Effectiveness of tunica albuginea incision and tunica vaginalis flap for testicular torsion: a systematic review.

PURPOSE: Testicular torsion (TT) requires prompt surgical intervention to prevent irreversible damage or orchiectomy. While orchidopexy remains the standard treatment, the tunica vaginalis flap (TVF) has emerged as a novel technique to offer testicular salvage and reduce orchiectomy rates. This systematic review with meta-analysis aims to evaluate the TVF outcomes in TT patients.

METHODS

This systematic review and meta-analysis adhered to the Cochrane collaborative and PRISMA guidelines. An extensive literature search was conducted up to December 2024. Data extracted included patient characteristics, surgical intervention description, postoperative outcomes, and complications. The ROBINS-I and MINORS tools were utilized to assess the quality of the study.

RESULTS

Eight studies with 293 patients were included. Meta-analysis of three comparative studies revealed that standard orchidopexy had a marginally higher testicular salvage rate than TVF pooled odds ratio of 2.33 (95% CI: 0.95-5.68, p = 0.06). However, this difference was not statistically significant. Testicular salvage rates were notably affected by the duration of ischemia, with prolonged ischemia linked to worse outcomes. Several studies highlighted TVF's effectiveness in preventing orchiectomy by decreasing testicular compartment pressure and postoperative testicular volume retention, maintaining at least 50% of testicular volume. Complications from the TVF procedure were rare. Most studies included in the analysis exhibited a high risk of bias.

CONCLUSION

TVF may be offered for its potential to preserve testicular volume and prevent orchiectomy, though its effectiveness depends on ischemic duration and procedural standardization. Further research is needed to better assess TVF's role in TT management and refine patient selection criteria.