A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database.

Testicular torsion is a severe urological emergency caused by the twisting of the spermatic cord. The nationwide incidence of testicular torsion in Japan has not been previously reported. Accordingly, we aimed to estimate the nationwide incidence of testicular torsion using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and examine the orchiectomy rate. This cross-sectional study was based on data from the NDB. We extracted data of patients aged < 21 years with documented testicular torsion and relevant treatment from January 2018 to December 2020. Testicular torsion was identified based on the Japanese standardized disease codes. The national incidence rate between 2018 and 2020 was calculated and assessed according to age and region of origin. Orchiectomy rates were evaluated according to age. The nationwide incidence rates of testicular torsion were 14.46, 15.09, and 15.88 per 100,000 males aged < 21 years in 2018, 2019, and 2020, respectively. The orchiectomy rate was 7.1%. Testicular torsion was most frequently observed during winter. A similar trend was observed nationwide. To the best of our knowledge, this study is the first to report the nationwide incidence of testicular torsion in Japan.

Testicular Torsion in Jiaodong Peninsula: A 14-Year Multicenter Retrospective Study.

BACKGROUND: To investigate the correlation between temperature and testicular torsion in Jiaodong Peninsula which has temperate continental monsoon climate and is represented by Yantai and its surrounding areas. METHODS: A retrospective analysis was conducted by reviewing clinical data of 292 patients who were admitted and surgically confirmed to have testicular torsion in the Yantai Yuhuangding hospital medical complex between January 1, 2009, and August 31, 2022. Male patients who underwent circumcision (foreskin) were allocated to the control group. Temperature data were obtained from the China Meteorological Data Service Center. Chi-squared test or Fisher's exact test and one-way analysis of variance were employed to compare patient characteristics and climatic variables among the different groups. Pearson's correlation analysis was used to analyze the association between monthly average ambient temperature and monthly cumulative number of cases. Moreover, a logistic regression model was utilized to identify the independent factors of testicular torsion. RESULTS: The mean age of patients with testicular torsion was 16.8 years. The number of cases was the highest in autumn. The temperature was the highest in summer and the lowest in winter (p < 0.01). Furthermore, the temperature difference (TD) in autumn was the highest in the four seasons groups (p < 0.01). The patients were divided into the high TD and low TD groups according to the mean TD (7.62 ◦C) on the admission day. The high TD group had a higher number of patients than the low TD group, and the temperature was lower in the former group than in the latter group (p < 0.01). A roughly negative correlation was observed between ambient temperature and the number of cases (Pearson's r = -0.228, 95% confidence interval (CI): -0.366 to -0.079, p = 0.003). Logistic regression analysis revealed that the independent risk factor for testicular torsion was TD on admission day (odds ratio, 1.82; 95% CI, 1.28-2.59; p < 0.001). CONCLUSIONS: To some extent, external temperature can affect the body surface temperature of patients and then induce testicular torsion. We concluded that testicular torsion easily occurs in the season in which the temperature drops and the TD is high.

Testicular Torsion in Jiaodong Peninsula: A 14-Year Multicenter Retrospective Study

Background: To investigate the correlation between temperature and testicular torsion in Jiaodong Peninsula which has temperate continental monsoon climate and is represented by Yantai and its surrounding areas. Methods: A retrospective analysis was conducted by reviewing clinical data of 292 patients who were admitted and surgically confirmed to have testicular torsion in the Yantai Yuhuangding hospital medical complex between January 1, 2009, and August 31, 2022. Male patients who underwent circumcision (foreskin) were allocated to the control group. Temperature data were obtained from the China Meteorological Data Service Center. Chi-squared test or Fisher’s exact test and one-way analysis of variance were employed to compare patient characteristics and climatic variables among the different groups. Pearson’s correlation analysis was used to analyze the association between monthly average ambient temperature and monthly cumulative number of cases. Moreover, a logistic regression model was utilized to identify the independent factors of testicular torsion. Results: The mean age of patients with testicular torsion was 16.8 years. The number of cases was the highest in autumn. The temperature was the highest in summer and the lowest in winter (p < 0.01). Furthermore, the temperature difference (TD) in autumn was the highest in the four seasons groups (p < 0.01). The patients were divided into the high TD and low TD groups according to the mean TD (7.62 ◦C) on the admission day. The high TD group had a higher number of patients than the low TD group, and the temperature was lower in the former group than in the latter group (p < 0.01). A roughly negative correlation was observed between ambient temperature and the number of cases (Pearson’s r = −0.228, 95% confidence interval (CI): −0.366 to −0.079, p = 0.003) (AU)

[Effect of the COVID-19 pandemic on the outcome of testicular torsion in children]. / A COVID­19-járvány hatása a gyermekkori herecsavarodások kimenetelére.

