ÇOCUK VE ADÖLESANLARDA GÖRÜLEN TESTİS TORSİYONU OLGULARININ KLİNİK VE RADYOLOJİK ÖZELLİKLERİ İLE POSTOPERATİF TAKİP SONUÇLARI
Abstract
Giriş: Testis torsiyonu, testisin anormal bükülmesi sonucu testise kan akışının kaybı ile karakterize cerrahi akut bir durumdur. Erken tanı ve tedavi, testis kaybının önlenmesi açısından hayati derecede önemlidir. Bu çalışmada, çocuk ve adölesanlarda görülen testis torsiyonu olgularının klinik ve radyolojik özellikleri ile postoperatif takip sonuçlarının ortaya koyulması amaçlandı.
Yöntemler: Bu kesitsel çalışmada, Ocak 2014-Haziran 2023 tarihleri arasında testis torsiyonu tanısı ile opere edilen 17 yaş ve altı hasta verileri retrospektif olarak değerlendirildi. Hastaların yaşı, semptomları, hastaneye başvuru süresi, fizik muayene bulguları, skrotal renkli Doppler ultrason sonuçları, uygulanan ameliyat tekniği (manuel detorsiyon veya orşiektomi) ve geç dönem takip sonuçları istatistiksel açıdan analiz edildi.
Bulgular: Testis torsiyonu tanısı ile opere edilen 66 hastanın ortalama yaşı 6.55 (14 gün-17 yıl) olarak hesaplandı. Hastaların 48'sında (%72.7) sol, 18'sinde (%27.2) sağ testis torsiyonu tespit edildi. Bilateral torsiyon olgusu saptanmadı. Dört hastada, skrotal travma öyküsü ve üç hastada inmemiş testis mevcuttu. Olguların 31’inde (%46.9) sabaha karşı uykudan uyanma ile başlayan ani skrotal ağrı öyküsü mevcuttu. Semptomların başlangıcından acil servise kabulüne kadar geçen başvuru süresi değerlendirildiğinde, %50’sinin (n=33) 0-12 saat içinde, %36.3’unun (n=24) 12-24 saat içinde ve % 13.6’sının ise (n=9) 24 saatten daha uzun sürede olduğu tespit edildi. Operasyon sonucu toplamda 34 hastaya orşiopeksi yapılırken, 32 hastaya orşiektomi yapıldı. Başvuru süresi 12 saatten düşük olan hastaların %15.1’ine orşiektomi yapılırken, 12-24 saatte başvuran hastaların %79.1’ine, 24 saatten daha uzun başvuru süresi olan hastaların %88.9’una orşiektomi yapıldı. Operasyon esnasında 360 derece torsiyon saptanan hiçbir hastaya orşiektomi gerekmedi. 540 derece torsiyon saptanan hastaların %64.5’ine, 720 derece torsiyon saptanan hastaların %92.3’üne orşiektomi yapıldı. Ayrıca klinik takip sonucu testiküler atrofi gelişen 7 hastaya geç orşiektomi yapıldı.
Sonuç: Akut skrotum ile başvuran çocuklarda, testis torsiyonu ayırıcı tanısının en kısa zamanda yapılıp tedavi edilmesi hayati önem taşımaktadır. Ancak erken başvuru için toplumsal bilincin artırılması en az cerrahi işlem kadar önem taşımaktadır.
Keywords
Ethical Statement
İnsan katılımcıların yer aldığı çalışmalarda gerçekleştirilen tüm prosedürler, kurumsal ve/veya ulusal araştırma komitesinin etik standartlarına ve 1964 Helsinki deklarasyonuna ve daha sonraki değişikliklere veya karşılaştırılabilir etik standartlara uygundu. Çalışma için Sağlık Bilimleri Üniversitesi, Eskişehir Şehir Hastanesi, Girişimsel Olmayan Etik Kurulundan onay alındı (Karar No: ESH/GOEK-2023/48, Karar tarihi: 22.09.2023).
Project Number
Sağlık Bilimleri Üniversitesi, Eskişehir Şehir Hastanesi, Girişimsel Olmayan Etik Kurulundan onay alındı (Karar No: ESH/GOEK-2023/48, Karar tarihi: 22.09.2023)
References
- 1. Sharp VJ, Kieran K, Arlen AM. Testicular torsion: Diagnosis, evaluation, and management. Am Fam Physician 2013;88: 835-40.
- 2. Murali TV, Jaya KV, Kumar R. Testicular torsion - symptomatology and outcomes of 101 scrotal explorations. Urol Ann 2022;14: 167-171. doi: 10.4103/UA.UA_142_20.
- 3. Srinivasan AK, Freyle J, Gitlin JS, Palmer LS. Climatic conditions and the risk of testicular torsion in adolescent males. J Urol 2007;178: 2585–2588. doi: 10.1016/j.juro.2007.08.049
- 4. Chanchlani R, Acharya H. Acute scrotum in children: A retrospective study of cases with review of literature. Cureus 2023;15: e36259. doi: 10.7759/cureus.36259.
