title: Outcomes of Second Look Exploration in Testicular Torsion of Children.
abstract: BACKGROUND
  Testicular torsion (TT), or twisting of the testicle resulting in a strangulation of the blood supply, occurs in men whose tissue surrounding the testicle is not well attached to the scrotum. It is important to emphasize that testicular torsion is a medical emergency.
  
  
  OBJECTIVE
  The aim of this study is to evaluate the second look exploration and outcomes in TT.
  
  
  METHODS
  Seventy boys out of 124 patients underwent early exploration and 48 hours later second look exploration due to TT. All patients were checked with preoperative color-doppler ultrasonography (CDU) and intraoperative bleeding test. Data included age at admission, side of pathology, relation of TT with season of year, duration of preoperative history, degree of testicular torsion, CDU findings, and degree of bleeding; results of second look exploration, follow-up, and outcomes were analyzed.
  
  
  RESULTS
  Totally 70 patients were included in this study within five years, of which mean age was 28.6 ± 32.9 months (range 1 to 144), 48% of our patients had nausea and vomiting. Preoperative CDU showed absent/weak flow in 50 (71%) cases. Winter showed most frequently (44%) referred cases of testicular torsion. Orchidopexy was performed in 44 (63%) and orchidectomy in 26 (37%) cases after second look exploration. Mean follow-up duration was 3.1 ± 1.4 years. 4 (9%) cases in orchidopexy group developed testicular atrophy during follow-up, all four cases had a history of longer than 12 hours and grade II testicular bleeding test intra-operatively. Other orchidopexy patients salvaged. 26 patients, who were in grade III, underwent orchidectomy in second look exploration.
  
  
  CONCLUSIONS
  TT requires emergency attention. The ischemia time of the testis is traditionally after 6 hours, and imaging or other diagnostic modality should not be a cause of delay. Early surgical exploration is modality of choice, and second look exploration after 48 hours can be more effective and salvageable in these patients.
authors.affiliation: Pediatric Surgery Research Center, Shahid Beheshti University of Medial Sciences, Tehran, IR Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Rouzrokh
authors.affiliation: Pediatric Surgery Research Center, Shahid Beheshti University of Medial Sciences, Tehran, IR Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mirshemirani
authors.affiliation: Pediatric Surgery Research Center, Shahid Beheshti University of Medial Sciences, Tehran, IR Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Khaleghnejad-Tabari
keywords: Child; Outcomes; Second Look Exploration; Spermatic Cord Torsion