Predictors Of Testicular Injury Secondary To Incarcerated Inguinal Hernia In Children

Objective:To find out predictors of the testicular ischemia secondaryto incarcerated inguinal hernia and evaluate the ischemic injury of the testis more accurately,which can indicate testicle exploration in time or prevent unnecessary testicle exploration.Methods:Pediatric patients(median:9 months)undergoing operation of unilateral incarcerated inguinal hernia and ipsilateral testicular exploration between 1 Jul.2013 to 30 Jun.2019 were retrospectively investigated.Age at surgery,incarcerate duration,degree of intestinal and testicular injury,times of manual reduction and preoperative ultrasound data were collected.Statistical analysis was performed by SAS9.4(Copyright(?)2016 SAS Institute Inc.Cary,NC,USA).Results:460 patients(median:9 months),of which 57(12.39%)(median:1.4 months,interquartile range 0.8-10.7 months)had severe testicular injury,and their average incarceration time was(23.9±9.3)h.Univariate logistic regression revealed that increased times of manual reduction,ultrasound scores,incarcerate duration and degree of intestinal injury were positively correlated with the degree of testicular ischemia,while age at surgery was negatively correlated with the degree of testicular ischemia(P<0.05).A model for calculating the probability of severe testicularischemiainjurywas established:P=1-(?)(where Age is the age at operation,Score is the preoperative ultrasound score,and Time is the incarceration duration)through Multivariate analysis with backward stepwise logistic regression.When the probability was more than 0.85,the patient was considered to have severe testicular ischemia injury.The stability of the prediction model was validated by 10-fold cross-validation.The testicles was confirmed with severe injury during the operation had different degrees of atrophy after operation(P<0.05,compared with the healthy side).There was no difference in testicle volume between the two sides after operation in non-severe injury cases(P>0.05).Conclusion:This study provides a relative reliable model to predict the risk of irreversible testicular ischemia due to incarcerated inguinal hernia using readily available clinical characteristics in young pediatrics with testicular ischemia.