INTRODUCTION: The COVID-19 pandemic influenced not only the elective, but the acute surgeries also, all around the world. Some authors found more delayed cases and more orchiectomies performed in childhood because of testicular torsions during the pandemic. OBJECTIVE: To examine the impact of the COVID-19 pandemic on the treatment of childhood testicular torsion and the frequency of semicastration due to torsion at the first author's institute. METHODS: A retrospective observational cohort study was performed in a representative Hungarian centre. Boys under 18 years of age operated with testicular torsion were divided into two groups: before COVID-19 (BC; 01/07/2017-31/12/2019) and during COVID-19 (DC; 01/01/2020-30/06/2022) pandemic. PARAMETERS: elapsed time between the first symptom and arrival at the hospital (<24 h or >24 h), elapsed time to start the surgical procedure since the arrival to the hospital and the rate of semicastration were analysed. For statistical analysis, Mann-Whitney U and chi2 tests were used. RESULTS: During the study period, altogether, 100 patients (45 BC and 55 DC) were operated on testicular torsion. Statistically significant difference was found between the two timeframes: in the elapsed time from the first symptom and arrival at the hospital (p = 0.048). During the pandemic surgeries started earlier (1.5; 2.5 h) than before the pandemic (1.5; 3.25 h, p = 0.01). No difference was found in the frequency of semicastration between the groups (p = 0.594). DISCUSSION: Contrary to the literature, during the COVID-19 pandemic, patients with testicular torsion arrived earlier at the hospital, and surgeries were started earlier, than before the pandemic at the investigated institute. CONCLUSION: The reason behind this accelerated care pathway might be the absence of less severe cases during the COVID-19 period. When people are more prone to stay home, if it does not seem necessary to seek help for any kind of non-urgent medical problem. Orv Hetil. 2023; 164(35): 1367-1372.

Impact of seasonal variations on incidence and laterality of testicular torsion.

Nowadays, there is confusing evidence in the literature regarding the association between seasonal variations and events of testicular torsion (TT). We attempted to assess the correlation between seasonal variations, including season, ambient temperatures, and humidity levels to onset and laterality of testicular torsion. We conducted a retrospective review of patients diagnosed with testicular torsion and confirmed surgically between January 2009 and December 2019, at Hillel Yaffe Medical Center. Weather data was collected from meteorological observation stations near the hospital. TT incidents were stratified into five temperature categories (< 15 °C, 15-20 °C, 20-25 °C, 25-30 °C, > 30 °C) and into two categories of humidity (≤ 50%, > 50%). Potential associations between TT and seasonal variations were investigated. Of 235 patients diagnosed with TT, 156 (66%) were children and adolescents and 79 (34%) were adults. In both groups, rate of TT incidents increased in winter and fall months. Significant correlation between TT and temperatures below 15 °C was observed in both groups; OR 3.3 [95% IC 1.54-7.07], p = 0.002 in children and adolescents and 3.77 [1.79-7.94], p < 0.001) in adults. The correlation between TT and humidity was non-significant in both groups. Among children and adolescents left-sided TT was observed in most of the cases, with strong correlation to lower temperatures; OR 3.15 [1.34-7.40], p = 0.008. Higher rates of acute TT were observed in patients admitted to the emergency department (ED) during the cold seasons in Israel. Significant association was observed between left-side TT and temperatures below 15 °C in the children and adolescents' group. Our findings suggest that there might be a predilection for TT occurrence in cold weather, particularly left-side laterality among children and adolescents.

High risk and low prevalence diseases: Testicular torsion.

