Kurtz MP, Logvinenko T, Venna A, McNamara ER. Timing and outcomes of testicular torsion during the COVID-19 crisis. J Pediatr Urol 2020 Dec; 16(6): 841.e1e5.
• 23. Littman AR, Janssen KM, Tong L, Wu H, Wang MD, Blum E et al. Did COVID-19 affect time to presentation in the setting of pediatric testicular torsion? Pediatr Emerg Care 2021; 37(2): 123-5.
• 24. Gold DD, Lorber A, Levine H, Rosenberg S, Duvdevani M, Landau EH et al. Door to detorsion time determines testicular survival. Urology 2019; 133: 211-5.
• 25. Bayne CE, Villanueva J, Davis TD, Pohl HG, Rushton HG. Factors associated with delayed presentation and misdiagnosis of testicular torsion: a case-control study. J Pediatr 2017; 186: 200-4.
• 26. Preece J, Ching C, Yackey K, Jayanthi V, McLeod D, Alpert S et al. Indicators and outcomes of transfer to tertiary pediatric hospitals for patients with testicular torsion. J Pediatr Urol 2017; 13(4): 388.e1-388.e6.