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Abstract：
BACKGROUND: Suspicion of testicular torsion represents a urological emergency, necessitating immediate surgery. Comprehensive data on the current trends and perioperative outcomes regarding surgical exploration are sparse. Therefore, we utilized nationwide data on the prevalence and results of this surgery, aiming to provide evidence on this matter.
METHODS: We assessed the GeRmAn Nationwide inpatient Data (GRAND) from 2005 to 2021, provided by the Research Data Center of the Federal Bureau of Statistics. We performed multiple regression analyses to evaluate the perioperative outcomes (length of hospital stay, transfusion, and surgical wound infection) after surgical exploration due to suspected testicular torsion based on both the outcome of surgery (orchiectomy, detorsion with preservation of the testicle, and no testicular torsion) and on the department of operation (urological versus non-urological).
RESULTS: A total of 81,899 males underwent surgical exploration due to suspected testicular torsion in Germany from 2005 to 2021. Of them, 11,725 (14%) underwent orchiectomy, 30,765 (38%) detorsion with preservation of the testicle and subsequent orchidopexy, and 39,409 (48%) presented no testicular torsion. Orchiectomy was significantly associated with longer length of hospital stay (day difference of 1.4 days, 95%CI: 1.3-1.4, p < 0.001), higher odds of transfusion (1.8, 95% CI: 1.2-2.6, p = 0.002) and surgical wound infections (1.8, 95%CI: 1.4-2.3, p < 0.001) compared to no testicular torsion. The proportion of patients undergoing orchiectomy was significantly lower in urological departments (14%) versus non-urological departments (16%) and the proportion of patients undergoing preservation of testicle after detorsion was significantly higher in urological departments (38%) versus non-urological departments (37%), p < 0.001. Patients undergoing treatment in a urological department were discharged earlier and presented lower odds of transfusion and surgical wound infection (p < 0.001) compared to patients undergoing treatment in a non-urological department.
CONCLUSIONS: Nearly half of patients who underwent surgery for suspected testicular torsion did not have intraoperatively the condition confirmed. Patients treated in urological departments had significantly better perioperative outcomes compared to those treated in non-urological departments. Therefore, we advise to refer patients to urological treatment as early as possible.
METHODS: We assessed the GeRmAn Nationwide inpatient Data (GRAND) from 2005 to 2021, provided by the Research Data Center of the Federal Bureau of Statistics. We performed multiple regression analyses to evaluate the perioperative outcomes (length of hospital stay, transfusion, and surgical wound infection) after surgical exploration due to suspected testicular torsion based on both the outcome of surgery (orchiectomy, detorsion with preservation of the testicle, and no testicular torsion) and on the department of operation (urological versus non-urological).
RESULTS: A total of 81,899 males underwent surgical exploration due to suspected testicular torsion in Germany from 2005 to 2021. Of them, 11,725 (14%) underwent orchiectomy, 30,765 (38%) detorsion with preservation of the testicle and subsequent orchidopexy, and 39,409 (48%) presented no testicular torsion. Orchiectomy was significantly associated with longer length of hospital stay (day difference of 1.4 days, 95%CI: 1.3-1.4, p < 0.001), higher odds of transfusion (1.8, 95% CI: 1.2-2.6, p = 0.002) and surgical wound infections (1.8, 95%CI: 1.4-2.3, p < 0.001) compared to no testicular torsion. The proportion of patients undergoing orchiectomy was significantly lower in urological departments (14%) versus non-urological departments (16%) and the proportion of patients undergoing preservation of testicle after detorsion was significantly higher in urological departments (38%) versus non-urological departments (37%), p < 0.001. Patients undergoing treatment in a urological department were discharged earlier and presented lower odds of transfusion and surgical wound infection (p < 0.001) compared to patients undergoing treatment in a non-urological department.
CONCLUSIONS: Nearly half of patients who underwent surgery for suspected testicular torsion did not have intraoperatively the condition confirmed. Patients treated in urological departments had significantly better perioperative outcomes compared to those treated in non-urological departments. Therefore, we advise to refer patients to urological treatment as early as possible.
摘要：
背景：怀疑睾丸扭转代表泌尿外科急症，需要立即手术。关于手术探查的当前趋势和围手术期结果的综合数据很少。因此,我们利用了全国范围内的手术患病率和结果数据，旨在为此事提供证据。
方法：我们评估了2005年至2021年由联邦统计局研究数据中心提供的GeRmAn全国住院数据（GRAND）。我们进行了多元回归分析，以评估围手术期结果(住院时间，输血,和手术伤口感染），根据手术结果（睾丸切除术，保留睾丸的扭曲，并且没有睾丸扭转）和手术部门（泌尿外科与非泌尿外科）。
结果：从2005年到2021年，德国共有81,899名男性因怀疑睾丸扭转而接受了手术探查。其中,11,725（14％）接受了睾丸切除术，30,765（38％）扭曲，保留睾丸和随后的睾丸固定术，39,409（48%）未出现睾丸扭转。睾丸切除术与更长的住院时间显着相关（天数差异为1.4天，95CI：1.3-1.4，p<0.001），与无睾丸扭转相比,输血(1.8,95%CI:1.2-2.6,p=0.002)和手术伤口感染(1.8,95CI:1.4-2.3,p<0.001)的几率更高.泌尿科（14%）与非泌尿科（16%）相比，接受睾丸切除术的患者比例明显较低，泌尿科（38%）与非泌尿科（37%）相比，接受睾丸切除术的患者比例明显较高，p<0.001。与在非泌尿科接受治疗的患者相比，在泌尿科接受治疗的患者较早出院，输血和手术伤口感染的几率较低（p<0.001）。
结论：将近一半因怀疑睾丸扭转而接受手术的患者在术中未得到证实。与非泌尿外科治疗的患者相比，泌尿外科治疗的患者围手术期结局明显更好。因此,我们建议患者尽早接受泌尿外科治疗。
方法：我们评估了2005年至2021年由联邦统计局研究数据中心提供的GeRmAn全国住院数据（GRAND）。我们进行了多元回归分析，以评估围手术期结果(住院时间，输血,和手术伤口感染），根据手术结果（睾丸切除术，保留睾丸的扭曲，并且没有睾丸扭转）和手术部门（泌尿外科与非泌尿外科）。
结果：从2005年到2021年，德国共有81,899名男性因怀疑睾丸扭转而接受了手术探查。其中,11,725（14％）接受了睾丸切除术，30,765（38％）扭曲，保留睾丸和随后的睾丸固定术，39,409（48%）未出现睾丸扭转。睾丸切除术与更长的住院时间显着相关（天数差异为1.4天，95CI：1.3-1.4，p<0.001），与无睾丸扭转相比,输血(1.8,95%CI:1.2-2.6,p=0.002)和手术伤口感染(1.8,95CI:1.4-2.3,p<0.001)的几率更高.泌尿科（14%）与非泌尿科（16%）相比，接受睾丸切除术的患者比例明显较低，泌尿科（38%）与非泌尿科（37%）相比，接受睾丸切除术的患者比例明显较高，p<0.001。与在非泌尿科接受治疗的患者相比，在泌尿科接受治疗的患者较早出院，输血和手术伤口感染的几率较低（p<0.001）。
结论：将近一半因怀疑睾丸扭转而接受手术的患者在术中未得到证实。与非泌尿外科治疗的患者相比，泌尿外科治疗的患者围手术期结局明显更好。因此,我们建议患者尽早接受泌尿外科治疗。
