A multicenter study of acute testicular torsion in the time of COVID-19.

COVID-19 Humans Male Orchiectomy Pandemics Prospective Studies Retrospective Studies SARS-CoV-2 Spermatic Cord Torsion / diagnosis
COVID-19 Pandemic Testicular torsion Urologic emergencies

Journal

Journal of pediatric urology
ISSN: 1873-4898
Titre abrégé: J Pediatr Urol
Pays: England
ID NLM: 101233150

Informations de publication

Date de publication:
08 2021
Historique:
received: 19 02 2021
revised: 12 03 2021
accepted: 16 03 2021
pubmed: 10 4 2021
medline: 15 10 2021
entrez: 9 4 2021
Statut: ppublish

Résumé

Testicular torsion is a surgical emergency, and time to detorsion is imperative for testicular salvage. During the COVID-19 pandemic, patients may delay emergency care due to stay-at-home orders and concern of COVID-19 exposure. To assess whether emergency presentation for testicular torsion was delayed during the COVID-19 pandemic, and whether the rate of orchiectomy increased compared to a retrospective period. Patients were prospectively enrolled in a multicenter study from seven institutions in the United States and Canada. Inclusion criteria were patients two months to 18 years of age with acute testicular torsion from March through July 2020. The retrospective group included patients from January 2019 through February 2020. Statistical analysis was performed using Kruskal-Wallis tests, Chi-square tests, and logistic regression. A total of 221 patients were included: 84 patients in the COVID-19 cohort and 137 in the retrospective cohort. Median times from symptom onset to emergency department presentation during COVID-19 compared to the retrospective period were 17.9 h (IQR 5.5-48.0) and 7.5 h (IQR 4.0-28.0) respectively (p = 0.04). In the COVID-19 cohort, 42% of patients underwent orchiectomy compared to 29% of pre-pandemic controls (p = 0.06). During COVID-19, 46% of patients endorsed delay in presentation compared to 33% in the retrospective group (p = 0.04). We found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a higher proportion of patients reported delaying care. Strengths of the study include the number of included patients and the multicenter prospective design during the pandemic. Limitations include a retrospective pre-pandemic comparison group. In a large multicenter study we found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a significantly higher proportion of patients reported delaying care. Based on the findings of this study, more patient education is needed on the management of testicular torsion during a pandemic.

Sections du résumé

BACKGROUND
Testicular torsion is a surgical emergency, and time to detorsion is imperative for testicular salvage. During the COVID-19 pandemic, patients may delay emergency care due to stay-at-home orders and concern of COVID-19 exposure.
OBJECTIVE
To assess whether emergency presentation for testicular torsion was delayed during the COVID-19 pandemic, and whether the rate of orchiectomy increased compared to a retrospective period.
STUDY DESIGN
Patients were prospectively enrolled in a multicenter study from seven institutions in the United States and Canada. Inclusion criteria were patients two months to 18 years of age with acute testicular torsion from March through July 2020. The retrospective group included patients from January 2019 through February 2020. Statistical analysis was performed using Kruskal-Wallis tests, Chi-square tests, and logistic regression.
RESULTS
A total of 221 patients were included: 84 patients in the COVID-19 cohort and 137 in the retrospective cohort. Median times from symptom onset to emergency department presentation during COVID-19 compared to the retrospective period were 17.9 h (IQR 5.5-48.0) and 7.5 h (IQR 4.0-28.0) respectively (p = 0.04). In the COVID-19 cohort, 42% of patients underwent orchiectomy compared to 29% of pre-pandemic controls (p = 0.06). During COVID-19, 46% of patients endorsed delay in presentation compared to 33% in the retrospective group (p = 0.04).
DISCUSSION
We found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a higher proportion of patients reported delaying care. Strengths of the study include the number of included patients and the multicenter prospective design during the pandemic. Limitations include a retrospective pre-pandemic comparison group.
CONCLUSIONS
In a large multicenter study we found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a significantly higher proportion of patients reported delaying care. Based on the findings of this study, more patient education is needed on the management of testicular torsion during a pandemic.

Identifiants

DOI: 10.1016/j.jpurol.2021.03.013 PMID: 33832873 PMC: PMC7977032
pubmed: 33832873
pii: S1477-5131(21)00129-7
doi: 10.1016/j.jpurol.2021.03.013
pmc: PMC7977032
pii:
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

478.e1-478.e6

Informations de copyright

Copyright © 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Auteurs

Sarah A Holzman (SA)

University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA. Electronic address: saholzma@hs.uci.edu.

Jennifer J Ahn (JJ)

Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA.

Zoe Baker (Z)

Children's Hospital Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA.

Kai-Wen Chuang (KW)

University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.

Hillary L Copp (HL)

University of California, San Francisco, Department of Urology, San Francisco, CA, USA.

Jacob Davidson (J)

Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada.

Carol A Davis-Dao (CA)

University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.

Emily Ewing (E)

Western University, Department of Urology, London, Ontario, Canada.

Joan Ko (J)

Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA.

Victoria Lee (V)

University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA.

Amanda Macaraeg (A)

University of California, Irvine, Department of Urology, Irvine, CA, USA.

Lauren Nicassio (L)

Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA.

Michael Sadighian (M)

University of California, San Francisco, Department of Urology, San Francisco, CA, USA.

Heidi A Stephany (HA)

University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.

Renea Sturm (R)

University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA.

Kelly Swords (K)

University of California, San Diego, Department of Urology, La Jolla, CA, USA; Rady Children's Hospital, Division of Pediatric Urology, San Diego, CA, USA.

Peter Wang (P)

Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada.

Elias J Wehbi (EJ)

University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.

Antoine E Khoury (AE)

University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.

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Classifications MeSH

questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › COVID-19 › A multicenter study of acute testicular...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A multicenter study of acute testicular...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie urogénitale › Procédures de chirurgie urologique › Procédures de chirurgie urologique masculine › Orchidectomie › A multicenter study of acute testicular...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Épidémies de maladies › Épidémies › Pandémies › A multicenter study of acute testicular...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › A multicenter study of acute testicular...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › A multicenter study of acute testicular...
questionsmedicales.fr › Virus › Virus à ARN › Virus à ARN à brin positif › Nidovirales › Coronaviridae › Coronavirus › Betacoronavirus › Virus du SRAS › SARS-CoV-2 › A multicenter study of acute testicular...
questionsmedicales.fr › Maladies urogénitales › Maladies urogénitales de l'homme › Maladies de l'appareil génital mâle › Torsion du cordon spermatique › A multicenter study of acute testicular...