Contralateral orchiopexy during pediatric testicular torsion management: What are the national practice patterns?

Purpose: Evidence-based guidelines for contralateral orchiopexy during testicular torsion surgery are lacking. We aim to evaluate the rates of contralateral orchiopexy at time of testicular torsion surgery.

Material and methods: Utilizing Kids Inpatient Database, we performed a retrospective cohort study of children <18 years old who had surgery for testicular torsion from 2016 to 2019. Patients were identified using the ICD10 testicular torsion diagnosis code. Primary outcome was the rate of contralateral orchiopexy. Multivariable logistic regression evaluated patient and hospital factors associated with contralateral orchiopexy.

Results: We identified 1544 children who had surgery for testicular torsion. Of the 531 patients who underwent ipsilateral orchiopexy, 170 (32 %) did not have concurrent contralateral orchiopexy. Of the 528 patients who underwent orchiectomy, 186 patients (35 %) did not have concurrent contralateral orchiopexy. Overall, 1188/1544 (76.9 %) children underwent bilateral orchiopexy, and 356/1544 (23.1 %) did not undergo contralateral fixation. Multivariable logistic regression analysis showed that increased patient age was associated with decreased likelihood of having a contralateral orchiopexy (OR = 0.96, 95 % CI [0.94-0.98], p < 0.01). Patients having surgery at Western region (OR = 0.50, 95 % CI [0.34-0.73], p < 0.01), private non-profit (OR = 0.60, 95 % CI [0.39-0.92], p < 0.02) and private investor owned (OR = 0.58, 95 % CI [0.35-0.95], p < 0.03) hospitals were less likely to have a contralateral orchiopexy.

Conclusions: We observed that roughly a quarter of children having surgery for testicular torsion do not undergo a contralateral orchiopexy. Increasing patient age, surgery in Western region hospital, and private hospital, were associated with decreased likelihood of contralateral orchiopexy.