Pandemic effects on testicular torsion management and late referral of patients

Pandemic effects on testicular torsion management and late referral of patients

Authors

Keywords:

Testicular torsion, Pandemic, COVID-19, SARS-COV-2

Abstract

No Abstract.

Full Text:

Testicular torsion is a frequent pediatric emergency that happens when the ‎testicle twists around its axis, impairing blood flow and sometimes resulting ‎in irreparable alterations or even the entire loss of the testis. In boys under ‎the age of 25 there are 4.5 cases of testicular torsion per 100,000. Despite ‎the fact that testicular torsion can happen at any age, it most frequently ‎affects infants and young guys between the ages of 13 and 16 who are going ‎through puberty or adolescence (1). The eventual effect of untreated ‎testicular torsion is organ loss, making it a surgical emergency. Longer ‎ischemia durations are associated with an increased risk of testicular loss, ‎atrophy, and dysfunction‎‏ ‏‎(2). A diagnosis must be done quickly, ideally within ‎‎6 hours, to prevent negative results and to preserve the viability of the testis ‎‎(3). Furthermore, the amount of time it takes from the patient's emergency ‎department (ED) visit to get to the operating room (OR) is a separate ‎predictor of testicular survival (4). If the damaged testicle is determined to be ‎viable, orchidectomy with a permanent suture should be done to fix the ‎testicle within the scrotum permanently. However, the longer the hospital ‎visit is postponed, the more probable it is that an orchiectomy will be carried ‎out (5). Therefore, it's crucial to understand how testicular torsion often ‎presents, which is with rapid onset unilateral testicular discomfort that may ‎be followed by nausea and/or vomiting. When palpated, the afflicted testis ‎feels hard and is typically positioned at an odd angle ‏‎(3)‎.

Atypical pneumonia brought on by a new human coronavirus (COVID-19) ‎was initially identified towards the end of 2019 in Wuhan, China, and then ‎spread to other parts of the world. The COVID-19 outbreak was deemed a ‎Public Health Emergency of International Concern by the World Health ‎Organization (WHO) on January 30, 2020, and the worldwide pandemic was ‎notified on March 11, 2020(6). Since the World Health Organization ‎pronounced COVID-19 a worldwide pandemic, the disease has become more ‎than simply a threat to public health because of the sustained national ‎lockdowns it has caused and the changes in people's lifestyles. all these are ‎alterations to the accessibility and organization of how education is delivered ‎to pupils, food insecurity due to scarcity and price fluctuations, the global ‎economic downturn, and a rise in mental health issues, wellness, and quality of ‎life, among other things (7).  The lowest-income persons, who are already ‎medically vulnerable and socioeconomically disadvantaged, avoided time-sensitive emergency treatment in a way that was substantially correlated ‎with a lack of a personal doctor, lower subjective health conditions, and a large ‎load of comorbidities (8). During the COVID-19 pandemic, stay-at-home ‎directives and concern about coronavirus infection can potentially cause ‎delays in the presentation of patients with testicular torsion to emergency ‎rooms and dramatically increase the frequency of testicular losses (1). In ‎addition, the medical literature has noted an increased avoidance of emergency ‎rooms for non-COVID-19 infections during the coronavirus (COVID-19) ‎pandemic (9, 10). however, in a study with 82 torsions showed that in those ‎with acute testicular torsion, there hasn't been a noticeable change in the ‎time to operating room or the rate of orchiectomy (11)‎.

In a meta-analysis study in 2022, 6 papers were chosen to be included in the ‎meta-analysis of the orchiectomy rate among testicular torsion cases, with ‎the age range being confined to pediatric cases to reduce heterogeneity. This ‎was showing an increase in orchiectomy rates among testicular torsion in ‎COVID-19 cohorts compared to pre-COVID-19, which was statistically ‎significant (12). On the other hand, these rates depend on various factors, ‎such as the country being studied, the time of the study, the laws used to ‎control quarantine, the extent of their commitment to the laws, the cultural ‎conditions of the people of each country, and the level of awareness of the ‎people about Corona. Due to the passage of time and people getting used to ‎the quarantine conditions, their fear of getting infected by the coronavirus ‎can decrease. As a result, there might be differences in the findings of ‎different studies. For example, there is a cohort study in northern Italy in ‎the year 2022 with 188 patients that reported referral, intra-hospital ‎protocols, and ischemic time in testicular torsion were not increased during ‎the pandemic, as well as orchiectomy rate and atrophy (13). In a meta-analysis study in 2022, including six comparative studies. Between the two ‎patient groups, there were no significant changes in the average duration of ‎symptoms, the percentage of kids who presented late, or the frequency of ‎orchiectomies. Although the orchiectomy rate was 1.23 times (3). Zenon et al. ‎found in 2021 that A considerably greater prevalence of orchiectomies ‎and an increase in delayed presentations for testicular torsion were seen ‎during the COVID-19 pandemic (1)‎.

Since the coronavirus was declared a pandemic disease, it has caused ‎many changes around the world. The treatment system has also undergone ‎major changes, some of which were positive and some negative. Its ‎negative changes can be said to have effects on the treatment process of ‎other non-covid diseases, including emergency diseases. Testicular torsion is ‎one of the most important emergency diseases that must be addressed in ‎the golden hours to prevent permanent organ loss. In studies, it has been ‎shown that the rate of delay in patients' visits or the rate of orchiectomy has ‎increased compared to the era before Corona. Orchiectomy can be a ‎preventable process if patients go to the hospital at the golden ‎time. Educating patients, who are mostly children, or their companions can ‎have a significant impact on these delays. It is necessary to teach them the ‎early symptoms of the disease so that they can make the right and necessary ‎decisions in certain situations. Pre-hospital services and mass media can play ‎this role. Achieving these results requires attention to health education in the ‎structure of health departments of countries.

Ethics approval and consent to participate: Not applicable.‎

Consent For Publication: Not Applicable

Availability of Data and Materials:   Not Applicable

Competing interests:  None.

Funding: None.

Authors' contributions:  This letter was written due to an invitation from the editorial board. AA conducted all the study stages‎.

Acknowledgment: None.

 

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References

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Published

2022-11-13

How to Cite

Andishgar, A. (2022). Pandemic effects on testicular torsion management and late referral of patients . Updates in Emergency Medicine, 2(1), 75–77. Retrieved from http://uiemjournal.com/index.php/main/article/view/24
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