Sacha L Moore1, Ryad Chebbout2, Marcus Cumberbatch3, Jasper Bondad4, Luke Forster5, Jane Hendry6, Ben Lamb7, Steven MacLennan8, Arjun Nambiar9, Taimur T Shah10, Vasilis Stavrinides11, David Thurtle12, Ian Pearce13, Veeru Kasivisvanathan14. 1. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; North Wales Clinical Research Centre/Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wales, UK. 2. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK. 3. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 4. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Department of Urology, Lister Hospital, Stevenage, UK. 5. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Department of Urology, Royal Free Hospital, London, UK. 6. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Department of Urology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK. 7. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Department of Urology, Cambridge University Hospitals NHS Foundation Trust, UK. 8. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Academic Urology Unit, University of Aberdeen, Scotland, UK. 9. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK. 10. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Charing Cross Hospital, Imperial College Healthcare NHS Trust and Imperial Prostate, Department of Surgery and Cancer, Imperial College London, UK. 11. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Division of Surgery and Interventional Science, University College London, UK. 12. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK. 13. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK. 14. British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK; Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK. Electronic address: veeru.kasi@ucl.ac.uk.
Abstract
CONTEXT: Acute testicular torsion is a common urological emergency. Accepted practice is surgical exploration, detorsion, and orchidopexy for a salvageable testis. OBJECTIVE: To critically evaluate the methods of orchidopexy and their outcomes with a view to determining the optimal surgical technique. EVIDENCE ACQUISITION: This review protocol was published via PROSPERO [CRD42016043165] and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). EMBASE, MEDLINE, and CENTRAL databases were searched using the following terms: "orchidopexy", "fixation", "exploration", "torsion", "scrotum", and variants. Article screening was performed by two reviewers independently. The primary outcome was retorsion rate of the ipsilateral testis following orchidopexy. Secondary outcomes included testicular atrophy and fertility. EVIDENCE SYNTHESIS: To our knowledge, this is the first systematic review on this topic. The search yielded 2257 abstracts. Five studies (n = 138 patients) were included. All five techniques differed in incision and/or type of suture and/or point(s) of fixation. Postoperative complications were reported in one study, and included scrotal abscess in 9.1% and stitch abscess in 4.5%. The contralateral testis was fixed in 57.6% of cases. Three studies reported follow-up duration (range 6-31 wk). No study reported any episodes of ipsilateral retorsion. In the studies reporting ipsilateral atrophy rate, this ranged from 9.1% to 47.5%. Fertility outcomes and patient-reported outcome measures were not reported in any studies. CONCLUSIONS: There is limited evidence in favour of any one surgical technique for acute testicular torsion. During the consent process for scrotal exploration, uncertainties in long-term harms should be discussed. This review highlights the need for an interim consensus on surgical approach until robust studies examining the effects of an operative approach on clinical and fertility outcomes are available. PATIENT SUMMARY: Twisting of blood supply to the testis, termed testicular torsion, is a urological emergency. Testicular torsion is treated using an operation to untwist the cord that contains the blood vessels. If the testis is still salvageable, surgery can be performed to prevent further torsion. The method that is used to prevent further torsion varies. We reviewed the literature to assess the outcomes of using various surgical techniques to fix the twisting of the testis. Our review shows that there is limited evidence in favour of any one technique.
CONTEXT: Acute testicular torsion is a common urological emergency. Accepted practice is surgical exploration, detorsion, and orchidopexy for a salvageable testis. OBJECTIVE: To critically evaluate the methods of orchidopexy and their outcomes with a view to determining the optimal surgical technique. EVIDENCE ACQUISITION: This review protocol was published via PROSPERO [CRD42016043165] and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). EMBASE, MEDLINE, and CENTRAL databases were searched using the following terms: "orchidopexy", "fixation", "exploration", "torsion", "scrotum", and variants. Article screening was performed by two reviewers independently. The primary outcome was retorsion rate of the ipsilateral testis following orchidopexy. Secondary outcomes included testicular atrophy and fertility. EVIDENCE SYNTHESIS: To our knowledge, this is the first systematic review on this topic. The search yielded 2257 abstracts. Five studies (n = 138 patients) were included. All five techniques differed in incision and/or type of suture and/or point(s) of fixation. Postoperative complications were reported in one study, and included scrotal abscess in 9.1% and stitch abscess in 4.5%. The contralateral testis was fixed in 57.6% of cases. Three studies reported follow-up duration (range 6-31 wk). No study reported any episodes of ipsilateral retorsion. In the studies reporting ipsilateral atrophy rate, this ranged from 9.1% to 47.5%. Fertility outcomes and patient-reported outcome measures were not reported in any studies. CONCLUSIONS: There is limited evidence in favour of any one surgical technique for acute testicular torsion. During the consent process for scrotal exploration, uncertainties in long-term harms should be discussed. This review highlights the need for an interim consensus on surgical approach until robust studies examining the effects of an operative approach on clinical and fertility outcomes are available. PATIENT SUMMARY: Twisting of blood supply to the testis, termed testicular torsion, is a urological emergency. Testicular torsion is treated using an operation to untwist the cord that contains the blood vessels. If the testis is still salvageable, surgery can be performed to prevent further torsion. The method that is used to prevent further torsion varies. We reviewed the literature to assess the outcomes of using various surgical techniques to fix the twisting of the testis. Our review shows that there is limited evidence in favour of any one technique.