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.
British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK.
Eur Urol Focus. 2021 Nov;7(6):1493-1503. doi: 10.1016/j.euf.2020.07.006. Epub 2020 Aug 27.
Acute testicular torsion is a common urological emergency. Accepted practice is surgical exploration, detorsion, and orchidopexy for a salvageable testis.
To critically evaluate the methods of orchidopexy and their outcomes with a view to determining the optimal surgical technique.
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.
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.
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.
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.
急性睾丸扭转是一种常见的泌尿外科急症。目前的治疗方法是手术探查、松解扭转并进行睾丸固定术。
批判性地评估睾丸固定术的方法及其结果，以确定最佳的手术技术。
本综述方案通过 PROSPERO（CRD42016043165）发布，并按照系统评价和荟萃分析的首选报告项目（PRISMA）进行。使用以下术语在 EMBASE、MEDLINE 和 CENTRAL 数据库中进行检索：“睾丸固定术”、“固定”、“探查”、“扭转”、“阴囊”和变体。由两名评审员独立进行文章筛选。主要结局是睾丸固定术后同侧睾丸的扭转复发率。次要结局包括睾丸萎缩和生育能力。
据我们所知，这是该主题的第一项系统评价。搜索结果产生了 2257 篇摘要。纳入了五项研究（n=138 名患者）。所有五种技术在切口和/或缝线类型和/或固定点方面均存在差异。一项研究报告了术后并发症，包括 9.1%的阴囊脓肿和 4.5%的缝线脓肿。在 57.6%的病例中固定了对侧睾丸。三项研究报告了随访时间（范围 6-31 周）。没有研究报告任何同侧扭转复发的病例。在报告同侧萎缩率的研究中，该比例范围为 9.1%至 47.5%。任何研究都没有报告生育结局和患者报告的结局测量。
目前支持任何一种急性睾丸扭转手术技术的证据有限。在进行阴囊探查的知情同意过程中，应讨论长期危害的不确定性。本综述强调需要就手术方法达成临时共识，直到有研究检查手术方法对临床和生育结局的影响。
睾丸供血的扭曲，称为睾丸扭转，是一种泌尿外科急症。睾丸扭转采用手术来解开包含血管的精索来治疗。如果睾丸仍然可以挽救，手术可以防止进一步扭转。用于防止进一步扭转的方法有所不同。我们审查了文献，以评估使用各种手术技术固定睾丸扭转的结果。我们的综述表明，目前支持任何一种技术的证据有限。
