Abstract：
BACKGROUND: There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion (TT) in cases where the testis seems non-viable. The main problem is lack of objective criteria defining testicular viability. The aim of this study was to investigate the grade of injury in orchiectomy specimens obtained from cases of TT and its association with clinical findings.
METHODS: This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings.
RESULTS: A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p < 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172).
CONCLUSIONS: Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury.
METHODS: This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings.
RESULTS: A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p < 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172).
CONCLUSIONS: Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury.
摘要：
背景：在睾丸似乎无法存活的情况下，是否在睾丸扭转（TT）后进行睾丸切除术或睾丸固定术仍存在争议。主要问题是缺乏定义睾丸活力的客观标准。这项研究的目的是调查从TT病例中获得的睾丸切除术标本的损伤等级及其与临床发现的关系。
方法：这项多中心回顾性研究涉及使用Mikuz分类对患者档案和病理标本进行双盲重新评估，以分析临床和病理结果之间的关系。
结果：共审查了来自14个中心的289例患者图表，其中228例纳入本研究。20例（8.8％）患者有1级损伤，指可逆性损伤。将这20例患者的临床发现与208例损伤程度较高的患者进行了比较。不出所料,症状持续时间有统计学上的显著差异(p<0.001)；然而，两组的范围都很宽（一年级长达96小时，高年级短至7小时）。在包括年龄在内的任何其他变量上都没有统计学上的显著差异(两者的中位数为14，p=0.531),症状（疼痛：19/20vs.189/202，p=0.801；肿胀：13/19vs.168/197，p=0.094），多普勒超声中没有血流(15/19vs.164/197，p=0.635），或扭转度(两者的中位数为720°，p=0.172）。
结论：我们的研究揭示了需要更好的标准来定义TT后睾丸的活力。即使在一些围手术期发现更严重的患者中，组织病理学损伤也是可逆的，迟到,或高度扭曲。我们的发现支持睾丸固定而不是睾丸切除术的趋势，因为没有临床或围手术期发现可归因于严重损伤。
方法：这项多中心回顾性研究涉及使用Mikuz分类对患者档案和病理标本进行双盲重新评估，以分析临床和病理结果之间的关系。
结果：共审查了来自14个中心的289例患者图表，其中228例纳入本研究。20例（8.8％）患者有1级损伤，指可逆性损伤。将这20例患者的临床发现与208例损伤程度较高的患者进行了比较。不出所料,症状持续时间有统计学上的显著差异(p<0.001)；然而，两组的范围都很宽（一年级长达96小时，高年级短至7小时）。在包括年龄在内的任何其他变量上都没有统计学上的显著差异(两者的中位数为14，p=0.531),症状（疼痛：19/20vs.189/202，p=0.801；肿胀：13/19vs.168/197，p=0.094），多普勒超声中没有血流(15/19vs.164/197，p=0.635），或扭转度(两者的中位数为720°，p=0.172）。
结论：我们的研究揭示了需要更好的标准来定义TT后睾丸的活力。即使在一些围手术期发现更严重的患者中，组织病理学损伤也是可逆的，迟到,或高度扭曲。我们的发现支持睾丸固定而不是睾丸切除术的趋势，因为没有临床或围手术期发现可归因于严重损伤。
