eprintid: 10108476 rev_number: 29 eprint_status: archive userid: 608 dir: disk0/10/10/84/76 datestamp: 2020-08-26 12:05:30 lastmod: 2022-08-17 12:45:28 status_changed: 2020-08-26 12:05:30 type: article metadata_visibility: show creators_name: Kasivisvanathan, V title: Orchidopexy for Testicular Torsion: A Systematic Review of Surgical Technique ispublished: inpress subjects: RFH subjects: UCH divisions: UCL divisions: B02 divisions: C10 divisions: D16 divisions: G88 note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions. abstract: Context: Acute testicular torsion is a common urological emergency. Accepted practice is surgical exploration, detorsion, and orchidopexy for a salvageable testis. Objective: To critically evaluate the methods of orchidopexy and their outcomes with a view to determining the optimal surgical technique. Evidence acquisition: This review protocol was published via PROSPERO [CRD42016043165] and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). EMBASE, MEDLINE, and CENTRAL databases were searched using the following terms: “orchidopexy”, “fixation”, “exploration”, “torsion”, “scrotum”, and variants. Article screening was performed by two reviewers independently. The primary outcome was retorsion rate of the ipsilateral testis following orchidopexy. Secondary outcomes included testicular atrophy and fertility. Evidence synthesis: To our knowledge, this is the first systematic review on this topic. The search yielded 2257 abstracts. Five studies (n = 138 patients) were included. All five techniques differed in incision and/or type of suture and/or point(s) of fixation. Postoperative complications were reported in one study, and included scrotal abscess in 9.1% and stitch abscess in 4.5%. The contralateral testis was fixed in 57.6% of cases. Three studies reported follow-up duration (range 6–31 wk). No study reported any episodes of ipsilateral retorsion. In the studies reporting ipsilateral atrophy rate, this ranged from 9.1% to 47.5%. Fertility outcomes and patient-reported outcome measures were not reported in any studies. Conclusions: There is limited evidence in favour of any one surgical technique for acute testicular torsion. During the consent process for scrotal exploration, uncertainties in long-term harms should be discussed. This review highlights the need for an interim consensus on surgical approach until robust studies examining the effects of an operative approach on clinical and fertility outcomes are available. Patient summary: Twisting of blood supply to the testis, termed testicular torsion, is a urological emergency. Testicular torsion is treated using an operation to untwist the cord that contains the blood vessels. If the testis is still salvageable, surgery can be performed to prevent further torsion. The method that is used to prevent further torsion varies. We reviewed the literature to assess the outcomes of using various surgical techniques to fix the twisting of the testis. Our review shows that there is limited evidence in favour of any one technique. date: 2021 date_type: published publisher: Elsevier official_url: https://doi.org/10.1016/j.euf.2020.07.006 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1809194 doi: 10.1016/j.euf.2020.07.006 lyricists_name: Kasivisvanathan, Veeru lyricists_name: Shah, Taimur lyricists_name: Stavrinides, Vasilis lyricists_id: VKASI35 lyricists_id: TTSHA97 lyricists_id: VSTAV68 actors_name: Kasivisvanathan, Veeru actors_id: VKASI35 actors_role: owner full_text_status: public publication: European Urology Focus issn: 2405-4569 citation: Kasivisvanathan, V; (2021) Orchidopexy for Testicular Torsion: A Systematic Review of Surgical Technique. European Urology Focus 10.1016/j.euf.2020.07.006 <https://doi.org/10.1016/j.euf.2020.07.006>. (In press). Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10108476/3/Kasivisvanathan_Orchidopexy%20for%20Testicular%20Torsion-%20A%20Systematic%20Review%20of%20Surgical%20Technique_AAM.pdf