Delayed Care Seeking and Outcomes of Testicular Torsion among Children during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Zihan Ye; Hongsong Chen; Xing Liu; Guanghui Wei

doi:10.1055/s-0042-1758153

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2023; 33(05): 377-385
DOI: 10.1055/s-0042-1758153

Original Article

Delayed Care Seeking and Outcomes of Testicular Torsion among Children during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Authors

Zihan Ye

¹Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China

²Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China

³Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
Hongsong Chen

¹Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China

²Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China

³Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
Xing Liu

¹Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China

²Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China

³Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
Guanghui Wei

¹Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China

²Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China

³Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China

Abstract

Introduction Since the onset of coronavirus disease 2019 (COVID-19), stay-at-home orders and fear caused by the pandemic have had a significant effect on the timing and outcomes of testicular torsion. However, the evidence was limited since the study results were inconsistent. This study aims to examine the hospitalization rates, timing, and outcomes of testicular torsion in children before and during the pandemic.

Materials and Methods Using PubMed, Embase, and Google Scholar databases, we conducted a systematic search and meta-analysis of studies reporting the timing and outcomes of children admitted with testicular torsion before and during the COVID-19 pandemic. Subgroup analyses were conducted to explore possible sources of heterogeneity.

Result The outcomes of 899 testicular torsion patients from eight studies were evaluated. Our study found an increased hospitalization rate for patients with testicular torsion (incidence rate ratio = 1.60, 95% confidence interval [CI]: 1.27–2.03; p = 0.001). Despite a significant increase in the duration of symptoms during the COVID-19 pandemic (weighted mean difference = 11.04, 95% CI: 2.75–19.33; p = 0.009), orchiectomy rates did not increase (odds ratio = 1.33, 95% CI: 0.85–2.10; p = 0.147).

Conclusion During the COVID-19 pandemic, hospitalization rates for testicular torsion and the duration of symptoms among children increased significantly. Moreover, the rate of orchiectomy did not increase during the pandemic, indicating that pediatric emergency services have remained efficient and have prevented an increase in the number of orchiectomies performed despite pandemic-related closures and delays in transporting patients to medical care.

