A Predictive Model For Influence Factors Of Testicular Salvage After Testicular Torsion In Children

Objective: Testicular torsion is a common acute scrotal syndrome in children.After testicular torsion,surgical exploration should be performed as soon as possible,and orchiectomy or orchiopexy should be performed on the basis of the situation during the operation.However,there is no specific and unified standard for the indication of orchiectomy,and there are still some patients suffering from testicular atrophy after orchiopexy in a long run,so the evaluation of testicular vitality is a major difficulty in clinical work.The purpose of this study is to explore the influencing factors of testicular salvage after testicular torsion and establish a predictive model in order to provide references for clinical practice.Methods: The medical records of patients with testicular torsion treated in Shenzhen Children’s Hospital was from September 1,2005 to January 31,2022,were analyzed retrospectively.Inclusion criterias: 1.The age was under 18-years-old.2.The children were examined by urologists in our hospital before operation,and ultrasound examinations were performed by ultrasound doctors in our hospital.3.Testicular torsion was confirmed by operation.4.The postoperative follow-up period was at least 6 months.Exclusion criterias: 1.Neonatal testicular torsion.2.The medical records and follow-up data were incomplete.Research indicators: age of onset,left or right side of testicular torsion,clinical symptoms and signs,symptom duration,delayed factors,concomitant diseases,ultrasound results,operation-related data,hematological parameters,pathological examination results,postoperative follow-up data.Patients underwent orchiectomy and patients with testicular atrophy after orchiopexy were classified as testicular salvage failure group,patients underwent orchiopexy and without testicular atrophy during follow-up were classified as successful testicular salvage group.Using Logistic univariate and multivariate regression analysis,the independent risk factors of testicular rescue after testicular torsion were established,and the nomograms were established to predict the success rate of testicular salvage.In addition,the clinical data of patients undergoing testicular torsion surgery from February 1,2021 to September31,2022 were prospectively analyzed,and this group was used as a verification cohort to test the accuracy of the nomograms constructed.Results: 1.There were 155 patients with testicular torsion from September1,2005 to January 31,2021.The median age of successful testicular salvage group was 11.31 years-old(9.35～12.77 years-old),and that of testicular salvage failure group was 6.91 years-old(1.59～12.48 years-old).2.The median time of the duration of symptoms in successful testicular salvage group was 6 hours(4～24 hours),and that in testicular salvage failure group was 48 hours(24～72 hours).A total of 113 patients underwent orchiectomy and 42 patients underwent orchiopexy,but 5 of them developed testicular atrophy and were diagnosed as testicular salvage failure.3.Multivariate Logistic regression analysis showed that the independent risk factors of testicular salvage after testicular torsion were the duration of symptoms(OR = 0.970,95%CI:0.943～0.998),testicular blood circulation(OR = 0.003,95%CI: 0.000～0.070 P = 0.003),the degree of spermatic cord torsion(OR=0.995,95%CI: 0.991～1.000,P = 0.037)and monocyte count(OR=0.012).95%CI: 0.000～0.755(P = 0.036).Other factors were not statistically significant.4.We constructed a nomogram based on the above four independent risk factors.The clinical records of 48 patients in the verification cohort were substituted into the predictive model for verification.The results show that the area under the curve of ROC curve was 0.965(95%CI:0.867～0.997).The sensitivity of the prediction model was 90.5% and the specificity was 88.9%.Conclusion: This study showed that the duration of symptoms,testicular blood circulation under ultrasound,monocyte count and the degree of spermatic cord torsion are independent risk factors for testicular salvage after testicular torsion.The prediction model can provide references for clinical practice and enable clinicians to make individual operation plans according to the situation of patients in testicular torsion surgeries.