Dias Aderivaldo Cabral, Alves João Ricardo, Buson Hélio, Oliveira Paulo Gonçalves de
Serviço de Urologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil.
Serviço de Cirúrgica Pediátrica do Hospital de Base do Distrito Federal, Brasília, DF, Brasil.
Int Braz J Urol. 2016 Nov-Dec;42(6):1210-1219. doi: 10.1590/S1677-5538.IBJU.2016.0166.
To investigate the roles of age, testicular rotation and time in the surgical outcome of intravaginal testicular torsion (iTT).
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.
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.
Testicular rotation exerts a multiplicative effect on PrD, so time should not be regarded as the sole predictor of surgical outcome in iTT.
探讨年龄、睾丸扭转及时间在阴囊内睾丸扭转（iTT）手术结局中的作用。
我们检索了2012年1月至2014年1月在本单位接受治疗的所有iTT患者的记录。解释变量为：年龄（岁）；就诊延迟（PrD，症状出现至住院的时间）；手术延迟（SurgD，住院至手术的时间）和睾丸扭转（扭转），手术结局（睾丸固定术、睾丸切除术）作为反应变量。通过手术结局对PrD、SurgD、年龄和扭转的差异进行非参数评估。逐步逻辑回归将年龄、PrD、SurgD和扭转作为预测因素。统计学显著性和置信区间（CI）设定为p<0.05和0.95。比值比（OR）根据模型系数计算得出。
117例患者可获得完整的变量信息，大多数（61例，52.1%）接受了睾丸切除术。睾丸切除术和睾丸固定术患者的年龄相似（中位数分别为15.8岁和16.0岁，p=0.78）。相比之下，睾丸切除术和睾丸固定术患者的PrD（85.0小时对8.4小时，p<0.001）、SurgD（3.0小时对16.0小时，p<0.001）不同。当PrD<24小时时，SurgD相似（4.0对2.8，p=0.1）。睾丸切除术患者的扭转程度更大（3.0π弧度对2.0π弧度，p<0.001）。逻辑回归显示，PrD（OR 0.94；0.92 - 0.97；p<0.001）和扭转（OR 0.43；0.27 - 0.70；p<0.001）与睾丸固定术呈负相关。
睾丸扭转对PrD有倍增效应，因此在iTT中时间不应被视为手术结局的唯一预测因素。
