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Improving testicular examinations on paediatric patients in the emergency department:A quality improvement study to improve early diagnosis of testicular torsion

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Asian Journal of Urology 2022年第2期9卷 152-156页

作者： Ernest M.Cheng Juanita N.Chui Murray Crowe Andrew Cooke Department of Emergency Medicine St George HospitalKogarahNSWAustralia Sydney Medical School University of SydneyCamperdownNSWAustralia St George Clinical School University of New South WalesKogarahNSWAustralia

Objective:Male paediatric patients presenting with abdominal and/or testicular pain are common in the emergency department.As a time-sensitive diagnosis,the importance of early recognition,referral,and definitive management is critical.Missed or delayed diagnoses and management of testicular torsion can result in significant long-term sequelae including impaired fertility and psychological burden.In this quality improvement study,we utilised educational posters aiming to improve awareness of testicular torsion as a differential for abdominal pain and therefore,improve the quality of testicular examinations performed in the emergency department.Methods:Observational pre-and post-intervention study was conducted at a tertiary hospital emergency department.A pre-interventional retrospective review of the electronic medical records was conducted.All male patients under 16-years-old presenting with“abdominal pain”or“testicular problem”were included.We assessed the rate of testicular examination and the quality of the examination based on four domains:Cremasteric reflex,lie,swelling,and hardness.Educational posters targeting both patients and clinicians were placed around the emergency department.Subsequent review of the electronic medical records post-intervention was performed assessing the same domains.Results:A total of 235 presentations were analysed with 124 in the pre-intervention group and 111 in the post-intervention group.Overall rate of documented testicular examinations increased by 14%(p=0.032).The quality of testicular examinations also improved from an average of 0.85 domains documented to 2.29 post-intervention(ptesticular examination.Conclusion:Our study demonstrated the value of continuing education in promoting awareness of testicular torsion in the emergency department.We found a clear improvement in the quality of clinical documentation of a time-sensitive condition which may infer a

关键词： testicular torsion testicular examination Emergency department Quality improvement Urological emergency

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Long-term follow-up results of testicular torsion in children

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Asian Journal of Andrology 2022年第6期24卷 653-659页

作者： Cheng-Jun Yu Jie Zhao Jin Luo Yi-Fan Hong Tian-Xin Zhao Sheng Wen Li Jiang Tao Lin Da-Wei He Guang-Hui Wei Sheng-De Wu Department of Urology Children's Hospital of Chongqing Medical UniversityChongqing 400014China Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering Chongqing 400014China National Clinical Research Center for Child Health and Disorders Chongqing 400014China China International Science and Technology Cooperation Base of Child Development and Critical Disorders Chongqing 400014China Chongqing Key Laboratory of Pediatrics Chongqing Chongqing 400014China Ministry of Education Key Laboratory of Child Development and Disorders Chongqing 400014China Department of Pediatric Urology Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhou 510620China Department of Urology The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400042China

December 2020 to investigate the long-term follow-up results after testicular torsion(TT)in children.Boys with TT were divided into the salvage orchiopexy group and the orchiectomy group,and the baseline characteristics,ultrasonographic indications,intraoperative findings,testicular volumes,and adverse events during follow-up were compared.A total of 145 cases were included in this study.Approximately 56.6%of patients who underwent salvage orchiopexy had testicular atrophy(TA),and the median testicular volume loss of the testes was 57.4%.Age less than 6 years,delayed surgery,and intraoperative poor blood supply were associated with TA in pediatric TT after orchiopexy.Most atrophied testes appeared within 3-6 months after surgery.Compared with the corresponding age-matched healthy controls,the contralateral testicular volumes were larger in the orchiopexy(P=0.o01 without TA,and P=0.042 with TA)and orchiectomy groups(P=0.033).The adverse events were comparable in patients with orchiectomy or orchiopexy.In summary,follow-up before 3 months after surgery may not offer sufficient clinical value,while that 3 months after surgery should be regarded as the first follow-up time for testicular monitoring.The contralateral testes of patients with TT showed compensatory hypertrophy.We suggest performing orchiectomy when torsed testes are surgically assessed as Arda gradeⅢor inviable.

