PDF(Pubmed)
Abstract：
OBJECTIVE: To produce a best practice consensus guideline for the conduct of scrotal exploration for suspected testicular torsion using formal consensus methodology.
METHODS: A panel of 16 expert urologists, representing adult, paediatric, general, and andrological urology used the RAND/UCLA Appropriateness Consensus Methodology to score a 184 statement pre-meeting questionnaire on the conduct of scrotal exploration for suspected testicular torsion. The collated responses were presented at a face-to-face online meeting and each item was rescored anonymously after a group discussion, facilitated by an independent chair with expertise in consensus methodology. Items were scored for agreement and consensus and the items scored with consensus were used to derive a set of best practice guidelines.
RESULTS: Statements scored as with consensus increased from Round 1 (122/184, 66.3%) to Round 2 (149/200, 74.5%). Recommendations were generated in ten categories: consent, assessment under anaesthetic, initial incision, intraoperative decision making, fixation, medical photography, closure, operation note, logistics and follow-up after scrotal exploration. Our statements assume that the decision to operate has already been made. Key recommendations in the consent process included the discussion of the possibility of orchidectomy and the possibility of subsequent infection of the affected testis or wound requiring antibiotic therapy. If after the examination under anaesthesia, the index of suspicion of testicular torsion is lower than previously thought, then the surgeon should still proceed to scrotal exploration as planned. A flow chart guiding decision making dependent on intraoperative findings has been designed. If no torsion is present on exploration and the bell clapper deformity is absent, the testis should not be fixed. When fixing a testis using sutures, 3 or 4-point is acceptable and non-absorbable sutures are preferred.
CONCLUSIONS: We have produced consensus recommendations to inform best practice in the conduct of scrotal exploration for suspected testicular torsion.
METHODS: A panel of 16 expert urologists, representing adult, paediatric, general, and andrological urology used the RAND/UCLA Appropriateness Consensus Methodology to score a 184 statement pre-meeting questionnaire on the conduct of scrotal exploration for suspected testicular torsion. The collated responses were presented at a face-to-face online meeting and each item was rescored anonymously after a group discussion, facilitated by an independent chair with expertise in consensus methodology. Items were scored for agreement and consensus and the items scored with consensus were used to derive a set of best practice guidelines.
RESULTS: Statements scored as with consensus increased from Round 1 (122/184, 66.3%) to Round 2 (149/200, 74.5%). Recommendations were generated in ten categories: consent, assessment under anaesthetic, initial incision, intraoperative decision making, fixation, medical photography, closure, operation note, logistics and follow-up after scrotal exploration. Our statements assume that the decision to operate has already been made. Key recommendations in the consent process included the discussion of the possibility of orchidectomy and the possibility of subsequent infection of the affected testis or wound requiring antibiotic therapy. If after the examination under anaesthesia, the index of suspicion of testicular torsion is lower than previously thought, then the surgeon should still proceed to scrotal exploration as planned. A flow chart guiding decision making dependent on intraoperative findings has been designed. If no torsion is present on exploration and the bell clapper deformity is absent, the testis should not be fixed. When fixing a testis using sutures, 3 or 4-point is acceptable and non-absorbable sutures are preferred.
CONCLUSIONS: We have produced consensus recommendations to inform best practice in the conduct of scrotal exploration for suspected testicular torsion.
摘要：
目的：使用正式的共识方法，为可疑睾丸扭转的阴囊探查提供最佳实践共识指南。
方法：由16位泌尿科专家组成的小组，代表成年人，儿科,一般,和男科泌尿外科使用RAND/UCLA适当性共识方法对184份关于可疑睾丸扭转的阴囊探查的会前问卷进行评分。整理后的回复是在面对面的在线会议上提出的，每个项目在小组讨论后匿名重新评分，由具有共识方法专业知识的独立主席协助。对项目进行评分以达成共识和共识，并使用共识评分的项目得出一套最佳实践指南。
结果：与共识一致的声明从第一轮（122/184，66.3％）增加到第二轮（149/200，74.5％）。建议分为十个类别：同意，麻醉下的评估，初始切口,术中决策，固定,医学摄影,关闭,操作说明,阴囊勘探后的后勤和后续行动。我们的声明假设已经做出了运营决定。同意过程中的主要建议包括讨论睾丸切除术的可能性以及随后需要抗生素治疗的受影响睾丸或伤口感染的可能性。如果在麻醉下检查后，怀疑睾丸扭转的指数比以前认为的要低，那么外科医生仍然应该按计划进行阴囊探查。根据术中发现，设计了指导决策的流程图。如果勘探时没有扭转，并且没有钟形拍板畸形，睾丸不应该固定。用缝线固定睾丸时,3点或4点是可接受的,并且不可吸收的缝合线是优选的。
结论：我们已经提出了共识建议，为可疑睾丸扭转的阴囊探查提供最佳实践。
方法：由16位泌尿科专家组成的小组，代表成年人，儿科,一般,和男科泌尿外科使用RAND/UCLA适当性共识方法对184份关于可疑睾丸扭转的阴囊探查的会前问卷进行评分。整理后的回复是在面对面的在线会议上提出的，每个项目在小组讨论后匿名重新评分，由具有共识方法专业知识的独立主席协助。对项目进行评分以达成共识和共识，并使用共识评分的项目得出一套最佳实践指南。
结果：与共识一致的声明从第一轮（122/184，66.3％）增加到第二轮（149/200，74.5％）。建议分为十个类别：同意，麻醉下的评估，初始切口,术中决策，固定,医学摄影,关闭,操作说明,阴囊勘探后的后勤和后续行动。我们的声明假设已经做出了运营决定。同意过程中的主要建议包括讨论睾丸切除术的可能性以及随后需要抗生素治疗的受影响睾丸或伤口感染的可能性。如果在麻醉下检查后，怀疑睾丸扭转的指数比以前认为的要低，那么外科医生仍然应该按计划进行阴囊探查。根据术中发现，设计了指导决策的流程图。如果勘探时没有扭转，并且没有钟形拍板畸形，睾丸不应该固定。用缝线固定睾丸时,3点或4点是可接受的,并且不可吸收的缝合线是优选的。
结论：我们已经提出了共识建议，为可疑睾丸扭转的阴囊探查提供最佳实践。
