A Survey of Preoperative, Perioperative, and Postoperative Management Practices for Testicular Torsion in Pediatric Patients among European Surgeons

IF 1.5 3区医学 Q2 PEDIATRICS

European Journal of Pediatric Surgery Pub Date : 2024-09-09 DOI:10.1055/s-0044-1790244

Amit Beher, Julio César Moreno-Alfonso, Hanna Garnier, Dogus Darici, Martin Jonathan Salö, Ophelia Aubert

{"title":"A Survey of Preoperative, Perioperative, and Postoperative Management Practices for Testicular Torsion in Pediatric Patients among European Surgeons","authors":"Amit Beher, Julio César Moreno-Alfonso, Hanna Garnier, Dogus Darici, Martin Jonathan Salö, Ophelia Aubert","doi":"10.1055/s-0044-1790244","DOIUrl":null,"url":null,"abstract":"\nIntroduction Management of testicular torsion varies between specialties resulting in lack of standardization. The aim of this survey was to assess pre-, peri-, and postoperative differences. \nMethods An online questionnaire was distributed in 2023 to general and pediatric surgeons, pediatric urologists, and urologists by the Trainees of European Pediatric Surgery. \nMain Results Among 88 respondents (92% tertiary referral hospital), 38% always or usually perform sonography in case of suspected torsion respectively. In addition, 15% always attempt manual detorsion and 44% depending on the clinical presentation. Most surgeons (93%) favor a scrotal approach. Interestingly, pediatric surgeons choose a transscrotal while other specialties opt for a midline incision (p = 0.002). The majority (57%) employ a three-point fixation, while 42% opt for a two-point fixation. In case of necrotic testis, 61% puncture the testis with 52% opting for surgical removal, while 33% perform orchiectomy and 6% leave it in situ. Regarding necrotic or borderline-appearing testis, 54% take a biopsy. Furthermore, 82% perform prophylactic orchidopexy of the contralateral side during the same session. Postoperative antibiotics are always administered by 12%, while 52% do so sometimes. Most perform sonographic (58%) or clinical (57%) follow-up 3 months postoperatively. Notably, pediatric surgeons and urologists perform follow-up more frequently themselves, while general surgeons/urologists recommend follow-up by pediatricians (p = 0.002). In addition, 76% of responders affirm adhering to European Association of Urology guidelines. Unawareness of guidelines and institutional practices are reasons most commonly cited for nonadherence. \nConclusion Our study reveals significant disparities in the pre-, peri-, and postoperative management of testicular torsion underscoring the need for establishing standardized practices. ","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":"7 1","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Pediatric Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/s-0044-1790244","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction Management of testicular torsion varies between specialties resulting in lack of standardization. The aim of this survey was to assess pre-, peri-, and postoperative differences.

Methods An online questionnaire was distributed in 2023 to general and pediatric surgeons, pediatric urologists, and urologists by the Trainees of European Pediatric Surgery.

Main Results Among 88 respondents (92% tertiary referral hospital), 38% always or usually perform sonography in case of suspected torsion respectively. In addition, 15% always attempt manual detorsion and 44% depending on the clinical presentation. Most surgeons (93%) favor a scrotal approach. Interestingly, pediatric surgeons choose a transscrotal while other specialties opt for a midline incision (p = 0.002). The majority (57%) employ a three-point fixation, while 42% opt for a two-point fixation. In case of necrotic testis, 61% puncture the testis with 52% opting for surgical removal, while 33% perform orchiectomy and 6% leave it in situ. Regarding necrotic or borderline-appearing testis, 54% take a biopsy. Furthermore, 82% perform prophylactic orchidopexy of the contralateral side during the same session. Postoperative antibiotics are always administered by 12%, while 52% do so sometimes. Most perform sonographic (58%) or clinical (57%) follow-up 3 months postoperatively. Notably, pediatric surgeons and urologists perform follow-up more frequently themselves, while general surgeons/urologists recommend follow-up by pediatricians (p = 0.002). In addition, 76% of responders affirm adhering to European Association of Urology guidelines. Unawareness of guidelines and institutional practices are reasons most commonly cited for nonadherence.

Conclusion Our study reveals significant disparities in the pre-, peri-, and postoperative management of testicular torsion underscoring the need for establishing standardized practices.

查看原文本刊更多论文

欧洲外科医生对小儿睾丸扭转术前、围手术期和术后处理方法的调查

引言不同专科对睾丸扭转的处理方法各不相同，导致缺乏标准化。本调查旨在评估术前、围手术期和术后的差异。方法欧洲小儿外科学员组织于 2023 年向普外科、小儿外科医生、小儿泌尿科医生和泌尿科医生发放了一份在线问卷。主要结果在88名受访者（92%为三级转诊医院）中，38%的人在怀疑扭转时总是或通常会进行超声检查。此外，15%的受访者总是尝试人工剥离，44%的受访者根据临床表现尝试人工剥离。大多数外科医生（93%）倾向于阴囊入路。有趣的是，小儿外科医生选择经阴囊切口，而其他专科医生则选择中线切口（p = 0.002）。大多数（57%）采用三点固定，42%选择两点固定。在睾丸坏死的情况下，61%的人穿刺睾丸，52%的人选择手术切除，33%的人进行睾丸切除术，6%的人将睾丸留在原位。对于坏死的睾丸或濒临坏死的睾丸，54%的人会进行活组织检查。此外，82%的医生会在同一次手术中对对侧睾丸进行预防性睾丸切除术。12%的人术后总是使用抗生素，52%的人有时使用。大多数人在术后 3 个月进行声像图（58%）或临床（57%）随访。值得注意的是，小儿外科医生和泌尿科医生自己进行随访的频率更高，而普通外科医生/泌尿科医生则建议由儿科医生进行随访（P = 0.002）。此外，76%的受访者表示遵守欧洲泌尿外科协会的指南。不了解指南和机构惯例是不遵守指南的最常见原因。结论我们的研究揭示了睾丸扭转术前、围手术期和术后管理的显著差异，强调了建立标准化实践的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Pediatric Surgery 医学-外科

CiteScore

3.90

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.