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Abstract

Volume 24, Issue 6 (November 2022) 24, 575–578; 10.4103/aja2021126

Torsion of the spermatic cord in adults: a multicenter experience in adults with surgical exploration for acute scrotal pain with suspected testicular torsion

Van Thi Dang1, Benjamin Pradere2, Anne Mauger de Varennes3, Nadia Ali Benali4, Maxime Vallée4, William Berchiche5, Bastien Gondran-Tellier5, Gaelle Margue6, Clément Michiels6, Charles Gaillard7, Tristan Grevez7, Florian Bardet8, Maud Hulin9, Anthony Manuguerra10, Ugo Pinar11, Caroline Plassais11, Margeux Felber11, William Wandoren12, Kévin Kaulanjan12, Ines Dominique13, Marc Sbizerra13, Emilien Seizilles de Mazancourt13, Xavier Matillon13, Igor Duquesne14, Maxime Chabenes15, Victor Gaillard16, Lucas Freton3, Francois Lannes5, Zine-Eddine Khene3

1 Department of Urology, Toulouse University Hospital, Toulouse 31000, France
2 Department of Urology, Medical University of Vienna, Vienna 1090, Austria
3 Department of Urology, Rennes University Hospital, Rennes 35000, France
4 Department of Urology, Poitiers University Hospital, Poitiers 86000, France
5 Department of Urology, Marseille North Hospital, Marseille 13000, France
6 Department of Urology, Bordeaux University Hospital, Bordeaux 33000, France
7 Department of Urology, Tours University Hospital, Tours 37000, France
8 Department of Urology, Dijon University Hospital, Dijon 21000, France
9 Department of Urology, Reims University Hospital, Reims 51000, France
10 Department of Urology, Nancy University Hospital, Nancy 54000, France
11 Department of Urology, Hôpitaux Universitaires Pitie-Salpetriere, AP-HP, Paris 75013, France
12 Department of Urology, Pointe à Pitre University Hospital, Guadeloupe 97000, France
13 Department of Urology, Lyon University Hospital, Lyon 69000, France
14 Department of Urology, Cochin Hospital, AP-HP, Paris 75000, France
15 Department of Urology, Grenoble University Hospital, Grenoble 38000, France
16 Department of Urology, Strasbourg University Hospital, Strasbourg 67000, France

Correspondence: Dr. VT Dang (vanthi24.dang@gmail.com)

Date of Submission 12-Sep-2021 Date of Acceptance 10-Jan-2022 Date of Web Publication 22-Mar-2022

Abstract

Acute scrotal pain (ASP) requiring surgical exploration is common in the pediatric population, but little has been reported on this subject with regard to the adult population. The aim of this study was to investigate the demographic and clinical characteristics and outcomes of scrotal explorations performed on adult patients. Patients over 21 years of age who underwent surgical exploration for ASP with suspected testicular torsion (TT) at 14 French hospitals between January 2005 and December 2019 were included in this study. The main outcome measures were demographic characteristics, pathology found during scrotal exploration, and perioperative outcomes. Logistic regression was used to perform univariate and multivariate analyses to identify predictors of TT. Data for 1329 men were analyzed. The median age was 30 (interquartile range [IQR]: 25–35; range: 21–89) years. Regarding the clinical examination, 867 (65.2%) patients presented with an elevation of the testicle, 613 (46.1%) patients with scrotal edema or erythema, and 211 (15.9%) patients with nausea or vomiting. Operative findings identified TT in only 684 (51.5%) patients, epididymo-orchitis in 112 (8.4%) patients, a tumor in 16 (1.2%) patients, and no causes in 475 (35.7%) patients. Orchiectomy for nonviable testes was required in 101 (7.6%) patients. In multivariate analysis, an elevation of the testicle, erythema/swelling, and the presence of nausea/vomiting were found to be associated with the occurrence of TT. Testicular torsion is not exclusive to children and adolescents, so must be considered in males of any age with acute scrotal findings. However, one-third of scrotal explorations in adults did not lead to a diagnosis.

Keywords: adults; diagnosis; exploration; scrotal emergencies; spermatic cord torsion; ultrasonography

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