Torsion of the spermatic cord in adults.

Objectives: The objective of this retrospective study, conducted between Ja nuary 1988 and December 1998 was To demonstrate that physical examination i s sufficient to manage patients with torsion of the spermatic corn. Material and Methods: 72 patients, admitted with an empirical diagnosis of torsion of the spermatic cord based on physical examination, underwent emer gency surgery via a scrotal incision. Orchidopexy was performed when the su rgical diagnosis was in favour torsion. We classified our series into 2 gro ups according to the presence or absence of torsion mid we defined two subg roups in the torsion group: the orchidectomy subgroup and the non-orchidect omy subgroup. Results. The suspicion of torsion of the spermatic cord was confirmed in 70 .8% of cases. No mortality or morbidity Ir ere observed for wrongly operate d patients. The study of the sensitivity (Se) and positive predictive value (PPV) of clinical signs defined a group of men requiring emergency surgica l exploration: men presenting with scrotal pain in the absence of any urina ry 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 pejorat ive factor detected in the presence of testicular necrosis uns a delay befo re management greater than 6 hours. The length of hospital stay (p<0.041) a nd the complication rate (p<0.023) were greater in the orchidectomy subgrou p 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 bz ad ults and that emergency surgical exploration is justified at the slightest doubt.