Nigerian Journal of Medicine (Jan 2020)
Does the source of referral affect the outcomes of testicular torsion?
Abstract
Introduction: This single-center study retrospectively analyzed the intra-operative findings relative to the source of referral of patients with testicular torsion by the urologist in a tertiary teaching hospital. Methods: All patients who underwent emergency scrotal exploration under the care of the urologist in the Urology Division, Department of Surgery, and University of Abuja Teaching Hospital between January 2014 and January 2019 were identified. Clinical data were obtained from hospital records. Results: Over the five years of study, 33 patients had scrotal exploration for testicular torsion. The mean age was 25-years, and the mean duration of the presentation was 50.38 h (1–240 h). None of the patients who presented after 24 h had a viable testis, and there was a strong negative correlation between duration of presentation and intra-operative findings (r = −0.889, P < 0.001). The orchidectomy rate in this study was 54.5%. The orchidectomy rate of 83.3% was highest among the patients referred from primary health care centers, while it was 62.5% in patients referred from general hospitals. Those that presented directly to the emergency department in the tertiary hospital had an orchidectomy rate of 38.5%, and internal transfers within the teaching hospitals had an orchidectomy rate of 40%. Conclusion: Testicular loss following orchidectomy for testicular torsion is high in our environment. The orchidectomy rate was highest among patients referred from primary health-care centers and general hospitals. However, patients who presented directly to the emergency department and those transferred within the tertiary hospital to the urologist had better testicular salvage rate. Therefore, efforts towards enlightening health-care professionals and young males should serve to reduce the associated testicular loss associated with delays in presentation, diagnosis, and treatment.
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