Optimal Predictor of Gonadal Viability in Testicular Torsion: Time to Treat Versus Duration of Symptoms.

Abstract

BACKGROUND\nWe hypothesize that in testicular torsion, the duration of symptoms (DoS) better correlates with predicting testicular viability than minimizing the time-to-treat (TtT) after presentation to a medical facility.\n\n\nMATERIALS AND METHODS\nMedical records of male pediatric patients treated for suspected diagnosis of testicular torsion in the emergency department (ED) from January 1, 2016, to December 31, 2018, were retrospectively evaluated. Forty-one patients met inclusion criteria. Statistical analysis compared testicular viability based on TtT, DoS, and site of initial presentation.\n\n\nRESULTS\nTesticular salvage rates for patients presenting directly to our ED was 56.3% with an average TtT of 2.5\xa0h versus 77.8% and 1.96\xa0h, respectively, for transferred patients. Overall testicular survival was not statistically impacted by the difference in TtT. Comparing DoS, an 84% testicular salvage rate (DoS < 24\xa0h) versus a 15.4% salvage rate (DoS > 24\xa0h) was shown in patients presenting directly to our ED (P\xa0≤\xa00.0001). Within the total population (n\xa0=\xa041), a significant difference was also shown (P\xa0≤\xa00.0001) when comparing overall testicular salvage rates in patients presenting with <24\xa0h versus >24\xa0h total DoS (84% versus 25%).\n\n\nCONCLUSIONS\nThese data reveal that an alternative predictor of testicular salvage rates is a DoS < 24\xa0h. This is a meaningful metric when providing accurate preoperating counseling to parents and may be a better focus of quality improvement efforts surrounding this topic.