eP76 Management of suspected testicular torsion – audit of current practice

Aims

Recent publications from NCEPOD and GIRFT have prompted a review of the care provided to patients with suspected testicular torsion. A local audit was performed comparing our practice to these new guidelines.

Methods

All patients who underwent emergency surgery for suspected testicular torsion between 1st January and 31st December 2023 were included in the audit. Primary outcomes were time from arrival to review by a surgical decision maker, and time from decision to operate to surgery. Secondary outcomes included post-operative diagnosis, procedures performed, and post-operative complications.

Results

32 patients were included in the audit. 53.1% of patients (n=17) were reviewed by the surgical team within 1 hour of presentation and 37.5% (n=12) of patients underwent surgical exploration within 1 hour of surgical review. 21.8% (n=7) of patients were diagnosed with testicular torsion, 3 of which (42.8%) required an orchidectomy. A further 3 patients (9.3%) were suspected to have had testicular torsion which had de-torted by the time of surgery. Other post-operative diagnoses included hydrocoele (15.6%), epididymo-orchitis (21.9%) and torted hydatid of Morgagni (12.5%).

7 patients (21.8%) re-presented post-operatively: 3 were discharged with reassurance, 3 required antibiotics, and 1 required contralateral scrotal exploration following trauma.

Conclusion

Improvement is required to meet the standards recommended by GIRFT and NCEPOD. The data has been presented at a local governance meeting and a new clinical pathway has been created to facilitate prompt assessment and treatment of these patients. Data will be re-audited following this to monitor progress.