Background
Methods
Patients demographics, factors, and definitions
Surgical management
Statistical methods
Results
Total (n = 301) | 0–12 h (n = 81) | 13–24 h (n = 33) | >24 h (n = 187) | P | P(≤12h vs >12h) | P(≤24h vs >24h) | |
---|---|---|---|---|---|---|---|
Demographic features | |||||||
Age at symptoms onset (month), median (IQR) | 144 (76.5163.0) | 148 (126.0,164.5) | 136 (26.0,162.0) | 141 (53,162) | 0.020* | 0.010* | 0.176 |
Average age (month), mean ± SE | 119.9 ± 3.3 | 137.7 ± 4.98 | 102.8 ± 11.2 | 115.3 ± 4.4 | 0.020* | 0.010* | 0.176 |
Age category, n (%) | 0.014* | 0.030* | 0.228 | ||||
Pre-school (0–5) | 71 (23.6) | 9 (11.1) | 12 (36.4) | 50 (26.7) | Ref | Ref | Ref |
School-age (6–12) | 80 (26.6) | 24 (29.6) | 9 (27.3) | 47 (25.1) | 0.034* | 0.010* | 0.137 |
Puberty (13–18) | 150 (49.8) | 48 (59.3) | 12 (36.4) | 90 (48.1) | 0.004* | 0.002* | 0.134 |
Clinical features | |||||||
Laterality, n (%) | 0.114 | 0.093 | 0.598 | ||||
Left | 232 (77.1) | 57 (70.4) | 29 (87.9) | 146 (78.1) | |||
Right | 69 (22.9) | 24 (29.6) | 4 (12.1) | 41 (21.9) | |||
Other diagnosis, n (%) | 0.003* | 0.020* | 0.001* | ||||
None | 110 (36.5) | 21 (25.9) | 7 (21.2) | 82 (43.9) | Ref | Ref | Ref |
Cryptorchidism | 19 (6.3) | 5 (6.2) | 1 (10.6) | 13 (7.0) | 0.41 | 0.581 | 0.576 |
Hydrocele | 154 (51.2) | 51 (63.0) | 23 (69.7) | 80 (42.8) | 0.001* | 0.012* | <0.001* |
Ipsilateral | 140 (90.9) | 49 (96.1) | 21 (91.3) | 70 (87.5) | <0.001* | 0.005* | <0.001* |
Contralateral | 7 (4.5) | 0 (0) | 1 (4.3) | 6 (7.5) | |||
Bilateral | 7 (4.5) | 2 (3.9) | 1 (4.3) | 4 (5.0) | |||
Inguinal hernia | 3 (1.0) | 0 (0) | 0 (0) | 3 (1.6) | |||
Testicular microliathiasis | 8 (2.7) | 2 (2.5) | 1 (3.0) | 5 (2.7) | 0.541 | 0.486 | 0.740 |
Concomitant extra-scrotal symptoms, n (%) | 0.181 | 0.065 | 0.135 | ||||
None | 243 (80.7) | 71 (87.7) | 26 (78.8) | 146 (78.1) | Ref | Ref | Ref |
Abdominal pain | 16 (5.3) | 1 (1.2) | 2 (6.1) | 13 (7.0) | 0.077 | 0.089 | 0.092 |
Nausea and/or vomit | 27 (9.0) | 5 (6.2) | 4 (12.1) | 18 (9.6) | 0.465 | 0.241 | 0.506 |
Fever | 5 (1.7) | 0 (0) | 1 (3.0) | 4 (2.1) | |||
Inguinal pain/ mass | 10 (3.3) | 4 (4.9) | 0 (0) | 6 (3.2) | |||
With symptoms progress, n (%) | 0.001* | <0.001* | 0.003* | ||||
Yes | 55 (18.3) | 4 (4.9) | 7 (21.2) | 44 (23.5) | |||
No | 246 (81.7) | 77 (95.1) | 26 (78.8) | 143 (76.5) | |||
History of former treatment, n (%) | <0.001* | <0.001* | <0.001* | ||||
Yes | 91 (30.2) | 3 (3.7) | 8 (24.2) | 80 (42.8) | |||
No | 210 (69.8) | 78 (96.3) | 25 (75.8) | 107 (57.2) | |||
Class of first-consultant medical establishment and diagnosis, n (%) | <0.001* | <0.001* | <0.001* | ||||
Primary health-care unit | 32 (10.6) | 1 (1.2) | 5 (15.2) | 26 (13.9) | Ref | Ref | Ref |
Highly suspected TT | 2 (6.2) | 0 (0) | 0 (0) | 2 (7.7) | |||
Misdiagnosis | 30 (93.8) | 1 (100) | 5 (100) | 24 (92.3) | |||
Secondary | 45 (15.0) | 1 (1.2) | 3 (9.1) | 41 (21.9) | NA | NA | 0.118 |
Highly suspected TT | 13 (28.9) | 0 (0) | 2 (66.7) | 11 (26.8) | |||
Misdiagnosis | 32 (71.1) | 1 (100) | 1 (33.3) | 30 (73.2) | |||
Tertiary | 224 (74.4) | 79 (97.5) | 25 (75.8) | 120 (64.2) | 0.001* | P<0.001* | 0.003* |
Highly suspected TT | 204 (91.1) | 74 (93.7) | 22 (88.0) | 108 (90.0) | |||
Misdiagnosis | 20 (8.9) | 5 (6.3) | 3 (12.0) | 12 (10.0) | |||
Socioeconomic features | |||||||
Medical insurance, n (%) | 0.133 | 0.318 | 0.061 | ||||
Yes | 183 (60.8) | 53 (65.4) | 24 (72.7) | 106 (56.7) | |||
