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Recurrent torsion after previous testicular fixation.
Henry Sells1, Kim L Moretti, Geoffrey D Burfield
1Department of Urology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
ANZ Journal of Surgery
|March 22, 2002
Summary
Recurrent testicular torsion is possible after initial fixation. Eversion of the tunica vaginalis during surgery is crucial for adhesion formation and preventing re-torsion, more so than suture type.
Area of Science:
- Urology
- Pediatric Surgery
Background:
- Acute testicular pain can occur in patients with a history of testicular fixation for torsion.
- Recurrent testicular torsion after initial surgical fixation is a clinical concern.
Purpose of the Study:
- To review literature on recurrent testicular torsion post-fixation.
- To determine the possibility of recurrent torsion and the relevance of fixation techniques.
Main Methods:
- Literature search conducted on MEDLINE, Pre-MEDLINE, EMBASE, and CIANHL databases.
- Keywords included 'spermatic cord torsion', 'testicular torsion', 'treatment failure', 're-operation', and 'recurrence'.
Main Results:
- Twenty cases of recurrent testicular torsion post-fixation were identified.
- Fifteen of 17 cases specified absorbable sutures for initial fixation.
- Animal models indicate tunica vaginalis eversion is key for dense adhesions; non-absorbable sutures caused abscesses in 30%.
Conclusions:
- Recurrent torsion may be more frequent with absorbable sutures due to their wider use.
- Non-absorbable sutures have limitations due to high abscess rates.
- Eversion of the tunica vaginalis is the most critical factor for adhesion formation during testicular fixation.