Door to detorsion
Testicular torsion, although somewhat rare, can have significant morbidity with nearly 4/10 cases resulting in orchiectomy. Additional complications can include problems with fertility, endocrine abnormalities, and psychological trauma.
Time to detorsion is critical for testicular salvage. This study aimed to validate the "door to detorsion" time in a cohort of pediatric males that was previously studied in adults, aka the association between symptom duration and testicular viability. 286 patients with known testicular torsion were enrolled retrospectively, median age 14 years, with about 1/3 presenting within 6 hours of symptoms onset, followed by 1/4 presenting after 48 hours. Median door to detorsion was 146 minutes (range 25-668). Median DTD was 133 min for a viable teste, and 166 min for a non-viable teste. 195 patients underwent orchiopexy, and 91 underwent orchietcomy.
Importantly, for each additional hour of symptom duration, there was about a 35% increase in the odds of orchiectomy. For each additional 10 minutes of door to detorsion, they report a 6% increase in odds of orchiectomy, with this value increasing significantly at 30 minutes and 60 minutes. Decreasing the door to detorsion was also shown to increase the odds of testicular survival, independent of symptom duration.
Bottom Line: as the title of the article suggests, every minute counts toward improved testicular salvage in torsion. Prompt diagnosis and management is essential. Consider POCUS of the teste and manual detorsion if imaging and/or definitive management could be delayed. (see links below for how to do these!)
POCUS: https://www.youtube.com/watch?v=Ap4EULz4Iog
Detorsion (WARNING: testicles involved): https://www.youtube.com/watch?v=rDq8dIHM_Mo&rco=1
A different detorsion method (no real testicles): https://www.youtube.com/watch?v=gLsIgKDKvJw
Time to detorsion is critical for testicular salvage. This study aimed to validate the "door to detorsion" time in a cohort of pediatric males that was previously studied in adults, aka the association between symptom duration and testicular viability. 286 patients with known testicular torsion were enrolled retrospectively, median age 14 years, with about 1/3 presenting within 6 hours of symptoms onset, followed by 1/4 presenting after 48 hours. Median door to detorsion was 146 minutes (range 25-668). Median DTD was 133 min for a viable teste, and 166 min for a non-viable teste. 195 patients underwent orchiopexy, and 91 underwent orchietcomy.
Importantly, for each additional hour of symptom duration, there was about a 35% increase in the odds of orchiectomy. For each additional 10 minutes of door to detorsion, they report a 6% increase in odds of orchiectomy, with this value increasing significantly at 30 minutes and 60 minutes. Decreasing the door to detorsion was also shown to increase the odds of testicular survival, independent of symptom duration.
Bottom Line: as the title of the article suggests, every minute counts toward improved testicular salvage in torsion. Prompt diagnosis and management is essential. Consider POCUS of the teste and manual detorsion if imaging and/or definitive management could be delayed. (see links below for how to do these!)
POCUS: https://www.youtube.com/watch?v=Ap4EULz4Iog
Detorsion (WARNING: testicles involved): https://www.youtube.com/watch?v=rDq8dIHM_Mo&rco=1
A different detorsion method (no real testicles): https://www.youtube.com/watch?v=gLsIgKDKvJw
