title: Improving Organ Salvage in Testicular Torsion: Comparative Study of Patients Undergoing vs Not Undergoing Preoperative Manual Detorsion.
abstract: We compared surgical outcomes between patients undergoing and those not undergoing preoperative manual detorsion for intravaginal testicular torsion.
  
  
  
  We retrospectively analyzed consecutive patients treated surgically for testicular torsion who were examined within 24 hours of symptoms at our emergency department between January 2012 and September 2015. Explanatory variables were age, presentation delay (time between symptoms and urological examination), surgical wait time (time from examination to surgery), and whether manual detorsion was attempted and, if attempted, was declared successful. End points were surgical outcome (orchiopexy, orchiectomy) and testicular rotation at surgery. Statistical analysis included nonparametric tests and logistic regression. Statistical significance and confidence intervals were set at p <0.05 and 0.95, respectively.
  
  
  
  Detorsion was attempted in 76 of 133 cases (57.1%) and was successful in 72 (95.1%). Patient age (median 15.6 vs 17.4 years, p = 0.115), presentation delay (6.6 vs 6.3 hours, p = 1.0) and surgical wait time (3.5 vs 3.2 hours, p = 0.412) were comparable between patients who underwent manual detorsion attempt and those who did not. Testicular rotation was less among successfully detorsed patients. Orchiectomy was performed in 2 of 72 successfully detorsed patients (2.8%), compared to 15 of 61 patients (24.6%) in whom detorsion was not attempted or was unsuccessful (OR 11.23, p = 0.0002). Logistic regression indicated that surgical wait time (OR 0.95, p = 0.002) and successful detorsion (OR 17.38, p = 0.001) were independently associated with orchiopexy.
  
  
  
  Preoperative manual detorsion was associated with improved surgical salvage in patients with testicular torsion.
authors.affiliation: Urological Unit, Hospital de Base do Distrito Federal, Brasilia, Brazil. Electronic address: aderivaldo.uro@gmail.com.
authors.forename: Aderivaldo Cabral
authors.initials: AC
authors.lastname: Dias Filho
authors.affiliation: Urological Unit, Hospital de Base do Distrito Federal, Brasilia, Brazil.
authors.forename: Ruytemberg
authors.initials: R
authors.lastname: Oliveira Rodrigues
authors.affiliation: Department of Surgery, Division of Urology, Hospital das Clínicas da Universidade Estadual de Campinas, Campinas, Brazil.
authors.forename: Cassio L Z
authors.initials: CL
authors.lastname: Riccetto
authors.affiliation: Department of Surgery, Faculdade de Ciências Médicas da Universidade de Brasília, Brasilia, Brazil.
authors.forename: Paulo Gonçalves
authors.initials: PG
authors.lastname: Oliveira
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D009919:Orchiectomy; D056126:Orchiopexy; D059351:Organ Sparing Treatments; D011300:Preoperative Care; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000628:therapy*; D055815:Young Adult
keywords: ischemia; male; spermatic cord torsion; testis; urologic surgical procedures