关键词： long-term orchiectomy pediatrics salvage orchiopexy testicular torsion

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Single intratesticular injection of blood-serum-derived exosomes can potentially alleviate testopathy following testicular torsion

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Animal Models and Experimental Medicine 2022年第4期5卷 362-368页

作者： Mona Keivan Fatemeh Mansouri Torghabeh Samira Davoodi Shima Moradi Maryamneghari Reza Dadfar Member of Research Committee Medical SchoolKermanshah University of Medical SciencesKermanshahIran Department of Physiology Sciences Medical SchoolMashhad University of Medical SciencesMashhadIran Department of Anatomical Sciences Medical SchoolKermanshah University of Medical SciencesKermanshahIran Department of Anatomical Sciences Faculty of MedicineAJA University of Medical SciencesTehranIran

Background:testicular torsion(TT)is an acute inflammatory process leading to male infertility.Today,anti-i nflammatory effects of exosomes derived from blood serum are used in various laboratory procedures.In the present study,the anti-i nflammatory effects of blood-serum-derived exosomes in treatment of acute inflammation following TT in mice were evaluated.Materials and Methods:Eighteen male mice were grouped as healthy control,TT,and TT+exosome.TT was induced surgically,and exosomes were extracted from blood serum and administrated by a single intratesticular injection(10 IU).Malondialdehyde(MDA)and Griess assays were used to evaluate the level of oxidative stress.Sperm indices,testosterone(Tes),and apoptotic gene expression(p-53,Bcl2,and Caspase-3)were also assessed.H&E and immunohistochemistry(IHC)stainings were used for histopathological investigations.Data analysis was applied by SPSS(v.19)software.Results:Oxidative stress and apoptotic genes expression were increased significantly(ptesticular application of blood-serum-derived exosomes can be used clinically in acute phase of orchitis following TT to inhibit testicular inflammation.

关键词： anti-i nflammation exosome parameter sperm testicular torsion

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Ultrasound heterogeneity as an indicator of testicular salvage in testicular torsion: A single center experience

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Asian Journal of Urology 2022年第1期9卷 57-62页

作者： Omran Hasan Mohamed Mubarak S.Mohamed Jawad Alwedaie Hasan Baksh Husain Alaradi Ameer Alarayedh Ali Alaradi Abdolsalam Ahmadi Akbar Jalal Department of Surgery Salmaniya Medical Complex Ringgold Standard InstitutionManamaBahrain

Objective:testicular torsion is a common urological emergency,mainly in the younger population.Our aim is to evaluate the efficacy and value of testicular echogenicity in predicting testicular viability.Methods:Patients who were older than 13 years of age and were discharged with the diagnosis of testicular torsion were reviewed.Data obtained included demographic data,history,physical examination results,ultrasound findings including size,color Doppler flow,and echotexture,torsion degrees,and surgical procedure.In addition,the histopathological findings of patients who underwent orchiectomy were reviewed.Results:A total of 71 cases were diagnosed with testicular torsion between January 2016 to December 2018.The mean age at presentation was 20.4±7.0 years.The average time from the onset of pain until the presentation was 36.0±55.1 h.Out of the 71 ultrasound scans reviewed,45.1%showed homogenous echotexture and 54.9%showed heterogeneous echotexture of the affected testis.On scrotal exploration,the mean degree of torsion was 475.7±301.8 degrees;66.2%of the patients had a viable testis;and bilateral orchidopexy was done.The remaining 33.8%had a non-viable testis.Homogenous echotexture was after an average of 13.5 h of scrotal pain,while heterogeneous echotexture presented after 53.7 h of scrotal pain.There was a statistically significant difference between the time of presentation and echotexture changes on scrotal ultrasonography(ptesticular viability was statistically significant as well(ptesticular parenchyma is a good indicator of non-viability.However,we still advocate for surgical exploration as the gold standard in diagnosis and management.

关键词： Testis testicular torsion Orchiopexy Orchiectomy Ultrasound Echotexture

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Cryptorchid testicular torsion in children characteristics and treatment outcomes

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Asian Journal of Andrology 2021年第5期23卷 468-471页

作者： Hai-Jun Zhong Liang-Feng Tang Yun-Li Bi Department of Pediatric Urology Children's Hospital of Fudan UniversityShanghai 201102China.

