The Amount of spermatic cord rotation magnifies the timerelated orchidectomy risk in intravaginal testicular torsion

Vol. 42 (6): 1210-1219, November – December, 2016

doi: 10.1590/S1677-5538.IBJU.2016.0166


ORIGINAL ARTICLE

Aderivaldo Cabral Dias Filho 1, João Ricardo Alves 1, Hélio Buson Filho 2, Paulo Gonçalves de Oliveira 3

1 Serviço de Urologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil; 2 Serviço de Cirúrgica Pediátrica do Hospital de Base do Distrito Federal, Brasília, DF, Brasil; 3 Departamento de Cirurgia da Faculdade de Ciências Médicas da Universidade de Brasília, Brasília, DF, Brasil

ABSTRACT

Purpose: To investigate the roles of age, testicular rotation and time in the surgical outcome of intravaginal testicular torsion (iTT).

Patients and Methods: We retrieved the records of all iTT patients treated in our unit from January 2012 to January 2014. Explanatory variables were: age (years); presentation delay (PrD, time between symptoms and hospitalization); surgical delay (SurgD, time between hospitalization and surgery) and testicular rotation (rotation), with surgical outcome (orchidopexy, orchidectomy) as response variable. Differences in PrD, SurgD, age and rotation by surgical outcome were evaluated non-parametrically. Stepdown logistic regression included age, PrD, SurgD and rotation as predictors. Statistical significance and confidence intervals (CI) were set at p<0.05 and 0.95. Odds ratios (OR) were computed from the model’s coefficients.

Results: Complete variable information was available for 117 patients, and most (61, 52.1%) underwent orchidectomy. Ages were similar between orchidectomy and orchidopexy patients (median 15.8 vs. 16.0 years, p=0.78). In contrast, PrD (85.0 vs. 8.4 hours, p<0.001), SurgD (3.0 vs. 16.0 hours, p<0.001) were different between orchidectomy and orchidopexy patients. SurgD was similar with PrD<24 hours (4.0 vs. 2.8, p=0.1). Orchidectomy patients had greater rotation (3.0π vs. 2.0π radians, p<0.001).

Logistic regression revealed that PrD (OR 0.94; 0.92–0.97; p<0.001) and rotation (OR 0.43; 0.27–0.70; p<0.001) were inversely associated with orchidopexy.

Conclusion: Testicular rotation exerts a multiplicative effect on PrD, so time should not be regarded as the sole predictor of surgical outcome in iTT.

Keywords: Testis; Ischemia; Spermatic Cord Torsion

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