Keywords

testicular torsion - pediatric emergency - COVID-19 - orchiectomy

Full Text

References

References
1 Bartsch G, Frank S, Marberger H, Mikuz G. Testicular torsion: late results with special regard to fertility and endocrine function. J Urol 1980; 124 (03) 375-378
2 Mansbach JM, Forbes P, Peters C. Testicular torsion and risk factors for orchiectomy. Arch Pediatr Adolesc Med 2005; 159 (12) 1167-1171
3 Ann Kroger-Jarvis M, Gillespie GL. Presentation of testicular torsion in the emergency department. Adv Emerg Nurs J 2016; 38 (04) 295-299
4 Ridgway A, Hulme P. BET 2: Twist score in cases of suspected paediatric testicular torsion. Emerg Med J 2018; 35 (09) 574-575
5 Klinke M, Elrod J, Stiel C. et al. The BAL-score almost perfectly predicts testicular torsion in children: a two-center cohort study. Front Pediatr 2020; 8: 601892
6 Esperto F, Papalia R, Autrán-Gómez AM, Scarpa RM. COVID-19's impact on Italian urology. Int Braz J Urol 2020; 46 (Suppl. 01) 26-33
7 Salciccia S, Eisenberg ML, Maggi M. et al. Modeling the contribution of male testosterone levels to the duration of positive COVID testing among hospitalized male COVID-19 patients. Diagnostics (Basel) 2021; 11 (04) 11
8 Holzman SA, Ahn JJ, Baker Z. et al; Western Pediatric Urology Consortium (WPUC). A multicenter study of acute testicular torsion in the time of COVID-19. J Pediatr Urol 2021; 17 (04) 478.e1-478.e6
9 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25 (09) 603-605
10 McGrath S, Zhao X, Steele R, Thombs BD, Benedetti A. DEPRESsion Screening Data (DEPRESSD) Collaboration. Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis. Stat Methods Med Res 2020; 29 (09) 2520-2537
11 Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414): 557-560
12 Nelson CP, Kurtz MP, Logvinenko T, Venna A, McNamara ER. Timing and outcomes of testicular torsion during the COVID-19 crisis. J Pediatr Urol 2020; 16 (06) 841.e1-841.e5
13 Littman AR, Janssen KM, Tong L. et al. Did COVID-19 affect time to presentation in the setting of pediatric testicular torsion?. Pediatr Emerg Care 2021; 37 (02) 123-125
14 Shields LBE, Daniels MW, Peppas DS. et al. Surge in testicular torsion in pediatric patients during the COVID-19 pandemic. J Pediatr Surg 2022; 57 (08) 1660-1663
15 Lee AS, Pohl HG, Rushton HG, Davis TD. Impact of COVID-19 pandemic on the presentation, management and outcome of testicular torsion in the pediatric population - an analysis of a large pediatric center. Can J Urol 2021; 28 (04) 10750-10755
16 Pogorelic Z, Milanovic K, Versic AB. et al. Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic?-A retrospective multicenter study. J Pediatr Urol 2021; 17: 479.e1-479.e6
17 Zambaiti E, Cerchia E, Guanà R. et al. Testicular torsion during the COVID-19 pandemic: results of a multicenter study in northern Italy. J Pediatr Urol 2022; S1477-5131 (22) 00277-7
18 Yu X, Zhang Y. New characteristics of testicular torsion in children during COVID-19. J Pediatr Urol 2021; 17 (06) 882-883
19 Place R, Lee J, Howell J. Rate of pediatric appendiceal perforation at a children's hospital during the COVID-19 pandemic compared with the previous year. JAMA Netw Open 2020; 3 (12) e2027948
20 McDonnell T, Nicholson E, Conlon C. et al. Assessing the impact of COVID-19 public health stages on paediatric emergency attendance. Int J Environ Res Public Health 2020; 17 (18) 17
21 Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health 2020; 4 (05) e10-e11
22 Steeman A, Ngatchou W, Ramadan AS. et al. Impact of treatment delays on outcome of acute testicular torsion: a 15-year retrospective study. Acta Chir Belg 2022; 122 (02) 116-122
23 Feng S, Yang H, Lou Y, Ru W, Wang A, Liu W. Clinical characteristics of testicular torsion and identification of predictors of testicular salvage in children: a retrospective study in a single institution. Urol Int 2020; 104 (11-12): 878-883
24 Mellick LB, Sinex JE, Gibson RW, Mears K. A systematic review of testicle survival time after a torsion event. Pediatr Emerg Care 2019; 35 (12) 821-825
25 Morin OA, Carr MG, Holcombe JM, Bhattacharya SD. Optimal predictor of gonadal viability in testicular torsion: time to treat versus duration of symptoms. J Surg Res 2019; 244: 574-578
26 Tian XM, Tan XH, Shi QL. et al. Risk factors for testicular atrophy in children with testicular torsion following emergent orchiopexy. Front Pediatr 2020; 8: 584796
27 Zvizdic Z, Aganovic A, Milisic E, Jonuzi A, Zvizdic D, Vranic S. Duration of symptoms is the only predictor of testicular salvage following testicular torsion in children: a case-control study. Am J Emerg Med 2021; 41: 197-200
28 Gold DD, Lorber A, Levine H. et al. Door to detorsion time determines testicular survival. Urology 2019; 133: 211-215
29 Frisenda M, Signore S, Delicato G. et al. Influence of COVID-19 pandemic on timing and outcomes of treatment for acute testicular torsion in adults: a single institution experience. Can J Urol 2022; 29 (02) 11095-11100
30 Lombardo AM, Andolfi C, Deshpande AP, Aizen JM, Dangle PP, Gundeti MS. Pediatric urology amidst SARS-CoV-2 pandemic: building the future with current knowledge. J Pediatr Surg 2021; 56 (05) 923-928
31 Merino-Mateo L, Tordable Ojeda C, Cabezalí Barbancho D, Gómez Fraile A. Impact of the COVID-19 pandemic on the surgical activity of Pediatric Urology: analysis of postoperative complications according to the Clavien-Dindo classification [in English]. Actas Urol Esp (Engl Ed) 2020; 44 (10) 659-664
32 Quaedackers JSLT, Stein R, Bhatt N. et al. Clinical and surgical consequences of the COVID-19 pandemic for patients with pediatric urological problems: statement of the EAU guidelines panel for paediatric urology, March 30 2020. J Pediatr Urol 2020; 16 (03) 284-287
33 Ugwu BT, Dakum NK, Yiltok SJ. et al. Testicular torsion on the Jos Plateau. West Afr J Med 2003; 22 (02) 120-123
34 Mizrahi S, Shtamler B. Surgical approach and outcome in torsion of testis. Urology 1992; 39 (01) 52-54
35 Srinivasan AK, Freyle J, Gitlin JS, Palmer LS. Climatic conditions and the risk of testicular torsion in adolescent males. J Urol 2007; 178 (06) 2585-2588 , discussion 2588
36 Pogorelić Z, Anand S, Artuković L, Krishnan N. Comparison of the outcomes of testicular torsion among children presenting during the coronavirus disease 2019 (COVID-19) pandemic versus the pre-pandemic period: a systematic review and meta-analysis. J Pediatr Urol 2022; 18 (02) 202-209
37 Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14: 135