engleski

Torsion of testis – is there any space for improvement ?

Introduction & Objectives Testicular torsion is an emergency condition necessitating surgical treatment. Even today there are many unilateral orchyectomies performed because of hessitation of younger males to undergo medical attention concerning their genitalia. Resulting condition may later in the life lead to poor fertility. At the other side of the spectrum we observed torsion of the appendices of the testis, a condition that is rather benign toward fertility, but is mainly presented as acute scrotum, a condition that necessitates prompt treatment. Material & Methods At Department of urology of the University Hospital Osijek in the period between the years 1998 and 2007 there were 417 emergency surgical procedures, out of wich medical records for 80 cases of testicular torsion and 152 cases of torsion of the testicular appendices were observed. Additional 17 patients were excluded from this study because of insufficient medical data or because intraoperative findings were negative for torsion, and the sole intraoperative finding was epididymitis. Results Out of studied medical records, in the group of patients who had testicular torsion median age was 14.58 years of life, and in the group of those who achieved torsion of the testicular appendices the median age was 9.97 years of life. There was no statistical difference found concerning the side of the body that was more prone to torsion. During this period there were 14 (17.5 %) orchyectomies performed because of irreparable changes on the testes. Only 58% of the patients with testicular torsion visited urologist within 10 hour period from the onset of the first symptoms, and the remaining 42% waited between 10 hours and sometimes even longer than 1 month. Situation is even more critical with the torsion of the appendices of the testes or epididymis, only 40% visited urologist in the first 10 hours from the onset of the symptoms. Both torsions of the appendices and testicular torsions appear in males from early childhood days, but according to our experience cases concerning torsions of the appendices dissappear after the seventeenth year of life. In the same time testicular torsions occur in the later course of life, even in the adulthood. The oldest patient with testicular torsion in this study was 51 years old. Conclusion It has been observed that testicular torsion and torsion of testicular appendices have some similarities, but also there are differencess concerning time of first contact with medical providers, and first contact with urologist. Patients with torsion of appendices tend to search medical attention latter in the course of illnes in comparison with patients who have testicular torsion. There has also been observation concerning incidence and the age of patients with torsion of the appendices which diminished in the later pubertal ages, while torsions of the testes decreased and latter maintainded almost the same incidence through the postpubertal ages, even during some period of the adulthood. There is space for aprovement in decrease of testicular orchyectomies. We should make an effort and bring to knowledge problems concerning torsion in the group of prepubertal males. The best ways to do that would be either to educate males during the educational courses concerning sexual health in elementary school, or during the periodic medical examinations in school age.

testis; torsio

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