Reactive microglia and mitochondrial unfolded protein response following ventriculomegaly and behavior defects in kaolin-induced hydrocephalus.

BACKGROUND

The treatment modalities for testicular appendage torsion in children are classified as conservative or surgical, and the choice is controversial.

OBJECTIVES

This study aimed to identify ultrasound-based indicators influencing the outcome of conservative treatment in children with testicular appendage torsion to divide the boundaries between conservative and surgical management.

METHODS

A retrospective analysis was conducted on testicular appendage torsion data of children from November 2022 and November 2023 in the Children's Hospital of Zhejiang University School of Medicine to compare the conservatively successful and conservatively unsuccessful groups' clinical and ultrasound characteristics. Furthermore, we constructed a logistic regression model and evaluated its predictive ability.

RESULTS

We observed 405 (88.62%) and 52 (11.38%) cases of conservative success and failure, respectively. Univariate analysis indicated significant differences between these groups in testicular appendage torsion nodule size, terminology for hydrocele, scrotal wall edema, and increased epididymal blood flow (p<0.05). Additionally, binary logistic regression analysis indicated that the testicular appendage torsion nodule size was an independent risk factor influencing conservative treatment outcomes. There was a 12.3% rise in the incidence ratio of conservative failure (Odds ratio [OR] 1.123, 95% confidence interval [CI] 1.055-1.195, p<0.05) for every 1 mm2 increase in nodule size. The receiver operating characteristic (ROC) curve revealed an optimal critical value of 23.56 mm2, corresponding to an area under the curve (AUC) of 0.810, a sensitivity of 0.692, and a specificity of 0.798 (95% CI 0.752-0.867, p<0.05).

CONCLUSIONS

When the size of the testicular appendage torsion node measured by ultrasound exceeds 23.56 mm2, conservative treatment is predicted to fail, and surgical treatment may be considered. This result has certain clinical application potential and can be used as one of the important indicators to assist decision-making.