Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China.
Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Int J Urol. 2024 May;31(5):568-574. doi: 10.1111/iju.15420. Epub 2024 Feb 10.
This study aimed to establish a nomogram for predicting the probability of testicular salvage after testicular torsion in children.
We retrospectively collected data of children with testicular torsion who were treated at Shenzhen Children's Hospital between September 2005 and August 2022. Of the training cohort, 113 patients who underwent orchiectomy and five with testicular atrophy after orchiopexy were included in the failed testicular salvage group. Additionally, 37 patients who underwent orchiopexy without postoperative testicular atrophy were included in the successful testicular salvage group. The predictive factors affecting testicular salvage were determined using univariate and multivariate logistic regression analyses; a nomogram was constructed. The nomogram was verified using data from the validation group.
Using multivariate logistic regression analysis, the independent risk factors of testicular salvage after testicular torsion were symptom duration (p = 0.034), intratesticular blood flow (p = 0.003), spermatic cord torsion degree (p = 0.037), and monocyte count (odds ratio: 0.012, p = 0.036). A nomogram was established based on these four risk factors. In the training cohort, the area under the receiver operating characteristic curve was 0.969. The area under the receiver operating characteristic curve of the verification cohort was 0.965, indicating good discrimination ability of the nomogram. Increased symptom duration without intratesticular blood flow increased the monocyte count and spermatic cord torsion degree and decreased the success rate of testicular salvage.
This prediction model could obtain the corresponding probability of testicular salvage according to the clinical characteristics of different patients with testicular torsion, providing reference for clinicians and parents.
本研究旨在建立一个预测儿童睾丸扭转后睾丸保留概率的列线图。
我们回顾性收集了 2005 年 9 月至 2022 年 8 月期间在深圳儿童医院接受治疗的睾丸扭转患儿的数据。在训练队列中，113 例接受睾丸切除术且 5 例睾丸固定术后发生睾丸萎缩的患者被纳入睾丸挽救失败组，37 例接受睾丸固定术且术后无睾丸萎缩的患者被纳入睾丸挽救成功组。使用单因素和多因素逻辑回归分析确定影响睾丸挽救的预测因素；构建列线图。使用验证组的数据验证列线图。
使用多因素逻辑回归分析，睾丸扭转后睾丸挽救的独立危险因素是症状持续时间（p=0.034）、睾丸内血流（p=0.003）、精索扭转程度（p=0.037）和单核细胞计数（比值比：0.012，p=0.036）。基于这四个危险因素建立了一个列线图。在训练队列中，该列线图的受试者工作特征曲线下面积为 0.969。验证队列的受试者工作特征曲线下面积为 0.965，表明该列线图具有良好的区分能力。症状持续时间增加而无睾丸内血流增加会增加单核细胞计数和精索扭转程度，并降低睾丸挽救的成功率。
该预测模型可以根据不同睾丸扭转患者的临床特征获得相应的睾丸挽救概率，为临床医生和家长提供参考。