No | 118 (39.2) | 28 (34.6) | 9 (27.3) | 81 (43.3) | |||
Poverty county residence, n (%) | 0.004* | 0.002* | 0.001* | ||||
Yes | 42 (14.0) | 3 (3.7) | 3 (9.1) | 36 (19.3) | |||
No | 259 (86.0) | 78 (96.3) | 30 (90.9) | 151 (80.7) | |||
Neighboring main city zone, n (%) | <0.001* | <0.001* | <0.001* | ||||
Yes | 143 (47.5) | 62 (76.5) | 21 (63.6) | 60 (32.1) | |||
No | 158 (52.5) | 19 (23.5) | 12 (36.4) | 127 (67.9) | |||
Main guardian, n (%) | 0.886 | 0.692 | 0.969 | ||||
Parents | 277 (92.0) | 74 (91.4) | 31 (93.9) | 172 (92.0) | |||
Grandparent | 13 (4.3) | 4 (4.9) | 1 (3.0) | 8 (4.3) | |||
Near relation | 11 (3.7) | 3 (3.7) | 1 (3.0) | 7 (3.7) | |||
Degree of guardians’ education, n (%) && | 0.343 | 0.146 | 0.257 | ||||
Primary school | 27 (20.3) | 5 (12.2) | 3 (23.1) | 19 (24.1) | |||
Secondary school | 53 (39.8) | 14 (34.1) | 6 (46.2) | 33 (41.8) | |||
Senior high school | 25 (18.8) | 11 (26.8) | 3 (23.1) | 11 (13.9) | |||
College and above | 28 (21.1) | 11 (26.8) | 1 (7.7) | 16 (20.3) |
Factors | Parameter estimate | SE | P | OR (95% CI) |
---|---|---|---|---|
Age less than 6 years | 1.493 | 0.433 | 0.001 | 4.458 (1.906–10.425) |
Without other diagnosis | 0.873 | 0.342 | 0.011 | 2.393 (1.225–4.676) |
Away from the main city zone | 1.713 | 0.340 | <0.001 | 5.543 (2.844–10.804) |
History of former treatment | 2.421 | 0.561 | <0.001 | 11.262 (3.754–33.788) |
With symptoms progress | 1.972 | 0.581 | 0.001 | 7.186 (2.302–22.435) |
Total (n = 301) | 0–12 h (n = 81) | 13–24 h (n = 33) | >24 h (n = 187) | P | P(≤12h vs >12h) | P(≤24h vs >24h) | |
---|---|---|---|---|---|---|---|
Direction of rotation, n (%) | 0.816 | 0.543 | 0.552 | ||||
Clockwise | 181 (60.1) | 51 (63.0) | 20 (60.6) | 110 (58.8) | |||
Anticlockwise | 120 (39.9) | 30 (37.0) | 13 (39.4) | 77 (41.2) | |||
Degree of cord twisting, n (%) ° | 0.145 | 0.050* | 0.123 | ||||
0–180 | 44 (14.6) | 22 (27.2) | 5 (15.2) | 17 (9.1) | Ref | Ref | Ref |
181–360 | 104 (34.6) | 23 (28.4) | 9 (27.3) | 72 (38.5) | 0.002* | 0.001* | 0.001* |
361–540 | 67 (22.3) | 14 (17.3) | 10 (30.3) | 43 (23.0) | 0.014* | 0.005* | 0.007* |
541–720 | 80 (26.6) | 20 (24.7) | 9 (27.3) | 51 (27.3) | 0.006* | 0.001* | 0.008* |
>720 | 6 (2.0) | 2 (2.5) | 0 (0) | 4 (2.1) | |||
Type of torsion, n (%) | 0.787 | 0.625 | 0.491 | ||||
Extra-vaginal | 21 (7.0) | 7 (8.6) | 2 (6.1) | 12 (6.4) | |||
Intra-vaginal | 280 (93.0) | 74 (91.4) | 31 (93.9) | 175 (93.6) | |||
Blood supply, n (%) | <0.001* | <0.001* | <0.001* | ||||
Rich | 73 (24.2) | 49 (60.5) | 12 (36.4) | 12 (6.4) | Ref | Ref | Ref |
Poor | 84 (27.9) | 24 (29.6) | 9 (27.3) | 51 (27.3) | <0.001* | <0.001* | <0.001* |
Little | 144 (47.8) | 8 (9.9) | 12 (36.4) | 124 (66.3) | <0.001* | <0.001* | <0.001* |
Grade of Arda, n (%) ΓΓ | <0.001* | <0.001* | <0.001* | ||||
I | 27 (9.0) | 20 (24.7) | 4 (12.1) | 3 (1.6) | Ref | Ref | Ref |
II | 120 (39.9) | 51 (63.0) | 14 (42.4) | 55 (29.4) | 0.003* | 0.003* | 0.001* |
III | 154 (51.2) | 10 (12.3) | 15 (45.5) | 129 (69.0) | <0.001* | <0.001* | <0.001* |
Outcome of detorsion and adequate management, n (%) | <0.001* | <0.001* | <0.001* | ||||
Obviously improved | 67 (22.3) | 45 (55.6) | 8 (24.2) | 14 (7.5) | Ref | Ref | Ref |
Slightly improved | 85 (28.2) | 27 (33.3) | 10 (30.3) | 48 (25.7) | <0.001* | <0.001* | <0.001* |
Not improved | 39 (13.0) | 7 (8.6) | 7 (21.2) | 25 (13.4) | <0.001* | <0.001* | <0.001* |
Orchiectomy | 110 (36.5) | 2 (2.5) | 8 (24.2) | 100 (53.5) | <0.001* | <0.001* | <0.001* |