Paediatric testicular torsion in low- and middle-income countries: an OxPLORE scoping study

Area of Science:

• Pediatric Surgery
• Global Health
• Urology

Background:

• Limited research exists on pediatric surgical conditions in low- and middle-income countries (LMICs).
• Timely treatment of testicular torsion is a key indicator of pediatric emergency surgical care quality.
• This study synthesizes existing literature on pediatric testicular torsion in LMICs.

Purpose of the Study:

• To conduct a scoping review of all available literature on pediatric testicular torsion in LMICs.
• To identify gaps in knowledge and areas for future research.
• To assess the quality of existing evidence on pediatric testicular torsion management in LMICs.

Main Methods:

• A comprehensive database search was performed by the OxPLORE global pediatric surgery research group.
• Studies were identified using keywords 'testicular torsion' or 'acute scrotum' from LMICs.
• Thematic analysis was applied, and the quality of evidence for included articles was appraised.

Main Results:

• Seventeen studies involving 1798 patients were included, all from middle-income countries.
• The majority of studies (76%) had fewer than 100 patients and were appraised as providing less than adequate evidence.
• Significant delays in treatment, debates on diagnostic tools (scoring systems, Doppler ultrasonography), and heterogeneous surgical approaches were identified.

Conclusions:

• The literature on pediatric testicular torsion in LMICs is sparse and lacks consistency.
• There is an urgent need for prospective, multi-center research to improve the management of this common pediatric surgical emergency.
• Standardized diagnostic and treatment protocols are needed to address the heterogeneity observed.