A multicenter study of acute testicular torsion in the time of COVID-19

Sarah A Holzman¹, Jennifer J Ahn², Zoe Baker³, Kai-Wen Chuang⁴, Hillary L Copp⁵, Jacob Davidson⁶, Carol A Davis-Dao⁴, Emily Ewing⁷, Joan Ko², Victoria Lee⁸, Amanda Macaraeg⁹, Lauren Nicassio², Michael Sadighian⁵, Heidi A Stephany⁴, Renea Sturm⁸, Kelly Swords¹⁰, Peter Wang⁶, Elias J Wehbi⁴, Antoine E Khoury⁴; Western Pediatric Urology Consortium (WPUC)

Affiliations

¹ University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA. Electronic address: saholzma@hs.uci.edu.
² Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA.
³ Children's Hospital Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA.
⁴ University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.
⁵ University of California, San Francisco, Department of Urology, San Francisco, CA, USA.
⁶ Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada.
⁷ Western University, Department of Urology, London, Ontario, Canada.
⁸ University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA.
⁹ University of California, Irvine, Department of Urology, Irvine, CA, USA.
¹⁰ University of California, San Diego, Department of Urology, La Jolla, CA, USA; Rady Children's Hospital, Division of Pediatric Urology, San Diego, CA, USA.

PMID: 33832873
PMCID: PMC7977032
DOI: 10.1016/j.jpurol.2021.03.013

Multicenter Study

A multicenter study of acute testicular torsion in the time of COVID-19

Sarah A Holzman et al. J Pediatr Urol. 2021 Aug.

. 2021 Aug;17(4):478.e1-478.e6.

doi: 10.1016/j.jpurol.2021.03.013. Epub 2021 Mar 19.

Authors

Affiliations

¹ University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA. Electronic address: saholzma@hs.uci.edu.
² Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA.
³ Children's Hospital Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA.
⁴ University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.
⁵ University of California, San Francisco, Department of Urology, San Francisco, CA, USA.
⁶ Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada.
⁷ Western University, Department of Urology, London, Ontario, Canada.
⁸ University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA.
⁹ University of California, Irvine, Department of Urology, Irvine, CA, USA.
¹⁰ University of California, San Diego, Department of Urology, La Jolla, CA, USA; Rady Children's Hospital, Division of Pediatric Urology, San Diego, CA, USA.

PMID: 33832873
PMCID: PMC7977032
DOI: 10.1016/j.jpurol.2021.03.013

Abstract

Background: Testicular torsion is a surgical emergency, and time to detorsion is imperative for testicular salvage. During the COVID-19 pandemic, patients may delay emergency care due to stay-at-home orders and concern of COVID-19 exposure.

Objective: To assess whether emergency presentation for testicular torsion was delayed during the COVID-19 pandemic, and whether the rate of orchiectomy increased compared to a retrospective period.

Study design: Patients were prospectively enrolled in a multicenter study from seven institutions in the United States and Canada. Inclusion criteria were patients two months to 18 years of age with acute testicular torsion from March through July 2020. The retrospective group included patients from January 2019 through February 2020. Statistical analysis was performed using Kruskal-Wallis tests, Chi-square tests, and logistic regression.

Results: A total of 221 patients were included: 84 patients in the COVID-19 cohort and 137 in the retrospective cohort. Median times from symptom onset to emergency department presentation during COVID-19 compared to the retrospective period were 17.9 h (IQR 5.5-48.0) and 7.5 h (IQR 4.0-28.0) respectively (p = 0.04). In the COVID-19 cohort, 42% of patients underwent orchiectomy compared to 29% of pre-pandemic controls (p = 0.06). During COVID-19, 46% of patients endorsed delay in presentation compared to 33% in the retrospective group (p = 0.04).

Discussion: We found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a higher proportion of patients reported delaying care. Strengths of the study include the number of included patients and the multicenter prospective design during the pandemic. Limitations include a retrospective pre-pandemic comparison group.

Conclusions: In a large multicenter study we found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a significantly higher proportion of patients reported delaying care. Based on the findings of this study, more patient education is needed on the management of testicular torsion during a pandemic.

Keywords: COVID-19; Pandemic; Testicular torsion; Urologic emergencies.

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Figures

**Fig. 1**
Distribution of patterns in acute testicular torsion presentation by month of the COVID-19 pandemic. Gray bars represent rate of orchiectomy by month, while the black line represents median time from onset of symptoms to presentation by month.

See this image and copyright information in PMC

References

1. Mansbach J.M., Forbes P., Peters C. Testicular torsion and risk factors for orchiectomy. Arch Pediatr Adolesc Med. 2005;159:1167–1171. - PubMed
1. Pogorelić Z., Mrklić I., Jurić I., Biočić M., Furlan D. Testicular torsion in the inguinal canal in children. J Pediatr Urol. 2013;9:793–797. - PubMed
1. Gold D.D., Lorber A., Levine H., Rosenberg S., Duvdevani M., Landau E.H. Door to detorsion time determines testicular survival. Urology. 2019;133:211–215. - PubMed
1. Lange S.J., Ritchey M.D., Goodman A.B., Dias T., Twentyman E., Fuld J. Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions - United States, January-May 2020. Am J Transplant. 2020;20:2612–2617. - PMC - PubMed
1. Place R., Lee J., Howell J. Rate of pediatric appendiceal perforation at a children's hospital during the COVID-19 pandemic compared with the previous year. JAMA Netw Open. 2020;3 - PMC - PubMed

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A multicenter study of acute testicular torsion in the time of COVID-19

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A multicenter study of acute testicular torsion in the time of COVID-19

Authors

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Abstract

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Full Text Sources

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