INTRODUCTION: Testicular torsion is a serious condition that carries with it a high rate of morbidity. OBJECTIVE: This review highlights the pearls and pitfalls of testicular torsion, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION: Testicular torsion is a urological emergency that occurs with rotation of the testicle along its supporting ligaments leading to obstruction of vascular flow. A key risk factor is the presence of a bell-clapper deformity. The most common population affected includes children in a bimodal distribution with the most cases occurring in the first year of life and between 12 and 18 years, although cases do occur in adults. Acute, severe, unilateral scrotal pain is the most common presenting symptom. Nausea and vomiting are common, but the presence or absence of a cremasteric reflex is not a reliable indicator of disease. The TWIST score may assist with clinical decision making in patients presenting with acute testicular pain but should not be used in isolation. If torsion is suspected or confirmed, consultation with the urology specialist should not be delayed, as outcomes are time sensitive. Ultrasound can be used for diagnosis, but a normal ultrasound examination cannot exclude the diagnosis. Treatment includes emergent urology consultation for surgical exploration and detorsion, as well as symptomatic therapy in the ED. Manual detorsion can be attempted in the ED while awaiting transfer or consultation. CONCLUSIONS: An understanding of testicular torsion can assist emergency clinicians in diagnosing and managing this disease.

Testicular torsion and subsequent testicular function in young men from the general population.

STUDY QUESTION: Is prior testicular torsion associated with testicular function (semen quality and reproductive hormones) in young men from the general population? SUMMARY ANSWER: In young men from the general population, no differences in semen parameters were observed in those who had experienced testicular torsion compared to controls and observations of higher FSH and lower inhibin B were subtle. WHAT IS KNOWN ALREADY: Testicular function may be impaired after testicular torsion, but knowledge is sparse and based on studies with small sample sizes and no control group or a less than ideal control group. STUDY DESIGN, SIZE, DURATION: A cross-sectional population-based study was carried out including 7876 young Danish men with unknown fertility potential, examined from 1996 to 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: All men (median age 19.0 years) had a physical examination, provided a blood and semen sample, and filled in a questionnaire including information about prior testicular torsion, birth, lifestyle and current and previous diseases. Markers of testicular function, including testis volume, semen parameters and reproductive hormones, were compared between men operated for testicular torsion and controls, using multiple linear regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE: The average participation rate was 24% for the entire study period. In total, 57 men (0.72%) were previously operated for testicular torsion (median age at surgery 13.4 years) of which five had only one remaining testicle. Men with prior testicular torsion were more often born preterm (25% versus 9.5% among controls), and they had significantly higher FSH and lower inhibin B levels, and a lower inhibin B/FSH ratio than controls in crude and adjusted models. The association was mainly driven by the subgroup of men who had undergone unilateral orchiectomy. No differences in semen parameters were observed. LIMITATIONS, REASONS FOR CAUTION: A limitation is the retrospective self-reported information on testicular torsion. Also, results should be interpreted with caution owing to the high uncertainty of the observed differences. WIDER IMPLICATIONS OF THE FINDINGS: Overall, the results of our study are reassuring for men who have experienced testicular torsion, especially when treated with orchiopexy, for whom reproductive hormone alterations were subtle and without obvious clinical relevance. Our study found no differences in semen parameters, but follow-up studies are needed to assess any long-term consequences for fertility. STUDY FUNDING/COMPETING INTEREST(S): Financial support was received from the Danish Ministry of Health; the Danish Environmental Protection Agency; the Research fund of Rigshospitalet, Copenhagen University Hospital; the European Union (Contract numbers BMH4-CT96-0314, QLK4-CT-1999-01422, QLK4-CT-2002-00603, FP7/2007-2013, DEER Grant agreement no. 212844); A.P. Møller and wife Chastine Mckinney Møllers Foundation; Svend Andersens Foundation; the Research Fund of the Capital Region of Denmark; and ReproUnion (EU/Interreg). The authors have nothing to declare. TRIAL REGISTRATION NUMBER: N/A.

Perinatal Testicular Torsion in Northern Ireland: A Nationwide 10-Year Review.