This study aimed to review and compare the characteristics and treatment outcomes of cryptorchid testicular torsion in pre-and postpubertal children.We reviewed the clinical data of 22 patients with testicular torsion complicated by cryptorchidism who were treated between January 2010 and December 2019.Patients were categorized into prepubertal(1 month to 9 years;n=12)and postpubertal groups(10-16 years;n=10).The age at presentation,clinical presentations,physical examination,and operation outcomes were assessed.The common clinical presentations in both groups were inguinal pain and a tender inguinal mass.Patients in the prepubertal group were significantly more likely to present with restlessness(33.3%)than those in the postpubertal group(0%;P-0.044).After detorsion,testicular blood flow recovered during surgery in 25.0%of the prepubertal and 80.0%of the postpubertal patients(P=0.010).Orchiectomy was required in 50.0%of the prepubertal and 20.0%of the postpubertal patients(P=0.145).Of the 22 patients with follow-up data,the rates of testicular salvage were significantly different,at 16.7%in the prepubertal patients and 60.0%in the postpubertal patients(P=0.035).Cryptorchid testicular torsion has various manifestations.Although an empty hemiscrotum and a painful groin mass were common in both groups,restlessness was more prevalent in the prepubertal patients during early testicular torsion onset than that in the postpubertal patients.Notably,the testicular salvage rate was significantly lower in the prepubertal patients than that in the postpubertal patients.

关键词： children cryptorchidism testicular torsion

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Establishment and internal validation of preoperative nomograms for predicting the possibility of testicular salvage in patients with testicular torsion

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Asian Journal of Andrology 2021年第1期23卷 97-102页

作者： Wan-Xiang Zheng Guang-Dong Hou Wei Zhang Di Wei Xue-Lin Gao Mei-Hong Chen Lu-Guang Huang Fei Yan Geng Zhang Lei Yu Fei Liu Bo Zhang Jian-Lin Yuan Department of Urology Xijing HospitalThe Fourth Military Medical UniversityXi'an 71CXD32China Department of Urology Tangdu HospitalThe Fourth Military Medical UniversityXi'an 710038China lnformation Center Xijing HospitalThe Fourth Military Medical UniversityXi'an 71CXD32China

This study aimed to establish nomograms to preoperatively predict the possibility of testicular salvage(TS)in patients with testicular torsion.The clinical data of 204 patients with testicular torsion diagnosed at Xijing Hospital and Tangdu Hospital(Xi'an,China)between August 2008 and November 2019 were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to determine the independent predictors of TS.Based on multivariate regression coefficients,nomograms to predict possibility of TS were established.The predictive ability of the nomograms was internally validated by receiver operating characteristic(ROC)curves and calibration plots.The duration of symptoms ranged from 2 h to 1 month,with a median of 3.5 days.Thirty(14.7%)patients underwent surgical reduction and contralateral orchiopexy,while the remaining 174(85.3%)underwent orchiectomy and contralateral orchiopexy.Finally,long symptom duration was an independent risk predictor for TS,while visible intratesticular blood flow and homogeneous testicular echotexture under color Doppler ultrasound were independent protective predictors.Internal validation showed that the nomograms,which were established by integrating these three predictive factors,had good discrimination ability in predicting the possibility of TS(areas under the ROC curves were 0.851 and 0.828,respectively).The calibration plots showed good agreement between the nomogram-predicted possibility of TS and the actual situation.In conclusion,this brief preoperative prediction tool will help clinicians to quickly determine the urgency of surgical exploration.

关键词： nomogram testicular salvage testicular torsion

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Clinical evaluation of testicular torsion presenting with acute abdominal pain in young males

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Asian Journal of Urology 2019年第4期6卷 368-372页

作者： Fujun Wang Zengnan Mo Center for Genomic and Personalized Medicine Guangxi Medical UniversityNanningGuangxiChina Department of Urology Heze Municipal HospitalHezeShandongChina

Objective:To evaluate the features of testicular torsion presenting with acute abdominal pain and to raise awareness of testicular torsion with specific symptoms.Methods:From October 2005 to June 2016,nine patients with testicular torsion who presented with isolated acute abdominal pain rather than scrotal pain as their primary symptom were retrospectively reviewed.Data,including the age of patients,season at admission,initial medical history,external genital examination,emergency ultrasound findings,operative findings,duration of abdominal pain,complications,and follow-up results,were collected.Results:The average age of patients was 14 years(range 10-17 years).Seven patients whose genitals were not initially examined externally were misdiagnosed as having ordinary abdominal diseases.Surgical exploration revealed that all the involved testes necrotized,and orchidectomy was performed.In the other two patients,scrotal and testicular abnormalities were detected immediately on admission,and emergency surgical exploration determined that the involved testis remained vital,so orchiopexy was performed.The mean duration from symptom onset to diagnosis was 4 h(3-5 h)in the orchiopexy group and 37 h(18-72 h)in the orchidectomy group.Six patients were psychologically affected during postoperative follow-up.Neither recurrence of testicular torsion nor testicular atrophy was recorded.Conclusion:Acute abdominal pain can be the initial and sole symptom of testicular torsion in young males.Physicians should pay close attention to the specific clinical presentation of testicular torsion.

