Impact of COVID-19 on testicular torsion : A single-center retrospective study from a children's hospital

Abstract

Purpose: Testicular torsion is a urological emergency necessitating immediate surgical intervention. However, the altered medical environment during the coronavirus disease 2019 (COVID-19) pandemic posed several challenges and the current study aimed to analyze its effects on the treatment of pediatric testicular torsion cases. Materials and Methods: We retrospectively analyzed 47 pediatric patients diagnosed with testicular torsion at Severance Children's Hospital from 2009 to 2022. Patients were categorized into pre-COVID-19 (n=38) and COVID-19 (n=8) groups. Data were collected for each patient, and the differences between the two groups were statistically analyzed. Results: The patients' median age was from 13 years (range, 1-19 years) to 13 years (range, 1-16 years) between the pre-COVID-19 and COVID-19 period (p=0.309). The analysis revealed a significant difference between the pre-COVID-19 and COVID-19 groups in the time from symptom onset to emergency department arrival (6.4 hours [0.7-120.0] vs. 20.0 hours [1.3-288.0], p=0.031) and the time from symptom onset to surgery start (19.5 hours [4.5-124.3] vs. 28.5 hours [6.1-293.4], p=0.047). The median postoperative size of the affected testis was 9.8 mL (range, 2.0-13.9 mL) during the COVID-19 period, compared to 1.6 mL (range, 0.1-7.3 mL) in pre-COVID-19 period (p=0.012). The testicular volume ratio (affected/unaffected) was used to evaluate outcomes across patients with varying ages and testicular sizes. Conclusions: The current study shows that pandemic-related delays in treatment may worsen ischemic injury in testicular torsion, emphasizing the importance of timely intervention even during global crises.