Adnexal Torsion Recurrence - Is the Degree of Adnexal Twist a Risk Factor?

Study Objective To determine whether the adnexal twist degree is related to torsion recurrence and whether there is a dose-dependent relationship. Design Cases of first ovarian torsion that were diagnosed operatively in non-pregnant women between 3.2011-8.2018 were collected retrospectively. The study was performed in a single tertiary care center. Information regarding recurrence was gathered using computerized database. Patients with missing data were approached via phone (response rate of 87.2%). Setting N/A Patients or Participants 336 cases were found, of them 195 met inclusion criteria. Interventions N/A Measurements and Main Results Twenty-two women had torsion recurrence (11.3%). In a univariate analysis, adnexal twist degree in the primary event was associated with a higher risk for recurrence: 4.3% of women with twist degree ≤360 (N=3/70), 14.5% of women with twist degree of 361-720 (N=9/62) and 19.6% of women with twist degree >720 (N=10/51) (P value=0.029). That association was observed in a Mann-Whitney analysis as well, as median twist degree among women without torsion recurrence was 540 (N=173, IQR 360-900) versus 720 among women with recurrence (N=22, IQR 675-1080) (P value=0.005). Other possible influencing factors for recurrence were evaluated, such as adnexal size, presence of a cyst, polycystic ovaries, adnexal color, presence of adhesions and contraceptives use, none were found significant. Logistic regression analysis after adjustment for confounding factors revealed that adnexal twist degree remained significantly associated with higher rates of torsion recurrence (OR 2.06, 95% CI 1.11-3.84, P value=0.022). Conclusion Adnexal twist degree in ovarian torsion might be correlated to risk of ovarian torsion. Further studies with bigger cohorts are needed.