Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
Department of Radiology, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
J Pediatr Surg. 2020 Dec;55(12):2728-2731. doi: 10.1016/j.jpedsurg.2020.02.026. Epub 2020 Feb 24.
Testicular torsion is one of the most common causes of acute scrotum in pediatric age. The present study aimed to evaluate the role of preoperative manual detorsion in the management of testicular torsion.
Retrospective data analysis of pediatric patients treated for acute testicular torsion at a tertiary center over the last 5 years. Manual detorsion was attempted by surgeon's preference. Successful manual detorsion was defined as complete pain resolution with a normal color Doppler ultrasound. All patients underwent surgical exploration. Patient data analyzed included: age, pain duration, site of onset, attempt of manual detorsion, pain relief after manual detorsion, color Doppler ultrasound results, surgical findings and outcome.
One hundred twenty-two patients were included. Manual detorsion was attempted in 48% (58/122) cases. Manual detorsion was successful in 26% (15/58) patients. In the unsuccessful, residual cord torsion was found at surgery in 27.5% (16/58); in the remaining 27, there was no cord torsion at surgery. Five patients (5/15) with successful manual detorsion underwent elective orchiopexy. Gonadal loss after manual detorsion (9%, 5/58) occurred after unsuccessful manual detorsion, all submitted to emergency surgery.
Testicular torsion warrants prompt detorsion. Manual detorsion is simple, immediately available, and maximizes testis salvage. A successful maneuver permits nonemergency orchiopexy. An algorithm for the management of testicular torsion that includes an attempt of manual detorsion prior to surgery is proposed.
Treatment study.
Level IV.
睾丸扭转是小儿时期阴囊急症最常见的原因之一。本研究旨在评估术前手法复位在睾丸扭转治疗中的作用。
回顾性分析过去 5 年在三级中心接受急性睾丸扭转治疗的小儿患者数据。手法复位由外科医生的偏好决定。成功的手法复位定义为疼痛完全缓解，彩色多普勒超声正常。所有患者均行手术探查。分析患者数据包括：年龄、疼痛持续时间、发病部位、手法复位尝试、手法复位后疼痛缓解、彩色多普勒超声结果、手术发现和结果。
共纳入 122 例患者。48%（58/122）的患者尝试了手法复位。26%（15/58）的患者手法复位成功。在不成功的病例中，27.5%（16/58）在手术中发现精索扭转残留；其余 27 例手术中未见精索扭转。15 例手法复位成功的患者中，有 5 例（5/15）行择期或睾丸固定术。手法复位失败后发生睾丸丢失（9%，5/58），均行急诊手术。
睾丸扭转需要及时复位。手法复位简单、即刻可用，最大限度地保留睾丸。成功的复位可以行非紧急的睾丸固定术。提出了一种包括术前尝试手法复位的睾丸扭转治疗方案。
治疗研究。
IV 级。
