Treatment of testicular torsion in children: One surgeon experience

Aim Testicular torsion (TT) is an urgency that requires operation in children. Here, it was aimed to investigate the characteristics of cases operated on due to TT and to discuss its results in light of the literature.Material and Methods:Operated due to TT, 22 cases and their ages, time spent between initial of complaints and hospital admission, color-Doppler-ultrasonography (CDUS) findings, degree of torsion and the results were investigated retrospectively.Results: While median (IQR) age was 7.5 (12.25) years (4hours-16years), median (IQR) application time was 18.5 (33) hours. Three cases were with prenatal torsion. The most common complaints were pain, swelling, discoloration of scrotum, and vomiting. Three cases were admitted with inguinal masses, two of whom were undescended TT. Left testicles were torsioned in 17 cases. Median (IQR) TT degree was 540 (225). While CDUS was descriptive in 20 patients, it was reported as epididymo-orchitis and hydrocele in two cases. Orchiectomy was performedin eight cases, while testicular detorsio-fixation was performed in 14 cases. The cases undergoing orchiectomy had an average of 792 degree. Two of these were prenatal, and two were undescended TT. Mean application time for the other four cases was 83.5 hours.Conclusion: For early and true diagnosis of TT, CDUS is a quite effective method. If reported not to be perfusion, the case is certainly assessed as torsion. If reported as epididymo-orchitis or hydrocele in CDUS, but suspected to be torsion, the patient should be explored immediately.

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Kaye JD, Levitt SB, Friedman SC, Franco I, Gitlin J, Palmer LS. Neonatal torsion: a 14-year experience and proposed algorithm for management. J Urol 2008;179(6):2377-83.
Brandt MT, Sheldon CA, Wacksman J, Matthews P. Prenatal testi¬cular torsion: principles of management. J Urol 1992;147(3):670.
17-Saraç M, Bakal Ü, Tartar T, Gürbaz MT, Onur MR, Kazez A. Çocuklarda testiküler detorsiyonun ön sonuçları. Çocuk Cerrahisi Dergisi 2014;28(2):57-60.
Pogorelic Z, Mrklic I, Juric I. Do not forget to include testicular torsion in differential diagnosis of lower acute abdominal pain in young males. J Pediatr Urol 2013;9(6PtB):1161-5.
Hutson JM. Undescended Testis Torsion and Varicocele. In: Coran AG,Adzick NS, Krummel T, Laberge JM, Shamberger R, Caldamone A, editors. Pediatric Surgery. 7th ed. Philadelphia: Elsevier Mosby; 2012. p. 1015-6.
Altinkilic B, Pilatz A, Weidner W. Detection of normal intratesticular perfusion using color coded duplex sonography obviates need for scrotal exploration in patients with suspected testicular torsion. J Urol 2013;189(5):1853- 8.
Allen TD, Elder JS. Shortcomings of color Doppler sonography in the diagnosis of testicular torsion. J Urol 1995;154(4):1508-10.
Ingram S, Hollman AS, Azmy A. Testicular torsion: missed diagnosis on colour Doppler sonography. Pediatr Radiol 1993;23(6):483-4.
Kass EJ, Stone KT, Cacciarelli AA, Mitchell B. Do all child¬ren with an acute scrotum require exploration? J Urol 1993;150(2Pt2):667-9.
Gatti JM, Patrick Murphy J. Current management of the acute scrotum. Semin Pediatr Surg 2007;16(1):58-63.
Baker LA, Sigman D, Mathews RI, Benson J, Docimo SG. An analysis of clinical outcomes using color doppler testicular ultrasound for testicular torsion. Pediatrics 2000;105(3Pt1):604-7.
McCombe AW, Scobie WG. Torsion of scrotalcontents in children. Br J Urol 1988;61(2):148-50.
Özdemir K, Savaş Ç. Çocuklarda akut skrotum. SDÜ Tıp Fakültesi Derg 2000;7:50-60.
Corbett HJ, Simpson ET. Management of the acute scrotum in children. ANZ J Surg 2002;72(3):226-8.
Makela E, Lahdes-Vasama T, Rajakorpi H, Wikstrom S. A 19-year review of paediatric patients with acute scrotum. Scand J Surg 2007;96(1):62-6.
Liang T, Metcalfe P, Sevcik W, Noga M. Retrospective review of diagnosis and treatment in children presenting to the pediatric department with acute scrotum. AJR Am J Roentgenol. 2013;200:444-9.
TT Ringdahl E, Teague L. Testicular Torsion. American Family Physician 2006;74(10):1739-43
Agrawal AM, Tripathi PS, Shankhwar A, Naveen C. Role of ultrasound with color Doppler in acute scrotum management. J Family Med Prim Care 2014;3(4):409-12.
Pentyala S, Lee J, Yalamanchili P, Vitkun S, Khan SA. Testicular torsion: a review. J Low Genit Tract Dis 2001;5(1):38-47.