Management of the Torsion of Spermatic Cord in the Urology-Andrology Department of the Ignace Deen National Hospital in Conakry

Introduction: Torsion of the spermatic cord is an emergency whose delay in treatment conditions the functional prognosis of the testicle. The aim of this study was to analyze the management of spermatic cord torsion in the Urology Andrology Department of the Ignace Deen National Hospital in Conakry. Material and methods: This was a ten-year retrospective descriptive study from January 1, 2012 to December 31, 2021. It involved all patients admitted for torsion of the spermatic cord, confirmed at surgical exploration. Results: We identified 21 cases of torsion of the spermatic cord. The mean age of the patients was 17.9 ± 4.4 years. The average consultation time was 19.2 ± 21.4 hours with extremes of [2 h and 98 h]. Only 6 patients (28.6%) consulted before the sixth hour. All patients presented with scrotal swelling. At scrototomy, all torsions were intravaginal with two turns of spiral in 13 cases and three turns in 8 cases. Orchiectomy followed by contralateral orchidopexy was performed in 6 cases. In the other cases, bilateral orchidopexy was performed after detorsion. The average hospital stay was 4.5 days. We recorded 4 cases of testicular atrophy after orchidopexy. Conclusion: Spermatic cord torsion is an infrequent emergency in our department. The delay in consultation remains the main predictive factor of testicular necrosis. Emergency exploratory scrotomy should be the rule.

Torsion of the spermatic cord in adults:a multicenter experience in adults with surgical exploration for acute scrotal pain with suspected testicular torsion

Acute scrotal pain(AsP)requiring surgical exploration is common in the pediatric population,but little has been reported on this subject with regard to the adult population.The aim of this study was to investigate the demographic and clinical characteristics and outcomes of scrotal explorations performed on adult patients.Patients over 21 years of age who underwent surgical exploration for ASP with suspected testicular torsion(TT)at 14 French hospitals between January 2005 and December 2019 were included in this study.The main outcome measures were demographic characteristics,pathology found during scrotal exploration,and perioperative outcomes.Logistic regression was used to perform univariate and multivariate analyses to identify predictors of TT.Data for 1329 men were analyzed.The median age was 30(interquartile range[IQR]:25-35;range:21-89)years.Regarding the clinical examination,867(65.2%)patients presented with an elevation of the testicle,613(46.1%)patients with scrotal edema or erythema,and 211(15.9%)patients with nausea or vomiting.Operative findings identified TT in only 684(51.5%)patients,epididymo-orchitis in 112(8.4%)patients,a tumor in 16(1.2%)patients,and no causes in 475(35.7%)patients.Orchiectomy for nonviable testes was required in 101(7.6%)patients.In multivariate analysis,an elevation of the testicle,erythema/swelling,and the presence of nausea/vomiting were found to be associated with the occurrence of TT.Testicular torsion is not exclusive to children and adolescents,so must be considered in males of any age with acute scrotal findings.However,one-third of scrotal explorations in adults did not lead to a diagnosis.

Morphological and microcirculatory evaluation of the rat testis after detorsion with or without a capsular release with a tunica vaginalis flap

Testicular torsion may lead to serious ischemia, and the viability depends on the duration of torsion and the effect of ischemia-reperfusion. Testicular decompression and tunica vaginalis flap application technique were introduced in 2008 by Kutikov et al. We aimed to examine the impact of this method on the testicular microcirculation and hemorheological parameters in a rat model. Six adult rats underwent bilateral scrotal exploration. Intravaginal torsion of the testis was created by 720° rotation on both sides for 2 h. After detorsion, the right testes underwent tunica albuginea incision and tunica vaginalis flap application. Testicular microcirculation was monitored and hematological parameters, erythrocyte deformability, and aggregation were determined. Measurements were performed before and after torsion, directly after detorsion, on the 1^st-2^nd and 8^th postoperative day. After the last sampling, testicles were removed to determine their volume for histological examinations. The microcirculatory parameters demonstrated slight differences between testicles. Apical zone of the left （nondecompressed） testicles had elevated compared to the middle zone （P 〈 0.05）. On the 2^nd and 8^th day, the microcirculation of the testes normalized but not equally. The erythrocyte aggregation and deformability decreased by the 8^th day. Both testicles underwent atrophy and epithelial necrosis, but the volume of the decompressed ones was lower （1.07±0.08 vs 1.25 ± 0.31）. Histologically, there was no significant difference in epithelial damage score between decompressed and nondecompressed testes. In conclusion, 2-h ischemia led to alteration in testicular microcirculation, reduction in volume, changes in hemorheological parameters and serious epithelial necrosis both in decompressed and nondecompressed testicles without remarkable differences.