Spermatic cord torsion in adults

OBJECTIVES: The objective of this retrospective study, conducted between January 1988 and December 1998, was to demonstrate that physical examination is sufficient to manage patients with torsion of the spermatic cord. MATERIAL AND METHODS: 72 patients, admitted with an empirical diagnosis of torsion of the spermatic cord based on physical examination, underwent emergency surgery via a scrotal incision. Orchidopexy was performed when the surgical diagnosis was in favour of torsion. We classified our series into 2 groups according to the presence or absence of torsion and we defined two subgroups in the torsion group: the orchidectomy subgroup and the non-orchidectomy subgroup. RESULTS: The suspicion of torsion of the spermatic cord was confirmed in 70.8% of cases. No mortality or morbidity were observed for wrongly operated patients. The study of the sensitivity (Se) and positive predictive value (PPV) of clinical signs defined a group of men requiring emergency surgical exploration: men presenting with scrotal pain in the absence of any urinary signs (Se = 98%, PPV = 72%), negative urinary dip-stick (Se = 97%, PPV = 71%), with pain described as violent (Se = 80%, PPV = 76%), an ascended testis (Se = 62%, PPV = 86%) and a subacute stage (Se = 68%, PPV = 79%). The only pejorative factor detected in the presence of testicular necrosis was a delay before management greater than 6 hours. The length of hospital stay (p < 0.041) and the complication rate (p < 0.023) were greater in the orchidectomy subgroup compared to the non-orchidectomy subgroup. CONCLUSION: This retrospective study confirms that physical examination is sufficient to ensure good management of torsion of the spermatic cord in adults and that emergency surgical exploration is justified at the slightest doubt.