INTRODUCTION: Perinatal or neonatal testicular torsion (PTT) is defined as testicular torsion within the first 30 days of life. PTT is a rare event, and bilateral PTT is even rarer. However, recent articles have advocated emergency bilateral exploration to exclude the catastrophic possibility of asymptomatic contralateral testicular torsion leading to anorchia. The aim of this study is to evaluate PTT in Northern Ireland (NI) using a nationwide population-based retrospective observational study. METHODS: All boys in NI who underwent emergency scrotal exploration within their first 30 days of life for possible testicular torsion over a 10-year period (January 2010-December 2019 inclusive) were included. Intraoperative findings primarily evaluated included diagnosis and presence of synchronous or asynchronous (metachronous) contralateral testicular torsion. Secondary outcomes included correlation between intraoperative findings and any preoperative ultrasound scan (USS), and scrotal examination findings during postoperative outpatient follow-up. RESULTS: A total of 19 patients who underwent emergency scrotal exploration in the study period were included. An intraoperative finding confirming the diagnosis of PTT was reported in 14 (73.7%) patients. The incidence of PTT was calculated as 11.3 per 100,000 per male live births in NI, with bilateral PTT accounting for two patients (14.2% of all PTTs), divided equally between synchronous and asynchronous PTTs. Of two affected testes where preservation was felt appropriate intraoperatively, only one was still palpable at follow-up, producing a testicular salvage rate after PTT of only 7.1%. Testicular findings on preoperative USS were confirmed intraoperatively in five out of six patients, producing a concordance rate of 83.3%. CONCLUSION: This is the first nationwide population-based study to calculate more accurately the incidence of PTT, and bilateral synchronous and asynchronous bilateral PTTs, all of which seem to be significantly higher than previously estimated. However, in keeping with previous reports, this study confirms the poor salvage rate of testes undergoing perinatal torsion, and suboptimal concordance between preoperative USS findings and intraoperative diagnosis.

Delayed Care Seeking and Outcomes of Testicular Torsion among Children during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

INTRODUCTION: Since the onset of coronavirus disease 2019 (COVID-19), stay-at-home orders and fear caused by the pandemic have had a significant effect on the timing and outcomes of testicular torsion. However, the evidence was limited since the study results were inconsistent. This study aims to examine the hospitalization rates, timing, and outcomes of testicular torsion in children before and during the pandemic. MATERIALS AND METHODS: Using PubMed, Embase, and Google Scholar databases, we conducted a systematic search and meta-analysis of studies reporting the timing and outcomes of children admitted with testicular torsion before and during the COVID-19 pandemic. Subgroup analyses were conducted to explore possible sources of heterogeneity. RESULT: The outcomes of 899 testicular torsion patients from eight studies were evaluated. Our study found an increased hospitalization rate for patients with testicular torsion (incidence rate ratio = 1.60, 95% confidence interval [CI]: 1.27-2.03; p = 0.001). Despite a significant increase in the duration of symptoms during the COVID-19 pandemic (weighted mean difference = 11.04, 95% CI: 2.75-19.33; p = 0.009), orchiectomy rates did not increase (odds ratio = 1.33, 95% CI: 0.85-2.10; p = 0.147). CONCLUSION: During the COVID-19 pandemic, hospitalization rates for testicular torsion and the duration of symptoms among children increased significantly. Moreover, the rate of orchiectomy did not increase during the pandemic, indicating that pediatric emergency services have remained efficient and have prevented an increase in the number of orchiectomies performed despite pandemic-related closures and delays in transporting patients to medical care.

Testicular torsion disparities in the pediatric population.

BACKGROUND: There are disparate findings in the literature on the impact of race and insurance status on gonadal loss in testicular torsion. We sought to determine if race or levels of social vulnerability influence the rate of torsion or gonadal loss. METHODS: Retrospective cross-sectional review between December 2017 and September 2019. Social vulnerability index was dichotomized using the 75th percentile. Primary outcome was the diagnosis of testicular torsion. RESULTS: 515 patients were included. There was no difference in median age, torsion diagnosis, and orchiectomy rate between the two institutions. Black/African American patients were >3 times more likely than Caucasian patients to be diagnosed with TT when controlled for dichotomized SVI, insurance, and age (OR 3.39, 95% CI 1.74 - 6.61, p < 0.01). CONCLUSION: Black/African American children have an increased risk of testicular torsion. Despite these patients having higher levels of social vulnerability, it was not associated.

Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy.

