Cut-off time for surgery and prediction of orchiectomy in spermatic cord torsion: a retrospective multicentric study over 15 years.

PURPOSE: Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic cord in a large cohort. METHODS: We performed a retrospective multicenter study (TORSAFUF cohort) of patients with suspected spermatic cord torsion between 2005 and 2019. All patients aged > 12 years who were suspected of having a torsion of the spermatic cord in 14 University Hospitals in France were included (n = 2986). Patients for whom data on pain duration were not available (n = 923) or for whom the final diagnosis was not torsion of the spermatic cord (n = 807) were excluded. The primary outcome was orchiectomy. The secondary outcomes were testicular survival time and the prediction of orchiectomy with the duration of pain. RESULTS: 1266 patients were included with an orchiectomy rate of 12% (150 patients). The mean age was 21.5 years old in the salvage group and 23.7 years old in the orchiectomy group (p = 0.01), respectively. The median time from the onset of pain to surgery was 5.5 (IQR = 5) hours in the salvage group and 51.1 (IQR = 70) hours in the orchiectomy group (p < 0.0001). The risk of orchiectomy increased after a time cut-off of 6 h 30. A delay of 15 h 30 in pain duration was found to predict orchiectomy (sensitivity: 0.81; specificity: 0.87). CONCLUSIONS: Pain duration can predict the probability of salvaging the testicles and performing orchiectomy. Rapid intervention should be recommended, regardless of the time elapsed from the onset of pain.

Torsion of the spermatic cord in adults: a multicenter experience in adults with surgical exploration for acute scrotal pain with suspected testicular torsion.

Acute scrotal pain (ASP) requiring surgical exploration is common in the pediatric population, but little has been reported on this subject with regard to the adult population. The aim of this study was to investigate the demographic and clinical characteristics and outcomes of scrotal explorations performed on adult patients. Patients over 21 years of age who underwent surgical exploration for ASP with suspected testicular torsion (TT) at 14 French hospitals between January 2005 and December 2019 were included in this study. The main outcome measures were demographic characteristics, pathology found during scrotal exploration, and perioperative outcomes. Logistic regression was used to perform univariate and multivariate analyses to identify predictors of TT. Data for 1329 men were analyzed. The median age was 30 (interquartile range [IQR]: 25-35; range: 21-89) years. Regarding the clinical examination, 867 (65.2%) patients presented with an elevation of the testicle, 613 (46.1%) patients with scrotal edema or erythema, and 211 (15.9%) patients with nausea or vomiting. Operative findings identified TT in only 684 (51.5%) patients, epididymo-orchitis in 112 (8.4%) patients, a tumor in 16 (1.2%) patients, and no causes in 475 (35.7%) patients. Orchiectomy for nonviable testes was required in 101 (7.6%) patients. In multivariate analysis, an elevation of the testicle, erythema/swelling, and the presence of nausea/vomiting were found to be associated with the occurrence of TT. Testicular torsion is not exclusive to children and adolescents, so must be considered in males of any age with acute scrotal findings. However, one-third of scrotal explorations in adults did not lead to a diagnosis.

Influence of the median lobe on the results at 4 years of the prostate vaporization by GreenLight laser.

OBJECTIVE: The aim of this study was to examine the influence of a median lobe (ML) on complications and functional results after 4 years of GreenLight photoselective vaporization of the prostate (PVP). METHODS: All men undergoing GreenLight PVP for benign prostatic hyperplasia were included in the baseline analysis and followed prospectively. Two groups were formed according to the presence or absence of the prostatic ML. Complications classified according Clavien and Dindo and functional results (International Prostate Symptom Score [IPSS], quality of life, maximum urinary flow rate [Qmax], and postvoid residual [PVR]) were evaluated with 4 years of follow-up. The pre- and postoperative data were compared by a chi-square test (χ2 ) for the qualitative variables and by a Student t test for the quantitative variables. RESULTS: A total of 432 patients (172 with ML and 260 without ML) were included prospectively from September 2005 to October 2013. The initial populations were comparable. At 4 years of follow-up, the improvement in mean IPSS was significantly greater for patients with ML at 6, 12, 24, and 48 months. The improvement in Qmax was significantly greater for patients with ML at 1, 6, 24, and 48 months. There was no significant difference between the two groups concerning the PVR reduction, the occurrence of complications, the level of average prostate-specific antigen, and the average ultrasound volume at 4 years. CONCLUSION: There is a clearer and longer-lasting improvement in urinary symptoms in patients with prostatic ML. The indication of PVP in those patients seems to be excellent, with good results persisting at 4 years.