A BURST-BAUS consensus document for best practice in the conduct of scrotal exploration for suspected testicular torsion: the Finding consensus for orchIdopeXy In Torsion (FIX-IT) study

Keiran D Clement, Alexander Light, Aqua Asif, Vinson Wai-Shun Chan, Sinan Khadhouri, Taimur T Shah, Frederick Banks, Trevor Dorkin, Christopher P Driver, Vinnie During, Nia Fraser, Maximilian J Johnston, Marc Lucky, Vaibhav Modgil, Asif Muneer, Arie Parnham, Ian Pearce, Majed Shabbir, Manoj Shenoy, Duncan J SummertonShabnam Undre, Alun Williams, Steven MacLennan, Veeru Kasivisvanathan* (Corresponding Author), FIX-IT collaborators

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
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Abstract

OBJECTIVES: To produce a best practice consensus guideline for the conduct of scrotal exploration for suspected testicular torsion using formal consensus methodology.

MATERIALS AND METHODS: A panel of 16 expert urologists, representing adult, paediatric, general, and andrological urology used the RAND/UCLA Appropriateness Consensus Methodology to score a 184 statement pre-meeting questionnaire on the conduct of scrotal exploration for suspected testicular torsion. The collated responses were presented at a face-to-face online meeting and each item was rescored anonymously after a group discussion, facilitated by an independent chair with expertise in consensus methodology. Items were scored for agreement and consensus and the items scored with consensus were used to derive a set of best practice guidelines.

RESULTS: Statements scored as with consensus increased from Round 1 (122/184, 66.3%) to Round 2 (149/200, 74.5%). Recommendations were generated in ten categories: consent, assessment under anaesthetic, initial incision, intraoperative decision making, fixation, medical photography, closure, operation note, logistics and follow-up after scrotal exploration. Our statements assume that the decision to operate has already been made. Key recommendations in the consent process included the discussion of the possibility of orchidectomy and the possibility of subsequent infection of the affected testis or wound requiring antibiotic therapy. If after the examination under anaesthesia, the index of suspicion of testicular torsion is lower than previously thought, then the surgeon should still proceed to scrotal exploration as planned. A flow chart guiding decision making dependent on intraoperative findings has been designed. If no torsion is present on exploration and the bell clapper deformity is absent, the testis should not be fixed. When fixing a testis using sutures, 3 or 4-point is acceptable and non-absorbable sutures are preferred.

CONCLUSIONS: We have produced consensus recommendations to inform best practice in the conduct of scrotal exploration for suspected testicular torsion.

Original languageEnglish
Pages (from-to)662-670
Number of pages9
JournalBJU International
Volume130
Issue number5
Early online date28 Jun 2022
DOIs
Publication statusPublished - Nov 2022

Bibliographical note

Acknowledgements
The authors would like to thank Jacqueline Emkes and Rachel Jury for their contribution to our protocol development with respect to patient and public involvement. Similarly, the authors would like to thank Dr Matthew Coward, Department of Urology, University of North Carolina, and Dr Selcuk Sarikaya, Department of Urology, University of Ankara, for their international perspectives and input to our study protocol. We would like to acknowledge the BAUS Trustees for allowing this collaboration. Unrelated to this work, The BURST Research Collaborative would like to acknowledge funding from the BJUI, the Urology Foundation, Ferring Pharmaceuticals Ltd, Rosetrees Trust and Action Bladder Cancer UK. Veeru Kasivisvanathan is an Academic Clinical Lecturer funded by the United Kingdom National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. PubMed Indexed Collaborative Authors: Matthew Coward, Selcuk Sarikaya, Jacqueline Emkes, Rachel Jury.

Research Funding
Department of Health
National Institute for Health Research
National Institute for Health Research
Rosetrees Trust
Ferring Pharmaceuticals
Urology Foundation
University of North Carolina

Keywords

  • testicular torsion
  • Orchidopexy
  • surgical technique
  • fixation
  • scrotal exploration

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