INTRODUCTION: The literature reported an increased avoidance of the Emergency Department (ED) during COrona VIrus Disease 19 (COVID-19) pandemic, causing a subsequent increase of morbidity and mortality for acute conditions. Testicular torsion is a surgical emergency, which can lead to the loss of the affected testicle if a delayed treatment occurs. As testicular loss is time-related, outcome was hypothesized to be negatively affected by the pandemic. OBJECTIVE: The aim is to investigate whether presentation, treatment and outcomes of children with testicular torsion were delayed during COVID-19. STUDY DESIGN: Medical records of pediatric patients operated for testicular torsion of six Paediatric Surgical Units in Northern Italy between January 2019 and December 2020 were retrospectively reviewed. Patients were divided as for ones treated during (dC) or before the pandemic (pC). To reflect possible seasonality, related to lockdown restrictions, winter and summer calendar blocks were also analysed. For all cohorts, demographic data, pre-operative evaluation, operative notes and post-operative outcomes were reviewed. Primary outcomes were referral time, time from diagnosis to surgery and ischemic time, while secondary outcomes were orchiectomy and atrophy rates. Statistic was conducted as appropriate. RESULTS: A total of 188 patients with acute testicular torsion were included in the study period, 89 in the pre-COVID-19 (pC) period and 99 during COVID-19 (dC). Time from symptom onset to the access to the Emergency Department (T1) was not different among the two populations (pC: 5,5 h, dC: 6 h, p 0.374), and similarly time from diagnosis to surgery (pC: 2,5 h, dC: 2,5 h, p 0.970) and ischemic time (pC: 8,2 h, dC: 10 h, p 0.655). T1 was <6 h in 46/99 patients (46%) pC and 45/89 patients (51%) dC (p = 0.88, Fisher's exact test). Subgroup analysis accounting for different lockdown measures, confirm the absence of any difference. Orchiectomies rate was 23% (23/99) dC and 21% (19/89) pC (p = 0.861, Fisher's exact test) and rate of post-operative atrophy was 9% dC (7/76) and 14% pC (10/70), p = 0,44, Fisher's exact test. DISCUSSION: Despite worldwide pediatric ED accesses reduction, we reported that neither ischemic time nor the long-term outcomes in children with testicular torsion increased during the COVID-19 pandemic. In the available literature, few studies investigated the topic and are controversial on the results. Similarly to our findings, some studies found that timing and orchiectomy rates were not significantly different during the pandemic, while others reported a correlation to pandemic seasonality. Furthermore, in the recent pediatric literature it has been reported a delayed testicular torsion diagnosis due to shame in informing parents. Strengths of this study are the large numerosity, its multicentric design and a long study period. Its main limitation is being retrospective. CONCLUSIONS: We reported our large cohort from one of the most heavily COVID-19-affected regions, finding that referral, intra-hospital protocols and ischemic time in testicular torsion were not increased during to the pandemic, as well as orchiectomy rate and atrophy.

The incidence of testicular torsion and testicular salvage rate in Korea over 10 years: A nationwide population-based study.

PURPOSE: We performed a nationwide epidemiological study of testicular torsion using the National Health Insurance System database for the entire male population of Korea. MATERIALS AND METHODS: Age, sex, socioeconomic status, regional information, and diagnostic codes were retrieved from January 2009 to December 2019. To clearly identify the diagnosis of testicular torsion, patients who had not undergone orchiectomy or orchiopexy were excluded from the study. Multivariable logistic regression models were used to analyze the association between demographic characteristics and testicular loss. RESULTS: The overall incidence of testicular torsion in males was 2.02 cases per 100,000 person-years and 6.99 cases per 100,000 person-years in males under 19 years of age. Testicular torsion most commonly occurred either in infancy or adolescence. The total testicular salvage rate was 75.22% and highest in children at 79.91%. The rate of orchiectomy was high in infancy and in the oldest patients. We determined that age distribution was related to the risk of testicular loss. CONCLUSIONS: This study is the first nationwide epidemiological study of testicular torsion, which contains the entire Korean population. Although the testicular salvage rate in Korea was higher compared to other countries, it is necessary to educate males under 19 years of age on the seriousness of acute testicular pain to minimize the possibility of testicular loss.

Supporting a Learning System in Pediatric Emergency Pathways: Using Organizational Comparisons, Serious Incidents, and Near-Miss Events to Improve the Diagnosis and Treatment of Testicular Torsion.

