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Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy
INTRODUCTION: The literature reported an increased avoidance of the Emergency Department (ED) during COrona VIrus Disease 19 (COVID-19) pandemic, causing a subsequent increase of morbidity and mortality for acute conditions. Testicular torsion is a surgical emergency, which can lead to the loss of t...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Journal of Pediatric Urology Company. Published by Elsevier Ltd.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188680/ https://www.ncbi.nlm.nih.gov/pubmed/35842391 http://dx.doi.org/10.1016/j.jpurol.2022.06.010 |
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author | Zambaiti, Elisa Cerchia, Elisa Guanà, Riccardo Scottoni, Federico Giannotti, Giulia Dalla Rosa, Davide Pagliara, Camilla Gobbi, Dalia Trovalusci, Emanuele Bucci, Valeria Carretto, Elena Bulotta, Anna Lavinia Chiarenza, Salvatore Fabio Midrio, Paola Gamba, Piergiorgio Cheli, Maurizio Alberti, Daniele Gennari, Fabrizio Gerocarni Nappo, Simona |
author_facet | Zambaiti, Elisa Cerchia, Elisa Guanà, Riccardo Scottoni, Federico Giannotti, Giulia Dalla Rosa, Davide Pagliara, Camilla Gobbi, Dalia Trovalusci, Emanuele Bucci, Valeria Carretto, Elena Bulotta, Anna Lavinia Chiarenza, Salvatore Fabio Midrio, Paola Gamba, Piergiorgio Cheli, Maurizio Alberti, Daniele Gennari, Fabrizio Gerocarni Nappo, Simona |
author_sort | Zambaiti, Elisa |
collection | PubMed |
description | INTRODUCTION: The literature reported an increased avoidance of the Emergency Department (ED) during COrona VIrus Disease 19 (COVID-19) pandemic, causing a subsequent increase of morbidity and mortality for acute conditions. Testicular torsion is a surgical emergency, which can lead to the loss of the affected testicle if a delayed treatment occurs. As testicular loss is time-related, outcome was hypothesized to be negatively affected by the pandemic. OBJECTIVE: The aim is to investigate whether presentation, treatment and outcomes of children with testicular torsion were delayed during COVID-19. STUDY DESIGN: Medical records of pediatric patients operated for testicular torsion of six Paediatric Surgical Units in Northern Italy between January 2019 and December 2020 were retrospectively reviewed. Patients were divided as for ones treated during (dC) or before the pandemic (pC). To reflect possible seasonality, related to lockdown restrictions, winter and summer calendar blocks were also analysed. For all cohorts, demographic data, pre-operative evaluation, operative notes and post-operative outcomes were reviewed. Primary outcomes were referral time, time from diagnosis to surgery and ischemic time, while secondary outcomes were orchiectomy and atrophy rates. Statistic was conducted as appropriate. RESULTS: A total of 188 patients with acute testicular torsion were included in the study period, 89 in the pre-COVID-19 (pC) period and 99 during COVID-19 (dC). Time from symptom onset to the access to the Emergency Department (T1) was not different among the two populations (pC: 5,5 h, dC: 6 h, p 0.374), and similarly time from diagnosis to surgery (pC: 2,5 h, dC: 2,5 h, p 0.970) and ischemic time (pC: 8,2 h, dC: 10 h, p 0.655). T1 was <6 h in 46/99 patients (46%) pC and 45/89 patients (51%) dC (p = 0.88, Fisher's exact test). Subgroup analysis accounting for different lockdown measures, confirm the absence of any difference. Orchiectomies rate was 23% (23/99) dC and 21% (19/89) pC (p = 0.861, Fisher's exact test) and rate of post-operative atrophy was 9% dC (7/76) and 14% pC (10/70), p = 0,44, Fisher's exact test. DISCUSSION: Despite worldwide pediatric ED accesses reduction, we reported that neither ischemic time nor the long-term outcomes in children with testicular torsion increased during the COVID-19 pandemic. In the available literature, few studies investigated the topic and are controversial on the results. Similarly to our findings, some studies found that timing and orchiectomy rates were not significantly different during the pandemic, while others reported a correlation to pandemic seasonality. Furthermore, in the recent pediatric literature it has been reported a delayed testicular torsion diagnosis due to shame in informing parents. Strengths of this study are the large numerosity, its multicentric design and a long study period. Its main limitation is being retrospective. CONCLUSIONS: We reported our large cohort from one of the most heavily COVID-19-affected regions, finding that referral, intra-hospital protocols and ischemic time in testicular torsion were not increased during to the pandemic, as well as orchiectomy rate and atrophy. [Figure: see text] |
format | Online Article Text |
