Summary
Introduction
Torsion of an undescended testis (UT) is a surgical emergency, difficult to diagnose,
whose prognosis depends on a quick management.
Aim of the study
To evaluate the management and outcome of these patients.
Study design
We retrospectively analyzed all cases of UT torsion operated in nine French hospitals
between 1997 and 2017. We divided patients in two groups: patients referred less than
6 h after the onset of symptoms (group A) or more than 6 h (group B).
Main results
We collected 60 cases (17 in group A and 43 in group B). Median age was 2.2 years
[IQR = 0.7–7.8] (2.3 y in group A and 2 y in group B, p = 0.76). Eleven patients (10
in group B) had neurological disorders (p = 0.15). The main reason for absence of
UT treatment was the absence of surgical consultation in a normal delay (n = 44, 73%).
Symptoms were pain (n = 58, 97%), inguinal mass (n = 55, 92%) and vomiting (n = 16,
27%). An inguinal mass with no palpable testis in the ipsilateral hemiscrotum was
seen in 55 patients (92%). An ultrasound scan performed in 27 patients led to the
diagnosis in 16 patients (59%). At surgery, an orchiectomy was performed in 4 patients
(23%) of group A and 24 patients (56%) of group B (p = 0.04). After a median follow-up
of 11 months [IQR = 4–23], 11 patients of group A (65%) and 7 patients of group B
(16%) had a clinically normal testis (p = 0.03). The salvage rate among patients with
conservative treatment was 85% for group A and 37% for group B (p = 0.01).
Discussion
Our study reveals that although UT torsion is an emergency, 72% of patients are referred
more than 6 h after the onset of symptoms. We mostly found classic clinical presentation
of UT torsion: a painful inguinal mass with an empty ipsilateral scrotum. Ultrasound
was performed in half cases, and even if the result was not significant, it still
seemed to be associated with a higher rate of orchiectomy especially in group B because
of the delay in care. However, when ultrasound was realized early, it led to diagnosis
in all cases. This dilemma poses the problem of the role of imaging in diagnostic
management.
Conclusions
Summary TableOperative findings and follow-up
| Group A (n = 17) | Group B (n = 43 ) | TOTAL (n = 60) | p-value | |
|---|---|---|---|---|
| Testis appearance, n (%) | ||||
| Ischemic | 10 (59) | 10 (23) | 20 (33) | 0.01 |
| Necrotic | 5 (30) | 26 (61) | 31 (52) | 0.04 |
| Vascularized | 2 (11) | 7 (16) | 9 (15) | 0.99 |
| Orchiectomy, n (%) | 4 (23) | 24 (56) | 28 (47) | 0.04 |
| Orchidopexy of the contralateral testis, n (%) | 2 (12) | 15 (35) | 17 (28) | 0.11 |
| Testis atrophy at last follow-up, n (%) | 2 (12) | 8 (18) | 10 (31) | 0.05 |
| Normal clinical testis at last follow-up, n (%) | 11 (65) | 7 (16) | 18 (30) | 0.03 |
a Four patients were lost to follow-up.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of care.J Urol. 2011; 186: 2009-2013
- Factors associated with delayed presentation and misdiagnosis of testicular torsion: a case-control study.J Pediatr. 2017; 186: 200-204
- Door to detorsion time determines testicular survival.Urology. 2019; 133: 211-215
- Epidemiology and pathogenesis of cryptorchidism.Hum Reprod Update. 2008; 14: 49-58
- Torsion of an undescended testis — a surgical pediatric emergency.J Pediatr Surg. 2019 June; (Epub ahead of print)https://doi.org/10.1016/j.jpedsurg.2019.06.018
- Torsion of undescended testis: clinical, imaging, and surgical findings.Urol Sci. 2014; 25: 31-34
- Images in clinical medicine. Torsion of undescended testis.N Engl J Med. 2012; 366: 1625
- Undescended testis and torsion: is the risk understated?.Arch Dis Child. 2013; 98: 77-79
- Testicular torsion in undescended testis: a persistent challenge.Asian J Urol. 2017; 4: 111-115
- Testicular torsion in the inguinal canal in children.J Pediatr Urol. 2013; 9: 793-797
- Torsion of an undescended testis located in the inguinal canal.J Emerg Med. 2012; 42: 538-539
- Testicular torsion and risk factors for orchiectomy.Arch Pediatr Adolesc Med. 2005; 159: 1167-1171
- Factors influencing rate of testicular salvage in acute testicular torsion at a tertiary pediatric center.West J Emerg Med. 2015; 16: 190-194
- Children with cryptorchidism complicated by testicular torsion: a case series.Urol Int. 2019; 102: 113-117
- Torsion of the cryptorchid testis--can it be salvaged?.J Urol. 2006; 175 (discussion 2289): 2287-2289
- Suspected testicular torsion in children: diagnostic dilemma and recommendation for a lower threshold for initiation of surgical exploration.Res Rep Urol. 2018; 10: 241-249
- [Diagnosis and treatment of 109 cases of testicular torsion in children and adolescents].Zhonghua Nan Ke Xue Natl J Androl. 2019; 25: 46-49
- Critical analysis of the clinical presentation of acute scrotum: a 9-year experience at a single institution.J Urol. 1997; 158: 1198-1200
- Clinical predictors for testicular torsion as seen in the pediatric ED.Am J Emerg Med. 2010; 28: 786-789
- Management of undescended testes: European association of urology/European society for paediatric urology guidelines.J Pediatr Urol. 2017; 13: 550
- Evaluation and treatment of cryptorchidism: AUA guideline.J Urol. 2014; 192: 337-345
- Changing trends in the referral and timing of treatment for congenital cryptorchidism: a single-center experience from Bosnia and Herzegovina.J Pediatr Surg. August 2019; (Epub ahead of print)https://doi.org/10.1016/j.jpedsurg.2019.08.013
- Factors associated with delay in undescended testis referral.J Pediatr Urol. 2019; 15: 380.e1-380.e6
- Undescended testis: 513 patients' characteristics, age at orchidopexy and patterns of referral.Arch Dis Child. 2014; 99: 401-406
- Acquired undescended testis and possibly associated testicular torsion in children with cerebral palsy or neuromuscular disease.J Pediatr Urol. 2018; 14: 402-406
- An infant with testicular torsion in the inguinal canal.Pediatr Radiol. 2003; 33: 722-724
- Torsion infarction in ectopic cryptorchidism: a rare entity occurring most commonly with spastic neuromuscular disease.Surgery. 1972; 71: 335-338
- Cremasteric reflex and retraction of a testis.J Pediatr Surg. 2001; 36: 863-867
- Critical validation of ultrasound Doppler in the diagnosis of torsion of undescended testis.Isr Med Assoc J IMAJ. 2007; 9: 99-101
- Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum.J Urol. 2007; 177 (discussion 301): 297-301
- Magnetic resonance imaging for detection of non palpable undescended testes: diagnostic accuracy of diffusion-weighted MRI in comparison with laparoscopic findings.Egypt J Radiol Nucl Med. 2015; 46: 205-210
- Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion.J Ultrasound Med Off J Am Inst Ultrasound Med. 2006; 25: 563-574
Article info
Publication history
Published online: December 08, 2020
Accepted:
December 2,
2020
Received in revised form:
November 27,
2020
Received:
July 12,
2020
Identification
Copyright
© 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
