WOFAPS 2025 8th World Congress of Pediatric Surgery

İlayda Ser, Meltem Kaba, Mesut Demir, zeynab Mirhashimli, Nihat Sever, Abdullah Yıldız, Çetin Ali Karadağ

Health Sciences University, Şişli Hamidiye Etfal SUAM, Pediatric Surgery Departmant, Istanbul

Aim:The absence of objective criteria for viability assessment during testicular torsion surgery makes surgical decisions subjective. In this study, we aimed to analyze the long-term follow-up of cases that underwent orchiopexy despite clear signs of severe intraoperative ischemia, evaluating both the natural course of these cases and the challenges in their management.

Materials and Methods:We retrospectively reviewed cases underwent scrotal exploration with a preliminary diagnosis of testicular torsion between January 2017-December 2022 at our center. The study group consisted of patients whose testicular viability was highly suspicious during surgery but who ultimately underwent orchiopexy. These patients were evaluated based on postoperative physical examination and scrotal ultrasonography (USG) findings.

Results:Testicular torsion was diagnosed in 49 of 64 explored cases; orchiopexy was performed in 18(28%) of these, despite severe ischemia. Only 9 (50%) of these 18patients could be regularly followed long-term. Of the remaining 9 patients, 9 never attended follow-up or had a USG, and 4 completely abandoned follow-up after the initial control USG. All 9 regularly followed cases showed significant volume loss and decreased vascularity (atrophy) in the testis. Of these 9 patients who received an indication for orchiectomy clinically, only 1 (11%) accepted the recommended surgery.

Conclusion:Atrophy is frequently observed in testes that undergo orchiopexy despite severe intraoperative ischemia. Although guidelines don't support orchiectomy solely for the presence of atrophy, symptomatic conditions such as pain, mass effect, infection,or cosmetic concerns are accepted indications for orchiectomy. Therefore, the surgical decision shouldn't be based solely on intraoperative impression but should be individualized considering the patient's potential for long-term follow-up and the availability of objective evaluation. Patients experienced delays in the torsion process leading to ischemic necrosis and also demonstrated non-compliance in the follow-up period. Our study provides real-world data to the literature, addressing the gaps concerning follow-up difficulties, patient non-compliance, and uncertainties in decision-making processes.