BACKGROUND: Scrotal pain is a common presentation to the emergency department requiring prompt investigation and management to identify testicular torsion and increase the opportunity for testicular salvage. Using national data obtained from the NHS Improvement, we aim to identify key suboptimal areas in the acute diagnosis and management of testicular torsion with a view to learning from these and improving outcomes. METHODS: A freedom of information request was made to all 134 hospital groups in England and Wales that manage testicular torsion. Serious incidents experienced by these hospitals were analyzed to see whether those with pediatric emergency departments fared better than those without. In addition, a qualitative thematic analysis of the NHS Improvement National Reporting and Learning System database over a 12-year period (2007-2019) was undertaken, to identify common themes associated with orchidectomies and "near-miss" events in the pediatric population. RESULTS: Three hundred four patient safety incidents were returned and divided into 62 orchidectomies and 242 near-miss events. The most common factor in the orchidectomy group was individual factors (83.9%). Misdiagnosis of symptomatic testicle was not significant when comparing ED to specialist surgeons (odds ratio = 1.46, P = 0.3842). Atypical presentation resulting in orchidectomy was significant when comparing ED with specialists (odds ratio = 6, P = 0.0355). Near-miss events, not leading to orchidectomy, are often due to a wider variety of factors. A Mann-Whitney U test showed that there was no statistical significance in incidents when comparing general ED units caring for all ages with pediatric EDs in terms of incidents ( U = 807.5, z = -1.124, P = 0.261). CONCLUSIONS: There is a need for education in ED about atypical presentation of testicular torsion and examination of scrotum in cases of lower abdominal pain. It is also vital that specialist teams are cognizant of the standard operating procedures relevant to scrotal pain and testicular within the organization and the wider clinical network. Finally, there should be a drive for annual collation of data in urology and ED units with regards to testicular torsion as patient safety incidents may be underreported.

Influence of COVID-19 pandemic on timing and outcomes of treatment for acute testicular torsion in adults: a single institution experience.

INTRODUCTION: The worldwide spread of SARS-COV2 had led to a delay in treatment of numerous urological pathologies, even in emergency conditions. We therefore sought to determine whether the timing of diagnosis and treatment and the postoperative outcome of patients with testicular torsion had been changed during the COVID pandemic. MATERIALS AND METHODS: We considered all patients evaluated in the emergency department (ED) for testicular torsion from February 2018 to August 2019 (pre-COVID period) and from February 2020 to August 2021 (during COVID pandemic). All patients underwent clinical and ultrasound evaluation and subsequently scrotal exploration. Primary outcomes were the time differences from pain onset to ED presentation and from ED presentation to surgical treatment. We also investigated whether the number or orchiectomies required changed during the pandemic. RESULTS: A total of 54 patients were divided in two groups: 40 patients in pre-COVID-19 group and 14 in the COVID-19 cohort. Mean time from symptoms onset to ED access was longer during the pandemic (4.2 ± 5.7 versus 39.6 ± 37.3 hours, p = 0.009). Mean time from ED access to surgery was similar (2.9 ± 1.1 versus 4.2 ± 2.3, p = 0.355). In addition, the number of orchiectomies was higher in COVID-19 group (2.5% versus 28.6%, p < 0.01), compared to a lower number of detorsions (97.5% versus 71.4%, p < 0.01). Elapsed time from pain onset to surgery was directly correlated with the increased white blood cell (WBC) count after surgery (r = 0.399, p = 0.002). DISCUSSION AND CONCLUSIONS: The current study identifies a significant delay in presentation of testicular torsion which resulted in a significant increase in orchiectomies with the expected decreased in detorsion/orchiopexy. In addition, there was an increase in the WBC at presentation associated with delayed presentation.

Comparison of the outcomes of testicular torsion among children presenting during the Coronavirus Disease 2019 (COVID-19) pandemic versus the pre-pandemic period: A systematic review and meta-analysis.