- 5. Aihole JS. Testicular torsion; Clinical diagnosis or imaging diagnosis? Radiol Case Rep 2022;17: 2665-2667. doi: 10.1016/j.radcr.2022.05.010.
- 6. Palmer LS, Palmer JS. Management of abnormalities of the external genitalia in boys. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, editors. Campbell-Walsh-Wein Urology. 12th ed. Vol. 44. Philadelphia, PA, US: Elsevier; 2021. pp. 871–904.e10
- 7. Alzahrani MA, Alasmari MM, Altokhais MI, et al. Is there a relationship between waking up from sleep and the onset of testicular torsion? Res Rep Urol 2023;15: 91-98. doi: 10.2147/RRU.S404073
- 8. Xue E, Yu Y, Lin L, Li Z, Su H. Application value of real-time shear wave elastography in differential diagnosis of testicular torsion. Med Ultrason. 2020;22(1):43–48. doi: 10.11152/mu-2200
- 9. Longo VJ. Point of view-torsion of testis: A new twist. Urology. 1978;12(6):743. doi: 10.1016/0090-4295(78)90450-8.
- 10. King H, Whelan P. Treatment of acute scrotal pain. Br Med J. 1984;288(6430):1576–1577. doi: 10.1136/bmj.288.6430.1576-A
- 11. Korkes F, Cabral PR, Alves CD, Savioli ML, Pompeo AC. Testicular torsion and weather conditions: Analysis of 21,289 cases in Brazil. Int Braz J Urol. 2012;38(2):222–229. doi: 10.1590/s1677-55382012000200010
- 12. Kapoor S. Testicular torsion: A race against time. Int J Clin Pract. 2008;62(5):821-827.
- 13. Waldert M, Klatte T, Schmidbauer J, Remzi M, Lackner J, Marberger M. Color Doppler sonography reliably identifies testicular torsion in boys. Urology. 2010;75(5):1170-1174.
- 14. Yang C, Song B, Liu X, Wei GH, Lin T, He DW. Acute scrotum in children: An 18-year retrospective study. Pediatr Emerg Care. 2011;27(4):270-274.
- 15. Kaye JD, Shapiro EY, Levitt SB, et al. Parenchymal echo texture predicts testicular salvage after torsion: Potential impact on the need for emergent exploration. J Urol. 2008;180(4 suppl):1733-1736.
- 16. Shteynshlyuger A, Yu J. Familial testicular torsion: A meta analysis suggests inheritance. J Pediatr Urol 2013;9:683 90.
- 17. Favorito LA, Cavalcante AG, Costa WS. Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion. Int Braz J Urol. 2004;30(5):420-424.
- 18. Turner TT, Brown KJ. Spermatic cord torsion: Loss of spermatogenesis despite return of blood flow. Biol Reprod 1993;49: 401-7.
- 19. Turner TT, Bang HJ, Lysiak JL. The molecular pathology of experimental testicular torsion suggests adjunct therapy to surgical repair. J Urol 2004;172:2574-8.
CLINICAL AND RADIOLOGICAL CHARACTERISTICS OF TESTICULAR TORSION CASES IN CHILDREN AND ADOLESCENTS AND POSTOPERATIVELY FOLLOW-UP RESULTS
Abstract
Introduction: Testicular torsion is a surgical acute condition characterised by loss of blood supply to the testicle due to abnormal bending of the testicle. Early diagnosis and treatment are vitally important for the prevention of testicular loss. In this study, we aimed to present the clinical and radiological features and postoperative follow-up results of testicular torsion cases in children and adolescents.
Methods: In this cross-sectional study, the data of patients aged 17 years and younger who were operated for testicular torsion between January 2014 and June 2023 were evaluated retrospectively. Patients' age, symptoms, hospital admission time, physical examination findings, scrotal colour Doppler ultrasound results, surgical techniques (manual detorsion or orchiectomy) and late follow-up results were statistically analysed.
Results: The mean age of 66 patients operated with the diagnosis of testicular torsion was calculated as 6.55 years (14 days-17 years). Left testicular torsion was detected in 48 (72.7%) and right testicular torsion in 18 (27.2%) patients. There were no cases of bilateral torsion. Four patients had a history of scrotal trauma and three patients had undescended testis. A history of sudden scrotal pain on awakening from sleep in the morning was reported by 31 patients (46.9%). When the time from the onset of symptoms to admission to the emergency department was evaluated, it was found that 50% (n=33) of the patients were admitted within 0-12 hours, 36.3% (n=24) within 12-24 hours and 13.6% (n=9) more than 24 hours. A total of 34 patients underwent orchiopexy and 32 patients underwent orchiectomy. Orchiectomy was performed in 15.1% of the patients with a presentation time of less than 12 hours, 79.1% of the patients with a presentation time of 12-24 hours and 88.9% of the patients with a presentation time of more than 24 hours. None of the patients with 360 degrees of torsion during surgery required orchiectomy. 64.5% of patients with 540 degrees of torsion and 92.3% of patients with 720 degrees of torsion underwent orchiectomy. Late orchiectomy was performed in 7 patients who developed testicular atrophy as a result of clinical follow-up.
