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.

Autor: Clement KD; British Urology Researchers in Surgical Training (BURST) Collaborative.; NHS Greater Glasgow and Clyde, Glasgow, UK., Light A; British Urology Researchers in Surgical Training (BURST) Collaborative.; Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.; Department of Surgery and Cancer, Imperial College London, London, UK., Asif A; British Urology Researchers in Surgical Training (BURST) Collaborative.; Leicester Medical School, University of Leicester, Leicester, UK., Chan VW; British Urology Researchers in Surgical Training (BURST) Collaborative.; School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK., Khadhouri S; British Urology Researchers in Surgical Training (BURST) Collaborative.; Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.; Aberdeen Royal Infirmary, Aberdeen, UK., Shah TT; British Urology Researchers in Surgical Training (BURST) Collaborative.; Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.; Department of Surgery and Cancer, Imperial College London, London, UK., Banks F; Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford, UK., Dorkin T; Freeman Hospital, Newcastle NHS Foundation Trust, Newcastle upon Tyne, UK., Driver CP; Royal Aberdeen Children's Hospital, NHS Grampian, Aberdeen, UK., During V; New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK., Fraser N; Nottingham Children's Hospital, Medical Centre, Nottingham University Hospitals NHS Trust, Queen, Nottingham, UK., Johnston MJ; Department of Surgery and Cancer, Imperial College London, London, UK.; Salisbury NHS Foundation Trust, Salisbury, UK., Lucky M; Aintree University Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK., Modgil V; Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK., Muneer A; University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK.; Division of Surgery and Interventional Science, University College London, London, UK.; NIHR Biomedical Research Centre, University College London Hospital, London, UK., Parnham A; The Christie Hospital, The Christie NHS Foundation Trust, Manchester, UK.; Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK., Pearce I; Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK., Shabbir M; Guy's Hospital, NHS Foundation Trust, Guy's and St Thomas, London, UK., Shenoy M; Nottingham Children's Hospital, Medical Centre, Nottingham University Hospitals NHS Trust, Queen, Nottingham, UK., Summerton DJ; Leicester General Hospital, University Hospitals Leicester NHS Trust, Leicester, UK., Undre S; Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK., Williams A; New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK., MacLennan S; Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK., Kasivisvanathan V; British Urology Researchers in Surgical Training (BURST) Collaborative.; Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.; University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2022 Jun 10. Date of Electronic Publication: 2022 Jun 10.
DOI: 10.1111/bju.15818
Abstrakt: 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.
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Databáze: MEDLINE
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