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Low-Grade Injury following Testicular Torsion: A Multicenter Study Confirming a Disturbing Possibility
Emine Burcu Cigsar Kuzu1, Sibel Tiryaki2, Neslihan Guney3
1Department Pediatric Surgery, Tepecik Training and Research Hospital, İzmir, Turkey.
Urologia Internationalis
|November 1, 2023
Summary
Testicular viability after torsion is hard to determine. Histopathology shows reversible injury is possible even with late presentation, supporting testicular fixation over orchiectomy.
Area of Science:
- Urology
- Pathology
- Surgical Decision Making
Background:
- Debate exists on orchiectomy vs. orchidopexy for non-viable testes post-torsion.
- Lack of objective criteria for testicular viability is a significant clinical challenge.
Purpose of the Study:
- To investigate histopathological injury grading in orchiectomy specimens from testicular torsion (TT).
- To correlate injury grade with clinical and perioperative findings to improve viability assessment.
Main Methods:
- Multicenter retrospective study involving 228 patients with testicular torsion.
- Double-blinded reassessment of patient files and pathological specimens using the Mikuz classification.
Main Results:
- Only 8.8% of patients had Grade 1 (reversible) injury.
- Duration of symptoms varied widely in both reversible and non-reversible injury groups.
- No significant differences found in age, symptoms, Doppler US findings, or torsion degree between injury grades.
Conclusions:
- Better criteria are needed to define testicular viability post-torsion.
- Histopathological findings suggest reversible injury is possible even with delayed presentation or severe torsion.
- Findings support testicular fixation over orchiectomy due to lack of correlation between clinical factors and high-grade injury.
