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Dismal salvage of testicular torsion: A call to action!

Authors: Maranya GA1,2 MBChB, MMed, Cert.Urol. (E.A.) FCS(ECSA), FCS-Urol, Mwero BJ2 MBChB, MMed, Dip. Hosp. Manag. (Israel), Kinyanjui GM1 MBChB, Al-Ammary AY 1 MBChB, MMed, Cert.Urol. (E.A.), FCS(ECSA) and Maganga HM1 MBChB, MMed. Affi liations: 1- Coast Provincial Hospital, 2- Voi district hospital Correspondence: Dr. Maranya GA, P.O. Box 91066-80103, Mombasa, Kenya. Email:

Abstract

Background: Testicular ischaemia and infarction in cases of torsion depend on the duration and degree of twisting. Early evaluation and treatment are associated with high salvage reports.

Objective: To determine the salvage rates of testicular torsion in selected hospitals at the Coast Province of Kenya

Design: A retrospective study of patients managed for testicular torsion and related conditions between 1999 and 2011.

Setting: Coast Province General Hospital, Mombasa (1999 - 2008) and Moi District Hospital, Voi (2009 - 2011).

Patients and Methods: Case records of 44 patients were reviewed. Forty two underwent scrotal explorations while two patients with bilateral tes-ticular loss due to torsion had no surgery. Patients were reviewed for age,   operative diagnoses, testicular salvage, surgical procedures performed and recurrence of symptoms.

 

Results: Of 29 patients operated for acute testicular torsion, four had viable testes (salvage rate of 14%). Seven patients had bilateral orchido-pexy for intermittent testicular torsion. Three patients who had missed torsions with resultant total testicular atrophy, had orchidopexy of the contralateral testes. At scrotal exploration 2 patients with epididymor-chitis and one patient with a torsion of appendix testis that was excised, were not subjected to orchidopexy. There was no occurrence of torsion after orchidopexy.

 

Conclusion: Testicular torsions were associated with low salvage rates. Increased public awareness coupled with clinician, parental, teacher, teenage and adult male education with respect to the consequences of acute scrotal pain is warranted.

 

Introduction

Testicular ischaemia and infarction in cases of torsion de-pend on the duration and degree of twisting (1-4). Irrevers-ible ischaemia usually starts after 6 hours. In 10 hours, 80% of the testes are infarcted, while after 24 hours nearly 100% are necrotic (3). Early evaluation and treatment of acute hemiscrotal pair is important for salvage. In intermit-tent torsion, the presentation is with recurrent episodes of acute unilateral scrotal pain which usually resolves sponta-neously within a few hours (5-7). Missed testicular torsion with a totally atrophied testis is a late sequel of acute tor-sion. Although other causes of acute scrotal pain includ-ing epididymorchitis, strangulated inguinal hernia, torsion of testicular appendages, testicular trauma and idiopathic scrotal oedema (3, 5) are important, a clinical suspicion of torsion must lead to immediate surgical scrotal explora-tion (5, 8-11). This study describes testicular torsion at two coastal hospitals in Kenya and the associated salvage level.

 

Patients and Methods

This retrospective study was carried out at two hospitals at the Coast Province of Kenya over a 12 year period - Coast Province General Hospital, Mombasa (1999 - 2008) and Moi District Hospital, Voi (2009 - 2011). Case notes of all patients managed for testicular torsion at the two hospi-tals and a few patients followed up privately by the first author were reviewed. Data abstracted included patient demographics, clinical presentation,