Testicular torsion as seen at Kilimanjaro Christian medical center, Moshi-Tanzania

Obadia Venance Nyongole1*, Njiku Kimu2 , Bright Frank3 , Kien Alfred Mteta4 , Jasper Mbwambo5 3, 4, 5 Institute of Urology, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania 1 Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar ES Salaam, Tanzania 2 Department of Surgery, Muhimbili National Hospital, P.O. Box, Dares Salaam, Tanzania
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Background: Testicular torsion is a common condition in both developed and developing countries. Testicular torsion is an emergency urological condition. Early diagnosis and treatment are crucial to restore perfusion and preserve testicular viability. Testicular torsion needs special attention due to its psychosocial long term impact which can be avoided if early intervention is done.

Objectives: The aim of the study was to determine the pattern of presentation and early outcome of patients with testicular torsion managed at KCMC.

Patient and method: This was a hospital based descriptive retrospective and prospective study conducted at KCMC. It involved patients presenting to urology department confirmed to have testicular torsion managed during the period of study from January 2006-January2015.

Results: A total of 74 patients were managed for Testicular torsion during the study period of nine years as per inclusion criteria. The left side was more affected by 64.9%. None of our patients had synchronous bilateral torsion while 4(3.8%) patients had metachronous bilateral torsion. Fifty eight (78%) patients were 13 years of age with a mean age of 16.92 and a standard deviation of 6.01.Twenty two (29.7%) patients arrived at KCMC within six hours from the onset of symptoms while 48 (64.9%) patients reported to our hospital beyond six hours but less than 24 hours. Scrotal pain was the main complaint. Fifty (68%) patients were misdiagnosed at the peripheral health facilities and treated empirically with antibiotics. Ninety six point nine percent of those with more than 360 degrees of rotation and duration of arrival to KCMC beyond six hours were found with ischemic necrotic testis compared to 52.4% of those with a degree of rotation less than 360 and less than six hours on arrival at KCMC. (p- Value 0.000). Orchiectomy of the affected testis and fixation of the unaffected testis was the most commonly adopted treatment option by 55.4%. Eighty four percent of our patients had firm and smooth testis at follow up of three months with 16% having atrophic testis at three months in both groups (retrospective and prospective arms).

Conclusion: Testicular torsion is common in our setting affecting the young adolescent group with the left testis being more affected. The majority of patients presenting late (>6 h) require orchiectomy owing to testicular necrosis. Chances of testicular salvage after torsion are higher if patients present early. Outcome at three months for both affected and those fixed prophylactically is promising by having viable testis.