What matters in testicular torsion? Association of hospital transfer, race and socioeconomic factors with testicular outcomes in a single center experience.

IF 2 3区 医学 Q2 PEDIATRICS
Curran Uppaluri, Katherine Fischer, Tyler Gaines, Connie Tan, Jane Lavelle, Summer Kaplan, Karl Godlewski, Sameer Mittal, Jason Van Batavia, Christopher Long, Dana Weiss, Arun Srinivasan, Aseem Shukla, Mark Zaontz, Stephen Zderic, Thomas Kolon
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引用次数: 0

Abstract

Introduction: Testicular torsion is a surgical emergency that is managed with either septopexy-only or tunica vaginalis flap with septopexy if the testis is potentially viable or orchiectomy if not. Minimizing time from ischemia onset to surgery maximizes the likelihood of testicular preservation. While factors such as time from door to OR can be easily targeted, others such as inequalities in access to care are more difficult to address.

Objective: We sought to determine whether patient transfer affects testicular outcomes intraoperatively and in the long-term. Secondary goals included investigating the impact of race and Child Opportunity Index (COI) on testicular torsion outcomes and defining the optimal time cutoff from symptom onset to presentation that predicts salvage.

Methods: We reviewed our prospective testicular torsion database to identify boys who underwent operative intervention for testicular torsion between January 2015 and March 2022. The association of race and COI with testicular salvage, defined as septopexy-only, was evaluated with univariate and multivariate logistic regression controlling for time to presentation, while the association of transfer with salvage was evaluated with univariate and multivariate logistic regression controlling for age, time to presentation, and time to OR. To determine the optimal cutoff for time to presentation to predict testicular salvage, the Youden index was calculated.

Results: Race and COI were not associated with testicular salvage on either univariate or multivariate logistic regression that controlled for time to presentation. Transfer status was not associated with salvage, while age, time from symptoms to presentation, and time from institutional arrival to OR were associated with salvage. The optimal time cutoff to predict salvage using the Youden index was 10.5 hours from symptom onset to presentation and 14.5 hours from symptom onset to detorsion.

Discussion: Time to presentation was the strongest, modifiable risk factor associated with testicular salvage. As it may be difficult for children to accurately communicate their symptoms, diagnosis and prompt management of testicular torsion can be delayed. Improvement in outcomes can be achieved by placing greater efforts into patient, parental, and primary care provider education of the signs and symptoms of testicular torsion.

Conclusions: Race, COI, and transfer status were not found to have a statistically significant effect on testicular salvage outcomes in patients presenting with testicular torsion. Despite the common premise of a 6-hour window until testicular loss, we found that intervention within the acute window of 14.5 hours from symptom onset is still associated with salvage.

睾丸扭转的关键是什么?转院、种族和社会经济因素与睾丸结局的关联:单中心经验。
导言:睾丸扭转是一种外科急症,如果睾丸可能存活,可采用单纯睾丸隔成形术或阴道韧带瓣加睾丸隔成形术;如果睾丸不能存活,则采用睾丸切除术。从缺血开始到手术的时间越短,保留睾丸的可能性就越大。虽然从门诊到手术室的时间等因素很容易锁定,但其他因素如获得医疗服务的不平等则更难解决:我们试图确定病人转院是否会影响术中和长期的睾丸治疗效果。次要目标包括调查种族和儿童机会指数(COI)对睾丸扭转结果的影响,并确定从症状出现到就诊的最佳时间截点,以预测抢救结果:我们回顾了我们的前瞻性睾丸扭转数据库,以确定在 2015 年 1 月至 2022 年 3 月期间因睾丸扭转接受手术干预的男孩。通过控制发病时间的单变量和多变量逻辑回归评估了种族和COI与睾丸救治(定义为单纯隔睾)的相关性,而通过控制年龄、发病时间和手术时间的单变量和多变量逻辑回归评估了转归与救治的相关性。为了确定预测睾丸存活率的最佳发病时间截点,计算了尤登指数:结果:在控制发病时间的单变量或多变量逻辑回归中,种族和COI与睾丸存活率无关。转院状态与睾丸存活率无关,而年龄、从症状到发病的时间以及从到达医院到手术室的时间与睾丸存活率有关。使用尤登指数预测抢救成功的最佳时间截断点是症状出现到发病的10.5小时,以及症状出现到脱离的14.5小时:讨论:发病时间是与睾丸救治相关的最重要的可调整风险因素。由于儿童可能难以准确表达自己的症状,睾丸扭转的诊断和及时处理可能会被延误。通过加强对患者、家长和初级保健提供者进行有关睾丸扭转体征和症状的教育,可以改善治疗效果:结论:对于睾丸扭转患者的睾丸抢救结果,种族、COI 和转院情况在统计学上没有显著影响。尽管人们普遍认为睾丸扭转发生前的 6 小时窗口期是抢救的最佳时机,但我们发现在症状发生后 14.5 小时的急性窗口期内进行干预仍与睾丸的挽救有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Pediatric Urology
Journal of Pediatric Urology PEDIATRICS-UROLOGY & NEPHROLOGY
CiteScore
3.70
自引率
15.00%
发文量
330
审稿时长
4-8 weeks
期刊介绍: The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review. It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty. It publishes regular reviews of pediatric urological articles appearing in other journals. It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty. It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.
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