Journal of pediatric urology · 2026
The importance of door to detorsion time in children diagnosed with testicular torsion - Every minute counts!
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Shields Lisa B E, Jawad Kahir, Wu Wayland J, Rosenberg Eran
Аннотация
INTRODUCTION/BACKGROUND: Testicular torsion (TT) represents an emergent pediatric condition that requires timely surgical intervention to minimize the likelihood of testicular loss. Numerous reasons may affect the survival rate of a torsed testis, including longer symptom duration, younger age, and higher degree of TT observed intraoperatively. "Door To Detorsion time" (DTD) has been described but not fully validated.
OBJECTIVE: We sought to evaluate the DTD on outcomes of TT.
STUDY DESIGN: We identified males 1-18 years old with TT over a 10-year period (January 1, 2015-December 31, 2024) in this retrospective and observational study. Univariate and multivariate analyses determined whether DTD, patient age, symptom duration, and degree of TT observed during surgery were predictors of testicular salvage.
RESULTS: Of the 286 patients diagnosed with TT, the median age was 14 years, and the median symptom duration was 9 h. The median DTD was 146.5 min (ranging between 25 and 668 min): 133 min with a viable testes and 166 min with a nonviable testes. A total of 195 (68 %) patients underwent an orchiopexy compared to 91 (32 %) patients who had an orchiectomy. A multivariate analysis demonstrated that each 10-min increase in DTD was associated with a 6 % increase in odds of undergoing an orchiectomy. Each additional hour of DTD was associated with a 35 % increase in odds of an orchiectomy. For each additional hour of symptom duration, the odds of undergoing an orchiectomy versus an orchiopexy increased by 3 %. Patients with a degree of TT > 540 had a 4.85 times higher odds of orchiectomy compared to those treated with 0 degrees of TT. Patients with symptoms lasting 24 h or longer had an 8.9 times higher odds of requiring an orchiectomy compared to those treated within 24 h. For each additional year of age, the odds of an orchiectomy decreased by 14 %.
DISCUSSION: Our study concurs with the literature with respect to a significantly increased risk of needing an orchiectomy with a longer DTD and extended symptom duration, with critical timepoints of greater than 6 h, greater than 12 h, and greater than 18 h.
CONCLUSION: The DTD is a very significant but often ignored factor. Every 10 min delay in the Emergency Department reduces the survival of the testis. Recognizing the symptoms of TT especially in younger males and seeking timely medical attention, coupled with a hastened hospital course prior to surgery, decrease the need for testicular loss.
OBJECTIVE: We sought to evaluate the DTD on outcomes of TT.
STUDY DESIGN: We identified males 1-18 years old with TT over a 10-year period (January 1, 2015-December 31, 2024) in this retrospective and observational study. Univariate and multivariate analyses determined whether DTD, patient age, symptom duration, and degree of TT observed during surgery were predictors of testicular salvage.
RESULTS: Of the 286 patients diagnosed with TT, the median age was 14 years, and the median symptom duration was 9 h. The median DTD was 146.5 min (ranging between 25 and 668 min): 133 min with a viable testes and 166 min with a nonviable testes. A total of 195 (68 %) patients underwent an orchiopexy compared to 91 (32 %) patients who had an orchiectomy. A multivariate analysis demonstrated that each 10-min increase in DTD was associated with a 6 % increase in odds of undergoing an orchiectomy. Each additional hour of DTD was associated with a 35 % increase in odds of an orchiectomy. For each additional hour of symptom duration, the odds of undergoing an orchiectomy versus an orchiopexy increased by 3 %. Patients with a degree of TT > 540 had a 4.85 times higher odds of orchiectomy compared to those treated with 0 degrees of TT. Patients with symptoms lasting 24 h or longer had an 8.9 times higher odds of requiring an orchiectomy compared to those treated within 24 h. For each additional year of age, the odds of an orchiectomy decreased by 14 %.
DISCUSSION: Our study concurs with the literature with respect to a significantly increased risk of needing an orchiectomy with a longer DTD and extended symptom duration, with critical timepoints of greater than 6 h, greater than 12 h, and greater than 18 h.
CONCLUSION: The DTD is a very significant but often ignored factor. Every 10 min delay in the Emergency Department reduces the survival of the testis. Recognizing the symptoms of TT especially in younger males and seeking timely medical attention, coupled with a hastened hospital course prior to surgery, decrease the need for testicular loss.