Scrotal exploration for acute testicular pain: a contemporary study
BAUS ePoster online library. Maynard W. 06/21/21; 319122; p8-4
Disclosure(s): Nothing to disclose
Mr. William Maynard
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Abstract
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Introduction & Objectives
Guidelines from the Royal College of Surgeons England on the management of acute testicular pain (ATP) state all patients with suspected testicular torsion (TT) should undergo surgery within 3 hours of decision to operate. The aim of this study was to identify challenges in contemporary management and outcomes for ATP.
Patients & Methods
Patients undergoing emergency scrotal exploration were identified from 2015 until 2020 in a single centre retrospective case review. Statistical analysis; SPSS(V.27); Fisher's exact test; Mann-Whitney U Test (p<0.05)
Results
140 consecutive patients underwent surgical exploration, median age 16 years (range 5–50 years). Time to theatre from decision to operate was <3 hours in 85.2%. Ultrasound testis (US) occurred in 23 patients, US delayed time to theatre by median 59 minutes (p=0.03). TT was the most frequent diagnosis (30%); more frequent in patients 13-16 years (62%). TT presented earlier than other causes of ATP, median 4:00 vs 8:50 hours (p=0.036). Contralateral fixation was performed in 89.7% of TT; surgical technique was highly variable in non-TT. Overall testicular salvage was 74.4% (figure 1). Follow up occurred in 42.5% TT patients, 30% who underwent orchidectomy were offered a prosthesis.
Conclusions
This study raises important concerns regarding the contemporary management of ATP; there is no uniformity of practice in surgical technique and follow up. Clinicians should have a high suspicion of TT in patients 13-16 years presenting <4 hours. We propose a management algorithm for ATP patients and propose guidance on management of TT should be updated.
Guidelines from the Royal College of Surgeons England on the management of acute testicular pain (ATP) state all patients with suspected testicular torsion (TT) should undergo surgery within 3 hours of decision to operate. The aim of this study was to identify challenges in contemporary management and outcomes for ATP.
Patients & Methods
Patients undergoing emergency scrotal exploration were identified from 2015 until 2020 in a single centre retrospective case review. Statistical analysis; SPSS(V.27); Fisher's exact test; Mann-Whitney U Test (p<0.05)
Results
140 consecutive patients underwent surgical exploration, median age 16 years (range 5–50 years). Time to theatre from decision to operate was <3 hours in 85.2%. Ultrasound testis (US) occurred in 23 patients, US delayed time to theatre by median 59 minutes (p=0.03). TT was the most frequent diagnosis (30%); more frequent in patients 13-16 years (62%). TT presented earlier than other causes of ATP, median 4:00 vs 8:50 hours (p=0.036). Contralateral fixation was performed in 89.7% of TT; surgical technique was highly variable in non-TT. Overall testicular salvage was 74.4% (figure 1). Follow up occurred in 42.5% TT patients, 30% who underwent orchidectomy were offered a prosthesis.
Conclusions
This study raises important concerns regarding the contemporary management of ATP; there is no uniformity of practice in surgical technique and follow up. Clinicians should have a high suspicion of TT in patients 13-16 years presenting <4 hours. We propose a management algorithm for ATP patients and propose guidance on management of TT should be updated.
Introduction & Objectives
Guidelines from the Royal College of Surgeons England on the management of acute testicular pain (ATP) state all patients with suspected testicular torsion (TT) should undergo surgery within 3 hours of decision to operate. The aim of this study was to identify challenges in contemporary management and outcomes for ATP.
Patients & Methods
Patients undergoing emergency scrotal exploration were identified from 2015 until 2020 in a single centre retrospective case review. Statistical analysis; SPSS(V.27); Fisher's exact test; Mann-Whitney U Test (p<0.05)
Results
140 consecutive patients underwent surgical exploration, median age 16 years (range 5–50 years). Time to theatre from decision to operate was <3 hours in 85.2%. Ultrasound testis (US) occurred in 23 patients, US delayed time to theatre by median 59 minutes (p=0.03). TT was the most frequent diagnosis (30%); more frequent in patients 13-16 years (62%). TT presented earlier than other causes of ATP, median 4:00 vs 8:50 hours (p=0.036). Contralateral fixation was performed in 89.7% of TT; surgical technique was highly variable in non-TT. Overall testicular salvage was 74.4% (figure 1). Follow up occurred in 42.5% TT patients, 30% who underwent orchidectomy were offered a prosthesis.
Conclusions
This study raises important concerns regarding the contemporary management of ATP; there is no uniformity of practice in surgical technique and follow up. Clinicians should have a high suspicion of TT in patients 13-16 years presenting <4 hours. We propose a management algorithm for ATP patients and propose guidance on management of TT should be updated.
Guidelines from the Royal College of Surgeons England on the management of acute testicular pain (ATP) state all patients with suspected testicular torsion (TT) should undergo surgery within 3 hours of decision to operate. The aim of this study was to identify challenges in contemporary management and outcomes for ATP.
Patients & Methods
Patients undergoing emergency scrotal exploration were identified from 2015 until 2020 in a single centre retrospective case review. Statistical analysis; SPSS(V.27); Fisher's exact test; Mann-Whitney U Test (p<0.05)
Results
140 consecutive patients underwent surgical exploration, median age 16 years (range 5–50 years). Time to theatre from decision to operate was <3 hours in 85.2%. Ultrasound testis (US) occurred in 23 patients, US delayed time to theatre by median 59 minutes (p=0.03). TT was the most frequent diagnosis (30%); more frequent in patients 13-16 years (62%). TT presented earlier than other causes of ATP, median 4:00 vs 8:50 hours (p=0.036). Contralateral fixation was performed in 89.7% of TT; surgical technique was highly variable in non-TT. Overall testicular salvage was 74.4% (figure 1). Follow up occurred in 42.5% TT patients, 30% who underwent orchidectomy were offered a prosthesis.
Conclusions
This study raises important concerns regarding the contemporary management of ATP; there is no uniformity of practice in surgical technique and follow up. Clinicians should have a high suspicion of TT in patients 13-16 years presenting <4 hours. We propose a management algorithm for ATP patients and propose guidance on management of TT should be updated.
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