Gopal M, Ibrahim U, Salphale I, Mostafizur M, Walker S, Clement M, Macafee D, Patel A, Balu R, Eswaravaka Sudha Radha K S
The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
County Durham and Darlington NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2025 Sep;107(7):473-478. doi: 10.1308/rcsann.2024.0078. Epub 2025 Apr 3.
Testicular torsion is a time-critical emergency, though its incidence in the paediatric age group is relatively rare. Changes in training pathways have led to a decreasing number of adult general surgical and urological trainees being comfortable in performing an emergency scrotal exploration in children, resulting in children being transferred to regional units with the requisite expertise. This delay has been shown to increase the risk of orchidectomy. There is, therefore, an increased emphasis on the diagnostic evaluation of these children by emergency department staff.
We explore how lack of experience and availability of appropriate investigations led to transfer of children presenting to a district general hospital in the North East of England.
Children with true testicular torsion in this cohort had an unacceptably high rate of needing an orchidectomy (∼67%) compared with the reported incidence of orchidectomy with testicular torsion (∼20%).
We offer potential solutions to the hurdles that have to be overcome to improve this service. This will align the service to the recently published Get It Right First Time report on the management of testicular torsion in children and young adults and is within the remit of Operational Delivery Networks.
睾丸扭转是一种时间紧迫的急症，尽管其在儿童年龄组中的发病率相对较低。培训途径的变化导致越来越少的成年普通外科和泌尿外科实习生能够熟练进行儿童急诊阴囊探查术，结果儿童被转至具备必要专业知识的区域单位。这种延误已被证明会增加睾丸切除的风险。因此，急诊科工作人员对这些儿童的诊断评估愈发重视。
我们探讨了经验不足以及缺乏合适的检查手段是如何导致向英格兰东北部一家地区综合医院就诊的儿童被转诊的。
与报道的睾丸扭转患者睾丸切除发生率（约20%）相比，该队列中真正发生睾丸扭转的儿童需要进行睾丸切除的比例高得令人无法接受（约67%）。
我们针对改善这项服务必须克服的障碍提供了潜在的解决方案。这将使该服务与最近发布的关于儿童和青年睾丸扭转管理的《一次做对》报告保持一致，并且属于运营交付网络的职责范围。
