Long time follow-up for patients with testicular torsion: new findings.

Am J Clin Exp Urol 2024;12(4):216-225 www.ajceu.us /ISSN:2330-1910/AJCEU0148140 Original Article Long time follow-up for patients with testicular torsion: new findings Vittoria Boscaini1, Francesco Saverio Camoglio1, Ilaria Dando2, Angelo Pietrobelli3, Nicola Zampieri1,4 Pediatric Surgery Unit, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Department of Engineering for Innovation Medicine, Pediatric Fertility Lab, University of Verona, Piazzale A. Stefani n.1, 37134 Verona, Italy; 2Department of Neurosciences, Biomedicine and Movement Sciences, Biochemistry Section University of Verona, 37134 Verona, Italy; 3Pediatric Unit, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Department of Surgery, Dentistry, Pediatrics and Gynaecology, University of Verona, Piazzale A. Stefani n.1, 37134 Verona, Italy; 4Unicamillus International Medical University, Via Di Sant’Alessandro 8, 00131 Roma, Italy 1 Received November 30, 2022; Accepted August 21, 2024; Epub August 25, 2024; Published August 30, 2024 Abstract: Background: Testicular torsion is the major urologic emergency. If not treated promptly, this condition can result in testicular necrosis or long-term functional impairment. At present, there are few paper about long time follow-up of these patients. The primary objective of our study is to report the long-term clinical-instrumental data (mean follow-up 12 years) of patients treated for testicular torsion. Methods: We considered patients treated for testicular torsion during the period between 1997 and 2017. Inclusion and exclusion criteria were created. Patients were contacted by phone between December 2021 and January 2022. Each patient underwent clinical and ultrasonographic evaluation, and in addition, some subjects were offered additional tests (hormonal assays and semen analysis). Results: During the study period, 22 patients were treated for testicular torsion. From the ultrasonographic study, it was found that the volume of the affected testis is reduced and it is associated with microcalcifications and heterogeneous echogenicity. Morphovolumetric recovery seems to be more related to age of onset than to the degree of torsion. Conclusions: Based on our results we can state that affected testes, if preserved, grow less and have altered ultrasonographic morphology. Clinically, the age of onset of torsion seems more important than the degree of torsion. Keywords: Fertility, follow-up, pediatric, testes, torsion Introduction Testicular torsion (TT) may result in altered blood supply and possible secondary transient or permanent ischaemic damage [1]. The annual incidence of this condition has been reported to be 3.8 cases per 100,000 males younger than 18 years [2]. The identification of the aetiological factors underlying testicular torsion is not easy. However, a number of genetic and environmental factors, a positive history of previous trauma, the abnormal conformation of the tunica and the presence of an increased cremasteric reflex have been reported to be predisposing factors [1, 3]. Finally, it should be mentioned that cryptorchid testicle and oscillating testicle are also risk factors [4]. Various studies report the existence of a time window of 4-8 hours, after which significant damage occurs. Although most patients present with different symptoms and timing, it is recommended to perform exploratory surgery as soon as possible if testicular torsion is suspected [5]; Urgent surgical treatment is now the gold standard for both definitive diagnosis and management of the condition [1, 6]. Currently there are only a few studies in the literature, concentrated in the last 20 years, concerning the long-term evaluation of testicular torsion outcomes, especially on testicular function and quality of tissue. These paper reported https://doi.org/10.62347/YGAQ8968 Testicular torsion outcomes different outcomes about testicular function, but really no data about the quality of tissue and parenchyma are reported. The aim of our study is to investigate gonadal quality in patients with a history of testicular torsion from childhood to adolescence. Analysing the data obtained from long time follow-up, we could find clinical and instrumental evidence associated with a probable alteration of fertile potential in order to avoid infertility. Material and methods Study population We considered patients treated for testicular torsion at our Hospital. To obtain a long-term follow-up of at least 5 years after surgery, patients treated from 1996 to 2017 were considered. All patients had to be over 18 years of age at the time of selection; subjects treated before 1997 (due to lack of searchable operating records) and subjects treated after 2017 (thus with lower follow-up) were excluded from the study. The research was approved by the IRB of the Pediatric Fertility Lab under number 2021/ PFL6, oral and written consent was obtained by each patients or parents. Ethical approval was obtained under number CESC 2021TORSION. All medical charts of the Pediatric Surgery Unit since 1997 were consulted, searching for the surgical diagnosis of ‘testicular torsion’. For more recent data, after 2013, the electronic ORMAWEB surgical register was consulted by entering the coding of testicular torsion (ICD-9 code 608.20-608.21-608.22) as the disease search code. We defined criteria for inclusion and exclusion from the study before consulting the surgical reports. Inclusion criteria: Surgery for single- or bilateral testicular torsion; Torsion was defined as twisted testes more than 180° detected during surgery; Patients currently alive and contactable by telephone; Patients who both accepted the telephone contact and performed the proposed clinical follow-up visit. 217 We considered as exclusion criteria: Incomplete data; Patients who have undergone other surgeries prior to testicular torsion or afterwards, excluding only re-torsion (crucial for epidemiological data); Patients diagnosed with testicular torsion pre-operatively but not confirmed at surgery. Preliminary contact All patient data were obtained via the GECOS operating system after approval by the Medical Directorate. The patients were contacted by telephone between December 2021 and January 2022, by the same surgeon, and the purpose of the study and the intention to perform an andrological check-up were explained and the date of the appointment agreed upon. Andrological examination During the examination, additional specific questions were asked about andrological health, including the quality of the erection, any problems with ejaculation, testicular pain, or lower urinary tract symptoms (L.U.T.S.-Low urinary tract symptoms). During the objective examination, scrotal skin, penile shaft, urethral meatus, preputial frenulum and gonad volume were checked. All visit were done by an experienced surgeon. All patients underwent scrotal ultrasound with measurement of the volume of the gonads, (...truncated)