id | pubmed-9188680 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Journal of Pediatric Urology Company. Published by Elsevier Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-91886802022-06-13 Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy Zambaiti, Elisa Cerchia, Elisa Guanà, Riccardo Scottoni, Federico Giannotti, Giulia Dalla Rosa, Davide Pagliara, Camilla Gobbi, Dalia Trovalusci, Emanuele Bucci, Valeria Carretto, Elena Bulotta, Anna Lavinia Chiarenza, Salvatore Fabio Midrio, Paola Gamba, Piergiorgio Cheli, Maurizio Alberti, Daniele Gennari, Fabrizio Gerocarni Nappo, Simona J Pediatr Urol Article INTRODUCTION: The literature reported an increased avoidance of the Emergency Department (ED) during COrona VIrus Disease 19 (COVID-19) pandemic, causing a subsequent increase of morbidity and mortality for acute conditions. Testicular torsion is a surgical emergency, which can lead to the loss of the affected testicle if a delayed treatment occurs. As testicular loss is time-related, outcome was hypothesized to be negatively affected by the pandemic. OBJECTIVE: The aim is to investigate whether presentation, treatment and outcomes of children with testicular torsion were delayed during COVID-19. STUDY DESIGN: Medical records of pediatric patients operated for testicular torsion of six Paediatric Surgical Units in Northern Italy between January 2019 and December 2020 were retrospectively reviewed. Patients were divided as for ones treated during (dC) or before the pandemic (pC). To reflect possible seasonality, related to lockdown restrictions, winter and summer calendar blocks were also analysed. For all cohorts, demographic data, pre-operative evaluation, operative notes and post-operative outcomes were reviewed. Primary outcomes were referral time, time from diagnosis to surgery and ischemic time, while secondary outcomes were orchiectomy and atrophy rates. Statistic was conducted as appropriate. RESULTS: A total of 188 patients with acute testicular torsion were included in the study period, 89 in the pre-COVID-19 (pC) period and 99 during COVID-19 (dC). Time from symptom onset to the access to the Emergency Department (T1) was not different among the two populations (pC: 5,5 h, dC: 6 h, p 0.374), and similarly time from diagnosis to surgery (pC: 2,5 h, dC: 2,5 h, p 0.970) and ischemic time (pC: 8,2 h, dC: 10 h, p 0.655). T1 was <6 h in 46/99 patients (46%) pC and 45/89 patients (51%) dC (p = 0.88, Fisher's exact test). Subgroup analysis accounting for different lockdown measures, confirm the absence of any difference. Orchiectomies rate was 23% (23/99) dC and 21% (19/89) pC (p = 0.861, Fisher's exact test) and rate of post-operative atrophy was 9% dC (7/76) and 14% pC (10/70), p = 0,44, Fisher's exact test. DISCUSSION: Despite worldwide pediatric ED accesses reduction, we reported that neither ischemic time nor the long-term outcomes in children with testicular torsion increased during the COVID-19 pandemic. In the available literature, few studies investigated the topic and are controversial on the results. Similarly to our findings, some studies found that timing and orchiectomy rates were not significantly different during the pandemic, while others reported a correlation to pandemic seasonality. Furthermore, in the recent pediatric literature it has been reported a delayed testicular torsion diagnosis due to shame in informing parents. Strengths of this study are the large numerosity, its multicentric design and a long study period. Its main limitation is being retrospective. CONCLUSIONS: We reported our large cohort from one of the most heavily COVID-19-affected regions, finding that referral, intra-hospital protocols and ischemic time in testicular torsion were not increased during to the pandemic, as well as orchiectomy rate and atrophy. [Figure: see text] Journal of Pediatric Urology Company. Published by Elsevier Ltd. 2022-08 2022-06-12 /pmc/articles/PMC9188680/ /pubmed/35842391 http://dx.doi.org/10.1016/j.jpurol.2022.06.010 Text en © 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Zambaiti, Elisa Cerchia, Elisa Guanà, Riccardo Scottoni, Federico Giannotti, Giulia Dalla Rosa, Davide Pagliara, Camilla Gobbi, Dalia Trovalusci, Emanuele Bucci, Valeria Carretto, Elena Bulotta, Anna Lavinia Chiarenza, Salvatore Fabio Midrio, Paola Gamba, Piergiorgio Cheli, Maurizio Alberti, Daniele Gennari, Fabrizio Gerocarni Nappo, Simona Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy |
title | Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy |
title_full | Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy |
title_fullStr | Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy |
title_full_unstemmed | Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy |
title_short | Testicular torsion during the COVID-19 pandemic: Results of a multicenter study in northern Italy |
title_sort | testicular torsion during the covid-19 pandemic: results of a multicenter study in northern italy |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188680/ https://www.ncbi.nlm.nih.gov/pubmed/35842391 http://dx.doi.org/10.1016/j.jpurol.2022.06.010 |
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