Centro Universitário FMABC, Santo André, SP, Brazil.
Einstein (Sao Paulo). 2023 Aug 14;21:eAO0220. doi: 10.31744/einstein_journal/2023AO0220. eCollection 2023.
To report the effects of a tunica vagina flap on testicular compartment syndrome.
This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months.
Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed.
The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma. Testicular torsion causes orchiectomy in more than 80% of the cases after 24 hours of pain onset. Testicular detorsion only (P1-P2) showed a small difference in intratesticular pressure (median 4mmHg). Testicular incision (P2-P3) only demonstrated a major pressure decrease (median, 45mmHg). The final pressure after TVR was similar to the non-twisted testicle pressure (median, 1mmHg). Testicular salvage (88.9%) and atrophy (66.3%) rates were slightly higher than the previous literature reports, perhaps the initial learning curve of this novel technique.
报告鞘膜壁层切开术对睾丸间隔综合征的影响。
这是一项单臂临床试验，于 2020 年 9 月至 2021 年 10 月进行。纳入疼痛发作后 24 小时内疑似发生睾丸扭转的连续患者。排除既往有睾丸扭转、双侧扭转或既往萎缩的患者。打开鞘膜，在从阴囊取出和复位睾丸之前测量睾丸内压（P1）、复位后（P2）和横切后（P3）。进行鞘膜壁层切开术，并记录新的睾丸内压（P4）。在固定前记录对侧睾丸压（Pc）。最短随访时间为 6 个月。
2020 年 9 月至 2021 年 10 月期间共纳入 15 名患者，其中 9 名患者完成了随访。中位年龄（范围）为 15 岁（9-19 岁）。平均 P1、P2、P3、P4 和 Pc（范围）分别为 43mmHg（40-52mmHg）、60mmHg（51-67mmHg）、23mmHg（15-30mmHg）、20mmHg（16-25mmHg）和 14mmHg（11-16mmHg）。萎缩率为 66.3%，活力为 88.9%。未观察到重大并发症。
急性睾丸扭转中改良的鞘膜壁层切开术降低了睾丸内压。此外，正常的睾丸压力可以改善睾丸保存。它还可以将睾丸压力降低到正常水平并保留睾丸实质。睾丸扭转在疼痛发作后 24 小时内，超过 80%的病例会导致睾丸切除术。仅睾丸复位（P1-P2）显示睾丸内压略有差异（中位数 4mmHg）。仅睾丸切开（P2-P3）显示出较大的压力下降（中位数，45mmHg）。TVR 后的最终压力与未扭转的睾丸压力相似（中位数，1mmHg）。睾丸保存（88.9%）和萎缩（66.3%）率略高于之前的文献报道，这可能是该新技术的初始学习曲线。