关键词： Acute abdominal pain testicular torsion Young males Initial symptom Retrospective analysis

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Clinical characteristics of testicular torsion and factors influencing testicular salvage in children:A 12-year study in tertiary center

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World Journal of Clinical Cases 2024年第7期12卷 1251-1259页

作者： Xiang-Hui Gang Yuan-Yuan Duan Bin Zhang Zheng-Gan Jiang Rong Zhang Jun Chen Xiang-Yu Teng Duo-Bing Zhang Department of Urology Suzhou Hospital Affiliated to Anhui Medical UniversitySuzhou 234000Anhui ProvinceChina Department of Ultrasound Diagnosis Suzhou Hospital Affiliated to Anhui Medical UniversitySuzhou 234000Anhui ProvinceChina Department of Urology The Second Affiliated Hospital of Anhui Medical UniversityHefei 230000Anhui ProvinceChina

BACKGROUND testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents.Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion.AIM To predict the possibility of testicular salvage(TS)in patients with testicular torsion in a tertiary center.METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University.Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion.The data included clinical findings,physical examinations,laboratory data,color Doppler ultrasound findings,operating results,age,presenting institution status,and follow-up results.RESULTS Our study included 75 patients.TS was possible in 57.3%of all patients;testicular torsion occurred mostly in winter,and teenagers aged 11-15 years old accounted for 60%.Univariate logistic regression analyses revealed that younger age(P=0.09),body mass index(P=0.004),torsion angle(P=0.013),red blood cell count(P=0.03),neutrophil-to-lymphocyte ratio(P=0.009),and initial presenting institution(Ptesticular torsion.Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.

关键词： testicular torsion testicular salvage Pediatrics Predictors Case report

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Emergency Treatment of testicular torsion and Postoperative Follow-up: A 71 Case Report

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2012年第5期32卷 704-706页

作者：潘峰朱朝晖李兵庞自力肖亚军曾甫清 Department of Urology Union HospitalTongji Medical CollegeHuazhong University of Science and Technology

This study presented our experience in the treatment of testicular torsion,which may help achieve early diagnosis and improve therapeutic effects.A retrospective analysis was conducted in 71 patients with testicular torsion who were treated in our hospital from October 2007 to April 2011.The age of the patients ranged from 16 days to 34 years.All the patients had unilateral testicular torsion,which took place on the left side in 43 cases and on the right side in 28 cases.The course of the disease varied between three hours to 30 days.Post-operative follow-up was conducted until October 2011.Items examined included signs and symptoms at their first clinical visit,ultrasound findings,treatment in emergency surgery,and post-operative follow-up.In this study,the 71 patients were diagnosed with testicular torsion by color Doppler sonography,7 had testicular fixation,63 patients received orchiectomy,while 1 patient did not undergo surgery due to pressure from family members.Post-operative follow-up showed that the one patient’s testicle,which had been reserved,atrophied,while all the other survived.No recurrence was found during the follow-up visits.It is concluded that an early diagnosis and surgery is important in improving the survival rate of testicular torsion,and the diagnosis and treatment by the first attending clinician is of critical importance.

关键词： testicular torsion emergency treatment post-operative follow-up

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Analysis of predictive factors of testicular salvage after testicular torsion in children

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Chinese Journal of Pediatric Surgery 2024年第5期45卷 468-471页

作者： Chen P. Yang Z. Li S. Department of Urology Shenzhen Children’s Hospital Shenzhen 518000 China

testicular torsion is characterized by rotations of testis and epididymis around spermatic vessels，resulting in an acute interruption of blood supply to testis. torsion may lead to testicular necrosis if not promptly corrected. testicular viability must be carefully evaluated intraoperatively to determine orchiectomy or orchiopexy. This review focused upon the related studies on the predictive factors of testicular salvage after testicular torsion to provide references for clinicians. © 2024 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.

关键词： Child Orchiectomy Predictive factors testicular torsion

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