Conclusion: In children presenting with acute scrotum, it is vital that the differential diagnosis of testicular torsion is made and treated as soon as possible. However, raising public awareness for early presentation is as important as the surgical procedure
Keywords
Project Number
Sağlık Bilimleri Üniversitesi, Eskişehir Şehir Hastanesi, Girişimsel Olmayan Etik Kurulundan onay alındı (Karar No: ESH/GOEK-2023/48, Karar tarihi: 22.09.2023)
References
- 1. Sharp VJ, Kieran K, Arlen AM. Testicular torsion: Diagnosis, evaluation, and management. Am Fam Physician 2013;88: 835-40.
- 2. Murali TV, Jaya KV, Kumar R. Testicular torsion - symptomatology and outcomes of 101 scrotal explorations. Urol Ann 2022;14: 167-171. doi: 10.4103/UA.UA_142_20.
- 3. Srinivasan AK, Freyle J, Gitlin JS, Palmer LS. Climatic conditions and the risk of testicular torsion in adolescent males. J Urol 2007;178: 2585–2588. doi: 10.1016/j.juro.2007.08.049
- 4. Chanchlani R, Acharya H. Acute scrotum in children: A retrospective study of cases with review of literature. Cureus 2023;15: e36259. doi: 10.7759/cureus.36259.
- 5. Aihole JS. Testicular torsion; Clinical diagnosis or imaging diagnosis? Radiol Case Rep 2022;17: 2665-2667. doi: 10.1016/j.radcr.2022.05.010.
- 6. Palmer LS, Palmer JS. Management of abnormalities of the external genitalia in boys. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, editors. Campbell-Walsh-Wein Urology. 12th ed. Vol. 44. Philadelphia, PA, US: Elsevier; 2021. pp. 871–904.e10
- 7. Alzahrani MA, Alasmari MM, Altokhais MI, et al. Is there a relationship between waking up from sleep and the onset of testicular torsion? Res Rep Urol 2023;15: 91-98. doi: 10.2147/RRU.S404073
- 8. Xue E, Yu Y, Lin L, Li Z, Su H. Application value of real-time shear wave elastography in differential diagnosis of testicular torsion. Med Ultrason. 2020;22(1):43–48. doi: 10.11152/mu-2200
- 9. Longo VJ. Point of view-torsion of testis: A new twist. Urology. 1978;12(6):743. doi: 10.1016/0090-4295(78)90450-8.
- 10. King H, Whelan P. Treatment of acute scrotal pain. Br Med J. 1984;288(6430):1576–1577. doi: 10.1136/bmj.288.6430.1576-A
- 11. Korkes F, Cabral PR, Alves CD, Savioli ML, Pompeo AC. Testicular torsion and weather conditions: Analysis of 21,289 cases in Brazil. Int Braz J Urol. 2012;38(2):222–229. doi: 10.1590/s1677-55382012000200010
- 12. Kapoor S. Testicular torsion: A race against time. Int J Clin Pract. 2008;62(5):821-827.
- 13. Waldert M, Klatte T, Schmidbauer J, Remzi M, Lackner J, Marberger M. Color Doppler sonography reliably identifies testicular torsion in boys. Urology. 2010;75(5):1170-1174.
- 14. Yang C, Song B, Liu X, Wei GH, Lin T, He DW. Acute scrotum in children: An 18-year retrospective study. Pediatr Emerg Care. 2011;27(4):270-274.
- 15. Kaye JD, Shapiro EY, Levitt SB, et al. Parenchymal echo texture predicts testicular salvage after torsion: Potential impact on the need for emergent exploration. J Urol. 2008;180(4 suppl):1733-1736.
- 16. Shteynshlyuger A, Yu J. Familial testicular torsion: A meta analysis suggests inheritance. J Pediatr Urol 2013;9:683 90.
- 17. Favorito LA, Cavalcante AG, Costa WS. Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion. Int Braz J Urol. 2004;30(5):420-424.
- 18. Turner TT, Brown KJ. Spermatic cord torsion: Loss of spermatogenesis despite return of blood flow. Biol Reprod 1993;49: 401-7.
- 19. Turner TT, Bang HJ, Lysiak JL. The molecular pathology of experimental testicular torsion suggests adjunct therapy to surgical repair. J Urol 2004;172:2574-8.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Pediatric Surgery, Pediatric Urology |
| Journal Section | Research Articles |
| Authors | |
| Project Number | Sağlık Bilimleri Üniversitesi, Eskişehir Şehir Hastanesi, Girişimsel Olmayan Etik Kurulundan onay alındı (Karar No: ESH/GOEK-2023/48, Karar tarihi: 22.09.2023) |
| Early Pub Date | October 16, 2023 |
| Publication Date | October 16, 2023 |
| Published in Issue | Year 2023 Volume: 4 Issue: Ek Sayı |
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