Methods A retrospective analysis was made of the data of 57 patients diagnosed with TT, comprising 20 patients with successful MD (Group I), 28 patients who underwent emergency orchiopexy (Group II), and 9 patients applied with orchiectomy (Group III). The groups were compared in respect of age, and duration of pain. The success rate of MD, the time of testicular fixation (TF), any problems encountered in follow-up, and follow-up times were analyzed in Group I. Data were analyzed with P-P pilot, Mann-Whitney U, Kruskal Wallis and Chi-square tests. A value of p.
Results MD was successful and detorsion could be achieved in 20 of 26 patients. The groups were similar in respect of age ( p = 0.217). The median duration of pain was 3 (1–8), 4 (1–72), and 48 (12–144) hours in Groups I, II, and III, respectively, and determined as similar in Groups I and II ( p = 0.257), although a statistically significant difference was determined between the 3 groups ( p. Background Testicular (spermatic cord) torsion (TT), which was first described by Hunter, is an emergency urological diagnosis that results in ischemic organ injury in the affected testis, and requires urgent diagnosis and treatment [, ]. Cold weather, activation of the cremasteric reflex, trauma, undescended testis, and fast enlargement of testis during puberty are the known risk factors in susceptible individuals. It shows a bimodal distribution, and peaks in the neonatal period and puberty.
Prevalence has been reported as 8.6/ 100,000 between the ages of 10 and 19 years in the United States [–]. With the exception of neonates, patients usually present with unilateral severe pain that has been present for a few hours [, ].
Pain is rarely mild, and it radiates to the inguinal region and abdomen. The most frequent physical examination findings are testicular tenderness and loss of the cremasteric reflex [, ]. An abnormal position of the testis is more common than other causes for acute scrotal pain . Doppler ultrasonography (USG), scintigraphy, dynamic magnetic resonance (MR), and high-resolution USG are the diagnostic imaging modalities . The most important factors for testicular salvage before it atrophies are known to be the duration between the onset of symptoms and detorsion, and the degree of the torsion [, ]. Emergency surgery after the diagnosis aims to shorten the duration of ischemia [,, ].
Manual detorsion (MD), as described by Nash, has been suggested before surgery to return blood flow faster, and some authors have indicated it as an alternative to surgery [,, ]. In this study, it was aimed to investigate the efficiency of MD, whether it could be a routine part of treatment or an alternative to surgery in patients with TT due to time saved by the application, and the reliability of elective orchiopexy rather than emergency orchiopexy in the light of information provided in literature. Methods A retrospective analysis was made of a total of 57 patients admitted to our outpatient clinic or Emergency Department between 2011 and 2015 with acute scrotal pain, and who were diagnosed with TT based on physical examination findings and decreased or absent testicular blood flow on Doppler USG. The approval of the Local Ethics Committee was obtained before starting the study. The MD procedure was applied by three urologists in our clinic, and it was not performed by other urologists. Group I comprised 20 patients with successful MD, Group II comprised 28 patients who underwent emergency orchiopexy or orchiopexy after failure of MD, and Group III comprised 9 patients that had emergency scrotal exploration and orchiectomy.