Chu DI, et al. - This trial was formulated in order to define the optimal window of ischemia time during which tunica vaginalis flap (TVF) could be most beneficial to avoid orchiectomy in the case of testicular torsion. Data revealed the possibility that individuals having testicular torsion with ischemia times ≤24 hours and who under consideration for orchiectomy gained most benefit from TVF. Nevertheless, TVF could still present with preserved testicular viability in two-thirds of cases for ischemia times >24 hours. Hence, researchers drew the conclusion that TVF served as a valid alternative to orchiectomy for torsed testicles, albeit with high testicular atrophy rates.

Methods

• The design of this research was a retrospective cohort study.
• The enrolled candidates were males presenting with testicular torsion at a single tertiary-care institution from January, 2003 to March, 2017.
• Experts defined the ischemia time as the duration of pain from onset to surgery.
• Taking into consideration TVF possibly serving as an option to orchiectomy and to longer ischemia time in testicles that underwent orchiectomy, matching was conducted.
• Herein, torsion cases treated with TVF were matched 1:1 with cases treated with orchiectomy on age at surgery, and ischemia time.
• Postoperative viability, defined as palpable testicular tissue with normal consistency, and atrophy, defined as palpable decrease in size relative to contralateral testicle constituted the outcomes.
• During this study, sensitivity analyses were performed restricting to the subgroups with postoperative ultrasound, >6 months’ follow-up, and additionally matching for degrees of twist.

Results

• Researchers enrolled 182 patients, among whom 49, 36, and 97 underwent orchiectomy, TVF, and septopexy alone, respectively.
• It was discovered that the median follow-up was 2.7 months.
• Data displayed that 26% of patients had postoperative ultrasound (61% of TVF group).
• The median ischemia times were 51, 11, and 8 hours in the orchiectomy, TVF, and septopexy groups, respectively, postoperative viability rates were found to be 0, 86, and 95%, and postoperative atrophy rates were 0, 68, and 24%.
• A total of 32 patients with TVF were matched to 32 patients who underwent orchiectomy, ater matching.
• The occurrence of postoperative viability was noted in 95% (19/20) in the TVF group, vs 67% (8/12) of patients with ischemia times ≤24 and >24 hours, respectively.
• Findings disclosed the occurrence of atrophy in 67% (12/18) vs 83% (10/12) of these same respective patients.
• Similar viability results were illustrated via sensitivity analysis by ultrasound and longer follow-up.
• However, higher atrophy rates were found.
• Lower viability and higher atrophy rates were demonstrated, by additional matching for degrees of twist, for increasing ischemia times.