兒童急性睪丸扭轉—社區醫院病例報告
莊梓昱1、邱逸淳1,2、張彰琦1,2、洪士奇1、邱文祥1,2
1台北市立聯合醫院忠孝院區外科部 泌尿科；2國立陽明大學醫學院泌尿學科
Testicular torsion of children in community hospital setting – case reports and literature reviews
Tzu-Yu Chuang1、Yi-Chun Chiu1,2、Chang-Chi Chang1,2、Shah-Chyi Hung1、Allen W. Chiu1,2
1Division of Urology, Department of Surgery, ZhongXiao Branch, Taipei City Hospital, Taipei, Taiwan
2Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Introduction
Testicular torsion is an urgent clinical conditions associated with significant morbidity. It is extremely challenging when occurred in children. Early identification and prompt surgical intervention are the key factors to preserve the fertility. We reviewed three cases of testicular torsion in children in our community hospital.
Methods
Three patients under eighteen years old with suspicion of testicular torsion from our emergency department were reviewed. The TWIST (Testicular Workup for Ischemia and Suspected Torsion) score were used to examined risk of testicular torsion retrospectively.
Results
Three of our patients were aged twelve, fourteen and eighteen years old. Two of them affected the right testis, and one of them affected left testis. Two of three experienced nausea and vomiting sensation. One of them visited our urologic clinic, and two of three were sent to emergency department. One of them underwent manual detorsion, and all of them underwent surgical exploration. Median TWIST score reported score 4 with intermediate risk. Average time to first visit of our hospital were 140 minutes (median time : 60 minutes ). Two of three underwent orchiectomy after warm water gauze packing. One patient had preserved the testis with 5 to 10 percent area of non-viable tissue during operation.
Conclusions
Acute testicular torsion in children is a challenging clinical scenario requiring fast identification and emergent surgical intervention. According to current research, Prehn signs reported relative low sensitivity rate compared to absent cremasteric reflex. Also, recent literature revealed that fast evaluation by using TWIST score yield better prognosis.