THE ROLE OF MANUAL DETORSION IN PEDIATRIC TESTICULAR TORSION DURING THE GLOBAL COVID-19 PANDEMIC: EXPERIENCE FROM TWO CENTRES

Objective: To evaluate the role of emergency manual detorsion as first line management for testicular torsion in the context of the COVID-19 pandemic. Methods: This retrospective observational study includes 90 pediatric patients ≤14 years old with diagnosis of testicular torsion made at 2 tertiary centers between October 2020 and June 2022. Variables examined included age, presentation delay, surgical wait time, number of attempts at manual testicular detorsion, and manual testicular detorsion success. All patients finally underwent surgery, including contralateral testicular fixation. Outcomes included predictors of successful manual detorsion, testicular findings at surgery, and operation time. Results: Mean (SD) age at diagnosis was 11.51 (2.64) years. Mean presentation delay was 11.76 (13.79) hours. Detorsion was attempted in 72 (80%) patients, resulting successful in 58 (80.5%). Surgical wait time after successful manual detorsion was 22.85 (16.94) hours. On multivariable analysis, successful manual detorsion was associated with a presentation delay <6 hours (OR 0.154, 95% CI 0.036-0.655, p=0.01) and absence of scrotal edema (OR 0.171, 95% CI 0.038-0.769, p=0.02). Vice versa, a heterogeneous echo-texture (OR 0.57, 95% CI 0.007 - 0.461, p=0.007) and absent blood flow on Doppler USS (OR 0.256, 95% CI 0.067 - 0.971, p=0.045) were significantly associated with the likelihood of manual detorsion failure. Conclusions: In our experience, manual detorsion provided safe and effective emergency treatment for pediatric testicular torsion, especially in absence of edema and when presentation delay is <6 hours. This maneuver should be more widely attempted immediately after diagnosis as temporizing rescue.