Academic Journal
The tunica vaginalis flap as a rescue procedure in testicular torsion: Quantifying salvage rates with matched cohorts.
| Τίτλος: | The tunica vaginalis flap as a rescue procedure in testicular torsion: Quantifying salvage rates with matched cohorts. |
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| Συγγραφείς: | Ahmad I; Temerty Faculty of Medicine, University of Toronto, Toronto, Canada., Khondker A; Division of Urology, The Hospital for Sick Children, Toronto, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada., Rickard M; Division of Urology, The Hospital for Sick Children, Toronto, Canada., Dos Santos J; Division of Urology, The Hospital for Sick Children, Toronto, Canada., Romao R; Division of Urology, The Hospital for Sick Children, Toronto, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada., Pippi Salle JL; Division of Urology, The Hospital for Sick Children, Toronto, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada., Lorenzo AJ; Division of Urology, The Hospital for Sick Children, Toronto, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada., Chua ME; Division of Urology, The Hospital for Sick Children, Toronto, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines. Electronic address: michael.chua@sickkids.ca. |
| Πηγή: | Journal of pediatric urology [J Pediatr Urol] 2026 Oct; Vol. 22 (5), pp. 106004. Date of Electronic Publication: 2026 May 11. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: England NLM ID: 101233150 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4898 (Electronic) Linking ISSN: 14775131 NLM ISO Abbreviation: J Pediatr Urol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Kidlington, Oxford, UK : Elsevier, c2005- |
| Ιατρικοί όροι (MeSH): | Spermatic Cord Torsion*/surgery , Orchiopexy*/methods , Orchiectomy*/methods , Salvage Therapy*/methods , Testis*/surgery , Surgical Flaps*, Fasciotomy/methods ; Humans ; Male ; Retrospective Studies ; Child, Preschool ; Adolescent ; Infant ; Child ; Treatment Outcome |
| Περίληψη: | Introduction: Testicular torsion is the most common urological emergency in children, and the role of tunica albuginea fasciotomy with tunica vaginalis flap (TVF) in its treatment is controversial. The objective of this study was to evaluate the outcomes among patients undergoing TVF, standard orchiopexy (SO), and orchiectomy, with attention to symptom duration. Methods: We performed a retrospective review of boys aged 1 month-18 years who underwent surgery for testicular torsion at a single centre from 2010 to 2024. Clinical, ultrasonographic, and operative variables were abstracted, and testicular salvage was defined as a follow-up volume ≥50% of the contralateral testis with blood flow. Propensity score matching for age, symptom duration, and parenchymal heterogeneity generated TVF-SO and TVF-orchiectomy cohorts. Salvage was further stratified by duration of symptoms (<6, 6-12, 12-24, >24 h). Results: Among 157 patients, 31 (20%) underwent orchiectomy, 39 (25%) TVF, and 87 (55%) SO. Overall salvage was 54%, differing by procedure (SO 82%, TVF 36%, orchiectomy 0%; p < 0.001). In the TVF-SO matched cohort (n = 64), salvage was 38% for TVF and 59% for SO (p = 0.133). In the TVF-orchiectomy matched cohort (n = 38), salvage was 32% in the TVF group and 0% in the orchiectomy group (p = 0.02). Salvage after TVF declined steeply with ischemia time, with higher rates observed within 6 h of presentation. Discussion: These findings suggest that TVF is used predominantly in high-risk torsion with adverse ultrasound features. When viewed descriptively, the TVF cohort showed lower follow-up viability than the SO cohort, but this difference must be interpreted in the context of the different intraoperative and preoperative risk profiles underlying procedure selection. We highlight TVF as a valuable additional consideration compared to outright orchiectomy. Conclusion: In this retrospective cohort, TVF was used in clinically severe torsion and was associated with follow-up viability in a subset of cases. These descriptive findings support further prospective study but should not be interpreted as evidence of equivalence or comparative benefit of TVF. (Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| Competing Interests: | Conflict of interest statement All authors declare no financial or non-financial conflicts of interest related to this work. |
| Contributed Indexing: | Keywords: Orchidopexy; Orchiectomy; Testicular torsion; Tunica vaginalis flap |
| Entry Date(s): | Date Created: 20260617 Date Completed: 20260901 Latest Revision: 20260901 |
| Update Code: | 20260901 |
| DOI: | 10.1016/j.jpurol.2026.106004 |
| PMID: | 42308691 |
| Βάση Δεδομένων: | MEDLINE |
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