Academic Journal
Manual detorsion and orchiectomy risk in testicular torsion: an updated systematic review and attempt-based meta-analysis.
| Τίτλος: | Manual detorsion and orchiectomy risk in testicular torsion: an updated systematic review and attempt-based meta-analysis. |
|---|---|
| Συγγραφείς: | Wu ZJ; Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, 518026, Guangdong, China.; Department of General Surgery, Shenzhen Children's Hospital, Lianhua district, Shenzhen, 518026, Guangdong, People's Republic of China., Long JX; Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, 518026, Guangdong, China.; Department of General Surgery, Shenzhen Children's Hospital, Lianhua district, Shenzhen, 518026, Guangdong, People's Republic of China., Wang B; Department of General Surgery, Shenzhen Children's Hospital, Lianhua district, Shenzhen, 518026, Guangdong, People's Republic of China. szwb1967@126.com., Yang ZL; Department of Urology, Shenzhen Children's Hospital, Lianhua district, Shenzhen, 518026, Guangdong, People's Republic of China. yangzhilin207@163.com. |
| Πηγή: | Pediatric surgery international [Pediatr Surg Int] 2026 Aug 27; Vol. 42 (1). Date of Electronic Publication: 2026 Aug 27. |
| Τύπος έκδοσης: | Journal Article; Meta-Analysis; Systematic Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer International Country of Publication: Germany NLM ID: 8609169 Publication Model: Electronic Cited Medium: Internet ISSN: 1437-9813 (Electronic) Linking ISSN: 01790358 NLM ISO Abbreviation: Pediatr Surg Int Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Berlin : Springer International, c1986- |
| Ιατρικοί όροι (MeSH): | Orchiectomy*/statistics & numerical data , Spermatic Cord Torsion*/surgery , Spermatic Cord Torsion*/therapy, Humans ; Male |
| Περίληψη: | Background: Testicular torsion requires urgent restoration of blood flow. Manual detorsion (MD) may reduce ischemic time before surgery, but evidence is observational and vulnerable to treatment-selection bias. Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library through April 30, 2026. The primary outcome was orchiectomy comparing attempted MD with no MD attempt, irrespective of technical success. Random-effects odds ratios were pooled using Paule-Mandel estimation and Hartung-Knapp inference. Risk of bias and certainty were assessed using ROBINS-I and GRADE. Results: Eight retrospective comparative studies involving 844 patients were included. Orchiectomy occurred in 17/406 patients (4.2%) after attempted MD and 127/438 (29.0%) without MD attempt. Attempted MD was associated with lower orchiectomy odds (OR 0.13, 95% CI 0.07-0.24; P < 0.001; I²=0%). All studies had serious overall risk of bias, mainly from confounding by indication, and certainty was low. No study directly compared ultrasound-assisted with non-guided MD. Shorter symptom duration was most consistently associated with technical success. Conclusions: Attempted MD was associated with lower orchiectomy odds, but causality is unproven. MD may be used as an adjunct if it does not delay urgent exploration and fixation. (© 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) |
| Competing Interests: | Declarations. Conflict of interest: The authors declare no competing interests. Consent for publication: Not applicable. Ethical approval and consent to participate: Not applicable. |
| References: | J Clin Epidemiol. 2019 Jul;111:105-114. (PMID: 29432858) J Urol. 1985 May;133(5):803-5. (PMID: 3989920) Zhonghua Nan Ke Xue. 2025 Mar;31(3):222-225. (PMID: 40787869) Int Urol Nephrol. 2024 Dec;56(12):3797-3804. (PMID: 38985245) Surg Clin North Am. 2017 Feb;97(1):161-172. (PMID: 27894425) J Ultrasound Med. 2006 May;25(5):563-74. (PMID: 16632779) Pediatr Radiol. 2000 Jan;30(1):41-4. (PMID: 10663509) Pediatr Radiol. 2025 Apr;55(4):674-681. (PMID: 39112569) J Urol. 2011 Jun;185(6 Suppl):2459-63. (PMID: 21527194) Int J Clin Pract. 2008 May;62(5):821-7. (PMID: 18412935) Pediatr Emerg Care. 2022 Feb 1;38(2):e936-e942. (PMID: 34225327) J Pediatr Surg. 2020 Dec;55(12):2728-2731. (PMID: 32169343) BMJ. 2008 Apr 26;336(7650):924-6. (PMID: 18436948) BMJ. 2021 Mar 29;372:n71. (PMID: 33782057) J Pediatr Surg. 1994 Apr;29(4):553-6. (PMID: 8014814) J Urol. 2011 Nov;186(5):2009-13. (PMID: 21944120) J Pediatr Urol. 2026 Feb;22(1):105681. (PMID: 41412855) BJU Int. 1999 Apr;83(6):672-4. (PMID: 10233577) J Pediatr Surg. 1983 Oct;18(5):607-10. (PMID: 6644503) BMC Urol. 2017 Sep 15;17(1):84. (PMID: 28915866) J Pediatr Urol. 2023 Feb;19(1):117-124. (PMID: 36266168) J Pediatr Urol. 2013 Jun;9(3):259-66. (PMID: 22763105) Medicine (Baltimore). 2026 Jan 30;105(5):e47417. (PMID: 41630269) Pediatr Emerg Care. 2019 Dec;35(12):821-825. (PMID: 28953100) J Urol. 2017 Mar;197(3 Pt 1):811-817. (PMID: 27697579) BMJ. 2016 Oct 12;355:i4919. (PMID: 27733354) BMJ. 2015 Apr 02;350:h1563. (PMID: 25838433) Urology. 2023 Oct;180:227-234. (PMID: 37150406) J Emerg Med. 2020 Jan;58(1):85-92. (PMID: 31653532) J Ultrasound Med. 2020 Jan;39(1):119-126. (PMID: 31268182) J Urol. 2003 Feb;169(2):663-5. (PMID: 12544339) |
| Grant Information: | No. SZSM202411010 Sanming Project of Medicine in Shenzen Municipality |
| Contributed Indexing: | Keywords: Manual detorsion; Orchiopexy; Testicular atrophy; Testicular torsion |
| Entry Date(s): | Date Created: 20260827 Date Completed: 20260827 Latest Revision: 20261008 |
| Update Code: | 20261008 |
| DOI: | 10.1007/s00383-026-06602-4 |
| PMID: | 42658281 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1437-9813 |
|---|---|
| DOI: | 10.1007/s00383-026-06602-4 |