Abstract

Background: Torsion of the testes is one of the major urological emergencies, with an incidence of1/4,000 in males younger than 25 years. In this paper, we report our experience in the management of testicular torsion (TT) in Salmaniya Medical Complex (SMC).

Methods: Using SMC’s operative logbook, we undertook a retrospective review on all patients who underwent immediate scrotal exploration for a presumptive diagnosis of TT from January 2004 through December 2017. Using SPSS, we present descriptive statistics and report all significant relationships.

Results: A total of 259 scrotal explorations were undertaken for suspected TT. The mean age of patients presenting with suspected TT in our cohort was 20 years, ranging from (11-58 years). Around 42%(n=109) of these had non-viable testes on exploration and a unilateral orchidectomy was performed, 28.5% (n=74) had TT for which detorsion was done while 27.8% (n=72) had a negative exploration. Amongst the patients with TT, 60% (n=183) had an orchidectomy whereas only 40% of testes were salvageable by detorsion and orchidopexy. Although we had an equal number of patients presenting with right and left TT, patients with left sided TT had a significantly higher orchidectomy rate than patients with right sided TT, 61 % (n=66) compared with 39% (n=43) respectively, p<0.029. Conversely the chance of salvaging the right testes was better than the left testes with an OR of 1.969 (95% CI, 1.069-3.626). Patients with salvageable testes, unsalvageable testes and negative explorations had varying contralateral orchidopexy rates of 90%, 71% and 62% respectively.

Conclusions: These findings indicate that our testicular salvage rate is low. As time to presentation is the most important factor in predicting outcome, more effort should be invested into increasing public awareness about TT in Bahrain.

Keywords: Testicular torsion; Orchidopexy; Orchidectomy; Testicular salvage rate; scrotal exploration.