Analysis Of Risk Factors Affecting The Outcome Of Cryptorchidism Torsion

Background:Undescended testis(UDT,Cryptorchidism)is a common disease in pediatric urogenital system.A larger number of epidemiologic studies recently showed that the incidence rate of abnormal development or deformity of genital system like cryptorchidism and hypospadias dramatically increased due to environmental pollution.Testis,is the key organ of the genitourinary system,its abnormal position(cryptorchidism)attracts more and more attention,because it can lead to infertility and even cancer.However,only a few hundreds of case reports focus on UDT torsion,which is one of the three common complications of cryptorchidism.After searching and analyzing relevant articles,we found that the incidence rate of UDT torsion was actually not that low.But maybe due to the inadequate attention to this complication,it was easily missed diagnosed or misdiagnosed so that the surgical salvage rates were extremely low,just about 0-10%.It deserved to be paid attention to and further investigation to avoid the severe consequence.Objective:By investigating possible risk factors that can influence the salvage rates of testicular torsion in pediatric cryptorchidism,to increase the awareness of this entity,thus get early prevention and early diagnosis and increase salvage rates of UDT torsion.Methods:Retrospective analysis of testicular torsion in Second Affiliated Hospital of Shantou University Medical College and Shenzhen Children’s Hospital during 2000 and2018,with the keywords of UDT,Cryptorchidism,Children and testicular torsion by using databases:PubMed,China National Knowledge Infrastructure(CNKI),Wanfang,and Weipu retrieved related articles.Inclusion criteria of retrospective clinical cases:the age was not more than 18 years old,cyptorchidism torsion was confirmed in surgical exploration.Exclusion criteria of retrospective clinical cases:over 18 years of age,or no operation confirmed cryptorchidism torsion.Inclusion criteria of retrieved literature:the age,onset time,clinical manifestations,duration of testicular torsion,degree of torsion,regional and climatic effects,testicular outcome and other clinical information were clearly documented,and the age was less than 18 years old.Exclusion criteria of retrieved literature:the literature contained only summaries or descriptions of cases with no inclusion criteria information could be used,or the age was older than 18 years old.Spearman rank correlation coefficient,X~2 test,fisher’s exact test,and Pearson’s correlation test were used to study the risk factors that influence the salvage rates of testicular torsion in cryptorchidism.Results:A total of 13 clinical cases were obtained.30 relevant English articles,and 110Chinese articles were reviewed.A total of 109 cases(71 in Chinese and 38 in English)were collected under inclusion and exclusion criteria.An article can contain several cases,from this kind of article,68 testicular torsion cases were enrolled in the study,though the most information was not in detail,but some of them wwere useful in this study.In the past 20 years in Shantou and Shenzhen,Guangdong Province,the proportion of UDT torsion in the congenital cryptorchidism was about 0.48%(13/2684),while that in children with testicular torsion was about 3.78%(13/344).The average age of onset was 7.1 year-old(2 day-old to 18 year-old).It was relatively higher in infancy(28.91%,37/128)and adolescence(25.78%,33/128).There was no significant difference between the left-side and right-side testicular torsion.The most common abnormal position of cryptorchidism was in the inguinal canal(97.89%,186/190),and it was commonly accompanied with unilateral patent processus vaginalis(88.89%,16/18).Testicular torsion commonly occurred extravaginal(63.16%,38/61).The necrosis rates of UDT torsion were 70.49%(86/122),and 12 of 36 testis-sparing patients underwent orchiatrophy eventually atrophied.Statistical analysis indicated that the during of onset(>17.5h),degree of testicular torsion(>362.5°),blood flow condition of torsional testis in ultrasound,and intra-and extra-vaginal torsion of the testis were closely related to testicular torsion in cryptorchidism(p<0.05),while the age of onset,left-side or right-side cryptorchidism,testis position in cryptorchidism,whether or not accompanied with patent processus vaginalis,north or south of China and climate change at the time of onset were not correlated with the consequences of testicular torsion(p>0.05).Logistic regression analysis showed that the duration and the degree of torsion were significantly correlated with the consequences of testicular torsion(p<0.05).Conclusion:The torsion of UDT commonly occurs in infants and adolescents with an extremely low surgical salvage rate.The duration and degree of UDT torsion in children are positive correlated with the consequences of cryptorchidism torsion.The long during time of torsion(>17.5h),the severe degree of torsion(>360°)usually increased the necrosis rates of torsional testis.However,the degree of testicular torsion was not always consistent with duration of testicular torsion.It can be assessed on the necrosis severity after the reduction of the UDT torsion by duration and degree of testicular torsion.It is crucial to early intervene this emergency situation by detailed physical examination and history taking,and this relied in deep understanding and education to pay attention to the complication of cryptorchidism torsion.Because this study is a retrospective study,and the cases are limited in number,the conclusion may have limitations,so we look forward to the further study and improvement.