OBJECTIVE: To evaluate whether the Coronavirus Disease 2019 (COVID-19) pandemic resulted in a prolonged duration of symptoms, a delayed presentation to the medical facility, and consequently more orchiectomy procedures among children with testicular torsion compared to the pre-COVID-19 period. METHODS: Systematic search of four scientific databases was performed. The search terms used were (coronavirus OR novel coronavirus OR SARS-CoV-2 OR COVID-19) AND (testicular torsion OR orchidectomy OR orchiectomy OR orchidopexy OR orchiopexy). The inclusion criteria were all boys presenting with testicular torsion during the COVID-19 and pre-COVID-19 periods. A comparison of the average duration of symptoms, the proportion of children with delayed presentation (>24 h), and the proportion of children requiring orchiectomy was made among the two groups. The Downs and Black scale was used for methodological quality assessment. RESULTS: The present meta-analysis included six comparative studies (five retrospective studies). A total of 711 patients (473 during the COVID-19 period) were included. No significant differences in the average duration of symptoms (WMD: 2.6, 95% CI -6.78 to 11.99, P = 0.59), the proportion of children with delayed presentation (RR = 1.03, 95% CI 0.52-2.02, p = 0.94), and orchiectomy rate (RR = 1.23, 95% CI 0.82-1.84, p = 0.31) were observed among the two patient groups. All studies had a moderate risk of bias. CONCLUSION: The duration of symptoms, the proportion of children with delayed presentation, and orchiectomy rate did not significantly differ among the children with testicular torsion presenting during the COVID-19 and pre-COVID-19 periods. However, due to the moderate risk of bias, the level of evidence of the available comparative studies is limited.

The cost of testicular torsion care in Ireland 2009-2018: a novel cost estimation model using a national database.

Activity-based funding (ABF) is a reimbursement model for public hospitals in Ireland. Little data exist regarding cost estimates for acute surgical admissions in Ireland. This study presents a novel method of direct cost estimation for testicular torsion (TT) care in Ireland. Hospital Inpatient Enquiry (HIPE) data, covering all public hospital admissions in Ireland, were analysed to derive annual incidence rates for TT between 2009 and 2018. The monetary cost of each case was calculated by cross-referencing the diagnosis-related group (DRG) with reference prices for inpatients and day-cases in public hospitals in 2019. Annual cost was adjusted using the Consumer Price Index for Health (Ireland). One thousand seven hundred forty-six patients under 25 years underwent orchidectomy or orchidopexy for TT between 2009 and 2018. The direct cost of TT care in public hospitals between 2009 and 2018 was €6,331,402. Costs increased 54% over 10 years, from €513,232 in 2009 to €788,700 in 2018 (2019 Euros). Just over two-thirds of cases (70%, n = 1230) were reimbursed with public funding. This novel cost estimation model may serve as a template for future direct cost estimates for surgical interventions in Ireland. This will improve the accuracy of future economic evaluation for healthcare interventions in Ireland.

TORSAFUF - Surgical exploration for torsion of spermatic cord suspicion and risk factors for unnecessary surgery: Results of a French nationwide retrospective study on 2940 patients.

BACKGROUNDS: Spermatic cord torsion is a frequent urological emergency that mostly concerns teenagers and young adults. This study aimed to determine the clinical and surgical characteristics of young adults who had scrotal exploration for suspected spermatic cord torsion and to identify clinical risk factors associated with needless scrotal exploration. METHODS: We retrospectively collected national data from patients aged 12years and older who underwent a surgical exploration for suspicion of torsion of the spermatic cord between 2005 and 2019 in 17 hospitals. We analyzed demographics, surgical and postoperative characteristics in our population. We compared the cohort according to the intraoperative diagnosis of torsion or not. RESULTS: In total, 2940 had surgical exploration: 1802 (61.3%) patients had torsion of the spermatic cord and 1138 (38.7%) had another diagnosis. In multivariate analysis, age (OR: 1.04; 95% CI: 1.01-1.06; P=0.005), medical history of cryptorchism (OR: 4.14; 95% CI: 1.05-16.31; P=0.042) and VAS pain score (OR: 0.91; 95% CI: 0.83-0.98; P=0.018) were risk factors significantly associated with unnecessary surgical exploration. The rate of complications in the 90days after surgery was 11% in the "torsion" group, and 9.7% in the "non-torsion" group (P=0.28). CONCLUSION: Scrotal exploration without intraoperative diagnosis of torsion was performed in 40% of our cohort. VAS pain score and cryptorchism history can help for the diagnosis but scrotal exploration remains the way to diagnose spermatic cord torsion and should be performed on the slightest suspicion, even after 24hours of symptoms, as the chances for testicular salvage remains around 50%.

Where are the paediatric patients with testicular torsion during the COVID-19 pandemic?

