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

Authors

Sarah A. Holzman, University of California, Irvine
Jennifer J. Ahn, Seattle Children's
Zoe Baker, Children's Hospital Los Angeles
Kai wen Chuang, University of California, Irvine
Hillary L. Copp, University of California, San Francisco
Jacob Davidson, Western UniversityFollow
Carol A. Davis-Dao, University of California, Irvine
Emily Ewing, Western University
Joan Ko, Seattle Children's
Victoria Lee, University of California, Los Angeles
Amanda Macaraeg, University of California, Irvine
Lauren Nicassio, Seattle Children's
Michael Sadighian, University of California, San Francisco
Heidi A. Stephany, University of California, Irvine
Renea Sturm, University of California, Los Angeles
Kelly Swords, Department of Urology
Peter Wang, Western University
Elias J. Wehbi, University of California, Irvine
Antoine E. Khoury, University of California, Irvine

Document Type

Article

Publication Date

8-1-2021

Journal

Journal of Pediatric Urology

Volume

17

Issue

4

First Page

478.e1

Last Page

478.e6

URL with Digital Object Identifier

10.1016/j.jpurol.2021.03.013

Abstract

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.