Orchidopexy for Testicular Torsion: A Systematic Review of Surgical Technique.

CONTEXT: Acute testicular torsion is a common urological emergency. Accepted practice is surgical exploration, detorsion, and orchidopexy for a salvageable testis. OBJECTIVE: To critically evaluate the methods of orchidopexy and their outcomes with a view to determining the optimal surgical technique. EVIDENCE ACQUISITION: This review protocol was published via PROSPERO [CRD42016043165] and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). EMBASE, MEDLINE, and CENTRAL databases were searched using the following terms: "orchidopexy", "fixation", "exploration", "torsion", "scrotum", and variants. Article screening was performed by two reviewers independently. The primary outcome was retorsion rate of the ipsilateral testis following orchidopexy. Secondary outcomes included testicular atrophy and fertility. EVIDENCE SYNTHESIS: To our knowledge, this is the first systematic review on this topic. The search yielded 2257 abstracts. Five studies (n = 138 patients) were included. All five techniques differed in incision and/or type of suture and/or point(s) of fixation. Postoperative complications were reported in one study, and included scrotal abscess in 9.1% and stitch abscess in 4.5%. The contralateral testis was fixed in 57.6% of cases. Three studies reported follow-up duration (range 6-31 wk). No study reported any episodes of ipsilateral retorsion. In the studies reporting ipsilateral atrophy rate, this ranged from 9.1% to 47.5%. Fertility outcomes and patient-reported outcome measures were not reported in any studies. CONCLUSIONS: There is limited evidence in favour of any one surgical technique for acute testicular torsion. During the consent process for scrotal exploration, uncertainties in long-term harms should be discussed. This review highlights the need for an interim consensus on surgical approach until robust studies examining the effects of an operative approach on clinical and fertility outcomes are available. PATIENT SUMMARY: Twisting of blood supply to the testis, termed testicular torsion, is a urological emergency. Testicular torsion is treated using an operation to untwist the cord that contains the blood vessels. If the testis is still salvageable, surgery can be performed to prevent further torsion. The method that is used to prevent further torsion varies. We reviewed the literature to assess the outcomes of using various surgical techniques to fix the twisting of the testis. Our review shows that there is limited evidence in favour of any one technique.

Has the Bachelor of Surgery Left Medical School?-A National Undergraduate Assessment.

INTRODUCTION: Nearly all trainee doctors would undertake a surgical placement in their clinical training; however, there is anecdotal evidence of variability in undergraduate surgical teaching across the UK. We set out to describe the provision of undergraduate surgery and report graduating students' opinions of aspects of this. METHODS: We undertook a cross-sectional questionnaire of medical students graduating in 2014 from UK medical schools. An online electronic questionnaire was used to capture demographics, career intentions, and individual's undergraduate experience of surgery. A separate questionnaire was sent to medical schools to assess time devoted to surgical placements and how surgical sciences were taught and assessed. RESULTS: From 483 responses covering 31 UK medical schools, there were 328 completed student questionnaires. A third of respondents felt that teaching of surgical sciences was inadequate. Medical schools reported time allocated to surgical specialties ranging from 4 to 21 weeks (median 13 weeks). Among all, 1 medical school offered a basic surgical skills course and 1 medical school specifically assessed surgical-related skills. Overall, 65% of medical students felt prepared for a surgical foundation placement and 88% felt prepared for a medical foundation placement. In total, 78% felt ready to participate in an acute medicine on-call and 48% felt ready for emergency surgery on-call. There was a positive association between time dedicated to undergraduate surgery and reported preparedness for a foundation surgical job. CONCLUSIONS: UK medical students reported uniformly low rates of satisfaction with surgical science teaching. Students studying at medical schools with more time in the curriculum dedicated to surgery reported higher levels of preparedness for surgical foundation jobs. There were differences in the rates of perceived preparedness for surgical posts and for emergency surgery. There is a clear need to review undergraduate surgical provision to ensure that students are equipped for safe practice in junior surgical foundation jobs.