ABSTRACT
This study aimed to establish nomograms to preoperatively predict the possibility of testicular salvage (TS) in patients with testicular torsion. The clinical data of 204 patients with testicular torsion diagnosed at Xijing Hospital and Tangdu Hospital (Xi'an, China) between August 2008 and November 2019 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of TS. Based on multivariate regression coefficients, nomograms to predict possibility of TS were established. The predictive ability of the nomograms was internally validated by receiver operating characteristic (ROC) curves and calibration plots. The duration of symptoms ranged from 2 h to 1 month, with a median of 3.5 days. Thirty (14.7%) patients underwent surgical reduction and contralateral orchiopexy, while the remaining 174 (85.3%) underwent orchiectomy and contralateral orchiopexy. Finally, long symptom duration was an independent risk predictor for TS, while visible intratesticular blood flow and homogeneous testicular echotexture under color Doppler ultrasound were independent protective predictors. Internal validation showed that the nomograms, which were established by integrating these three predictive factors, had good discrimination ability in predicting the possibility of TS (areas under the ROC curves were 0.851 and 0.828, respectively). The calibration plots showed good agreement between the nomogram-predicted possibility of TS and the actual situation. In conclusion, this brief preoperative prediction tool will help clinicians to quickly determine the urgency of surgical exploration.
ABSTRACT
A clinical observation was made on 20 patients with testicular torsion admitted at Seoul Red Cross hospital between May l988 and F8bruary 1991 to find out reliable digcriminations on the differential diagnosis and useful informations about the treatment. Clinical features. operative findings and laboratory data were reviewed through the medical records. Of the patients 15(75%) were in age of second decade and 5 (25%) were in age of third decade. Torsion occurred during the cold weather in 14 cases(70% ). The onset of testicular pain was sudden in 14 cases(70%) and previous episodes of testicular pain were present in 10 cases(50%). Torsion occurred on the left side in 17 cases(85%). On physical examination. 13 patients(65%) showed horizontal lie of affected testis. Urinalysis was negative in 18 cases(90%). According to the interval time between the onset of testicular pain and of detorsion, testicular salvage rate was 100% within 6 hours, 89% within 12 hours but 9% in case of over 12 hours. According to the degree of torsion, testicular salvage rate was 50% in case of below 360` and 33% in cases of over 360`. In all 20 cases of testicular torsion, a type of anatomical anomaly was round in torsed testis. that was bell-clapper deformity in 18 cases(90%), long mesorchium in one and ectopic testis in one case. In the contralateral testis, bell-clapper deformity was round in 13 cases(65%). We found the following informations about the testicular torsion. I. It second. there are some reliable features in differential diagnosis, those are age of patients in his second decade. onset in cold weather. more sudden onset of pain, presence of previous episodes, occurrence on the left side, horizontal lie of affected testis and negative urinalysis. 2. Testicular salvage rate after testicular torsion seemed to relate more closely with time between the onset of symptoms and detorsion rather than the degree of torsion. It is advisable to detorse testis at least within 12 hours after the onset of symptoms for testicular salvage. 3. Bell-clapper deformity was found in majority of cases in torsed testis and 65% in the contralateral testis. Therefore. it is reasonable to explore contralateral testis and fix it if needed.