| Objective: To retrospectively analyze the case characteristics of patients with testicular torsion and investigate the prognosis of patients,and evaluate the value of preoperative hematological parameters in the diagnosis of testicular torsion and its role in predicting testicular viability.Determine whether the patient’s testis atrophied after surgery,and to determine whether testosterone levels,pubertal development,semen quality,fertility,sexual function and desire,mental health,and quality of life are affected.To provide reference for the preoperative diagnosis and long-term prognosis of testicular torsion.Method: 253 patients diagnosed with testicular torsion who were admitted to the Lanzhou University Second Hospital,the First Hospital of Lanzhou University,Gansu Provincial Maternity and Child-care Hospital and the General Hospital of Lanzhou Military Command from January 2002 to November 2021 were included.The characteristics of the cases were summarized and the preoperative blood routine data of the patients were obtained and compared with the blood routine data of patients with orchiepididymitis and healthy people.The patients were followed up on postoperative testicular atrophy,testosterone level,pubertal development,semen quality,marital and reproductive outcomes,sexual function and desire,mental health,quality of life.Ten questions were designed for patients to better understand the psychological changes of patients after surgery.Erectile function was assessed by International Index of Erectile Function-5（IIEF-5）and Erection Hardness Score（EHS）.Premature Ejaculation Diagnostic Tool（PEDT）,Premature Ejaculation Profile（PEP）and Intravaginal Ejaculation Latent Time（IELT）were used to evaluate whether patients had premature ejaculation.Questions 1 and 2 of the Brief Male Sexual Function Inventory for Urology（O’Leary 1995）were used to assess patients’ sexual desire.Self-rating Depression Scale（SDS）,Self-rating Anxiety Scale（SAS）,and Perceived Stress Scale-10（PSS-10）were used to evaluate postoperative depression,anxiety and stress feelings of patients respectively.The quality of life of patients was evaluated by the WHO-QOL-BREF.The patients were divided into orchiopexy group and orchiectomy group,and healthy men of similar age were selected as the control group to compare the differences among the three groups.Result: A total of 253 patients with unilateral torsion were collected,including171 cases in the orchiectomy group（including 4 cases of testicular necrosis but with orchiopexy）and 82 cases in the orchiopexy group.The preoperative color Doppler ultrasound reports of 185 patients were obtained.The patients with no blood flow signal,uneven parenchymal echo and reduced echo were more likely to undergo orchiectomy.The misdiagnosis rate of the first diagnosis was 59.7%,and the probability of orchiectomy after misdiagnosis was 79.5%,which was higher than that after diagnosis（50.0%）.The misdiagnosis rate of patients with chief complaint of non-scrotal/testicular symptoms was as high as 78.0%,which was higher than that of patients with chief complaint of scrotal/testicular symptoms（56.1%）,showing statistical difference.102 cases were diagnosed at the first diagnosis,of which 53 cases delayed treatment.High degree of torsion and long duration of torsion are the risk factors of orchiectomy.The neutrophil-to-lymphocyte ratio（NLR）and monocyte-to-eosinophil ratio（MER）have high sensitivity and specificity in the diagnosis of testicular torsion,which can be used for the diagnosis of testicular torsion.The white blood cell count（WBC）and monocyte count（MONO）of testicular torsion patients were lower than those of orchiepididymitis patients,which was helpful for differential diagnosis.None of the hematologic parameters had predictive value for testicular viability.No atrophy was observed on the healthy side of testis in the orchiectomy group or the orchiopexy group,but the atrophy rate of the affected side of testis in the orchiopexy group was 51.16%.Patients with high degree of torsion and long duration of torsion are more likely to have testicular atrophy on the affected side.The postoperative testosterone values of orchiopexy group and orchiectomy group were（509.93±59.85）ng/dl and（576.58±166.94）ng/dl,respectively.There was no significant difference in pubertal development between the two groups and healthy people.Only 6 patients’ semen quality reports were obtained.The infertility rates of orchiopexy group and orchiectomy group were20.00% and 13.04% respectively.There was no significant difference in the infertility rate compared with the domestic random population（15.26%）.There was no significant difference in IIEF-5 score and EHS grade among the three groups.There was no significant difference in PEDT,PEP,IELT and sexual desire scores in the orchiopexy group compared with the control group,but PEDT,PEP and IELT in the orchiectomy group were lower than those in the orchiopexy group and the control group.The sexual desire score in the orchiectomy group was also lower than that in the control group,the difference was statistically significant.The SDS,SAS standard scores and PSS-10 scores of the orchiopexy group were not significantly different from those of the control group,but the SDS,SAS standard scores and PSS-10 scores of the orchiectomy group were higher than those of the orchiopexy group and the control group,and showed mild depression and mild anxiety as a whole.Being the only son,living in the city and not having children are the risk factors of depression after orchiectomy,and being the only child is the risk factor of anxiety after orchiectomy.There is no significant difference in the postoperative quality of life of patients with orchiopexy compared with the control group.The quality of life of patients in the orchiectomy group is lower than that of the orchiopexy group and the control group,which is mainly reflected in three aspects:psychological field,social relationship field and environmental field.Conclusion: The misdiagnosis rate of testicular torsion is very high,which leads to an increased risk of orchiectomy.High torsion degree and long torsion duration are risk factors for orchiectomy and atrophy of the testis on the affected side.The healthy testis will not atrophy,but more than half of the affected testis will atrophy after orchiopexy.NLR MER can be used for the diagnosis of testicular torsion,but hematologic parameters are not valuable for predicting testicular viability.After unilateral testicular torsion,the testosterone level,puberty development and fertility of patients will not decrease.The sexual function,sexual desire,mental health and quality of life of patients with orchiopexy will not be affected.Patients with orchiectomy had normal erectile function,but they were more prone to premature ejaculation,depression,anxiety and had a stronger sense of stress,their quality of life also reduced after orchiectomy. |
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