title: [Testicular torsion in children: Factors influencing delayed treatment and orchiectomy rate].
abstract: BACKGROUND
  Acute scrotal pain is a true surgical emergency as patients presenting with acute scrotal pain may suffer from spermatic cord torsion and gonadal loss. We assessed whether the type of consultation (first consultation in our center or secondary transfer from a peripheral hospital or primary care practice), distance from home to hospital, and duration of pain had an impact on the orchiectomy rate.
  
  
  METHODS
  We retrospectively reviewed the medical records of all patients under 15years of age suffering from acute scrotal pain who had surgical exploration between January 2007 and January 2010 in our center. Patient demographics, transfer status, time to consultation in our center, time to surgery, operative findings and clinical outcome were reviewed.
  
  
  RESULTS
  Of the 76 patients with acute scrotal pain in whom surgical exploration was performed, 59 had acute spermatic cord torsion, 16 had torsion of the testicular appendage, and 1 had orchitis. In patients with acute spermatic cord torsion, the median age was 13 years (range: 0.18-14.97). In patients with acute spermatic cord torsion, 32 came straight to our center (direct admission group, 54.2%), and 27 (45.8%) came after a prior consultation out of side the center (transfer group). The median journey was 19km (range: 2.5-113) in the direct admission group and 44km (range: 2.5-393) in the transfer group (P=0.0072). The median time between pain onset and consultation at our center was 4.3h (range: 0.5-48) in the direct admission group, and 11h (range: 2-48) in the transfer group (P=0.6139). The median time between admission at our center and surgery was 2.5h, with no difference between the 2 groups (P=0.8789). The orchiectomy rate was 25% in the direct admission group and 14.8% in the transfer group (P=0.5177). In children who underwent orchiectomy, the duration of pain was consistently over 6h. The duration of pain was greater in patients with orchiectomy (12h [range: 1-72]) than in patients without orchiectomy (12h [range: 6-48]; P=0.0001).
  
  
  CONCLUSIONS
  In this study, the orchiectomy rate depended on the duration of pain but not on transfer status. Acute scrotal pain must lead to surgical exploration as soon as possible, requiring close collaboration between peripheral hospitals, primary care physicians, and referral centers.
authors: Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors: L
authors: L
authors: Even
authors: O
authors: O
authors: Abbo
authors: A
authors: A
authors: Le Mandat
authors: F
authors: F
authors: Lemasson
authors: L
authors: L
authors: Carfagna
authors: P
authors: P
authors: Soler
authors: J
authors: J
authors: Moscovici
authors: P
authors: P
authors: Galinier
authors: O
authors: O
authors: Bouali
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004638:Emergency Treatment; D006801:Humans; D007223:Infant; D008297:Male; D009919:Orchiectomy; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000601:surgery*; D013997:Time Factors