INTRODUCTION: The Irish people were put on lockdown in mid-March 2020 due to concern of the spread of coronavirus. With these societal changes came a notable reduction in emergency department attendance. Our aim was to analyse emergency urological procedures performed during the COVID-19 era versus the previous year. METHODS: A retrospective review of theatre logbooks was undertaken comparing numbers of emergency urological procedures performed between 1 March 2020 and 31 May 2020 (i.e. the COVID-19 era) with the corresponding 3-month period in 2019. RESULTS: A total of 173 cases were analysed between the two time periods. Similar overall numbers of cases were performed in 2019 (n = 90) and 2020 (n = 83). In particular, similar patient case numbers are also noted in both scrotal explorations (13 vs 9) and ureteric stone surgeries (69 vs 70). However, orchidectomies for testicular cancers were reduced by 63% (3/8). On further analysis of the scrotal exploration group, only 3 were performed in the period after lockdown regulations were instated. CONCLUSION: Whilst patients with ureteric colic continue to present, those with acute testis pain requiring exploration attended less frequently, raising the possibility of undiagnosed testicular torsion in the community.

Nomogram predicting testicular torsion in Japanese patients with acute scrotal pain using physical examination findings and environmental conditions: Development and prospective external validation.

OBJECTIVES: To develop a prediction tool based on physical findings and environmental conditions without utilizing color Doppler ultrasonography to guide non-urologists and patients' families in determining the testicular torsion possibility among patients with acute scrotal pain. METHODS: Overall, 110 consecutive patients aged ≤30 years with acute scrotal pain at Saitama Medical Center between 2012 and 2014 were retrospectively evaluated. Physical examination results, including scrotal inspection, palpation and gait observation, and environmental conditions at pain onset (time range and ambient temperature) were collected. Multivariate analysis identified significant and independent risk factors for testicular torsion, and a nomogram predicting testicular torsion was constructed. The model underwent prospective validation in an independent set of 123 consecutive patients admitted with acute scrotal pain to our institution between 2015 and 2017. RESULTS: Testicular torsion diagnosis rates were 27% (30/110) and 26% (32/123) in the training and validation cohorts, respectively. Logistic regression analysis showed four risk factors for developing testicular torsion: abnormal testicular position, walking difficulty, midnight to early morning onset and ambient temperature <15°C at pain onset. The constructed nomogram showed that the areas under the receiver operating characteristic curves were 0.92 and 0.84 for the training and validation cohorts, respectively. The calibration plot showed an acceptable fitness between the predicted probability and the observed rate of testicular torsion. CONCLUSIONS: A novel nomogram was developed solely based on physical findings and environmental conditions to predict testicular torsion in Japanese patients with acute scrotal pain.

Testicular torsion in Ireland: a 10-year analysis of incidence and risk of orchidectomy.

BACKGROUND: The estimated incidence of testicular torsion (TT) is 4 per 100,000 males under 25 years [1]. Age, region and health insurance status have been associated with a higher risk of orchidectomy following TT [2]. AIMS: This study aimed to establish incidence rates for TT in Ireland for the first time. Sociodemographic characteristics were analysed to assess risk factors for undergoing orchidectomy. METHODS: A retrospective analysis of a national database, Hospital In-Patient Enquiry (HIPE), was carried out. Cases of TT treated between 2009 and 2018 were identified. Incidence and age-specific rates were calculated in conjunction with census data. Descriptive statistics, non-parametric tests and logistic regression were used to evaluate risk factors for orchidectomy. RESULTS: Between 2009 and 2018, 1746 males under 25 years underwent scrotal exploration for TT. The crude incidence was 21.76 per 100,000 population. The age-standardised rate rose from 16.85 per 100,000 in 2009 to 26.31 per 100,000 in 2018. TT was most common in the 10-14 years age-group (n = 766, 43%) with a normal distribution across age-groups. TT most commonly occurred in spring (27.55%, 95% CI 25.46-29.71%), and was least common in summer (21.65%, 95% CI 19.46-23.36%, p < 0.01). Age, lack of private insurance, province of residence and transfer from another hospital were associated with orchidectomy. CONCLUSIONS: The incidence of TT appears to be higher in Ireland than elsewhere. Epidemiological data for TT in Ireland will help inform health policy and clinical guidelines, facilitate comparison with other jurisdictions and improve public awareness. Further research is needed to identify modifiable risk factors that predict treatment outcomes.