NEW YORK (Reuters Health) - Treating testicular torsion with a fixation procedure, even one using a nonabsorbable suture, is no guarantee that the problem will not happen again, new research suggests. As such, clinicians need to be aware of the possibility of recurrent torsion in treated patients and act expeditiously to prevent testicular loss.

This study is not the first to describe testicular torsion following orchiopexy. However, most previous studies were conducted at a time when absorbable sutures were used for fixation. Therefore, the impact of using nonabsorbable sutures on recurrent torsion has been unclear.

The findings, which appear in the Journal of Urology for January, are based on a review of 179 consecutive patients who underwent orchiopexy for unilateral testicular torsion at one center between 1991 and 2003. The patient age ranged from a few weeks to 45 years with a mean age of 18 years.

Of these patients, Dr. Yoram Mor and colleagues, from The Chaim-Sheba Medical Center in Tel-Hashomer, identified eight who were treated for a recurrent torsion occurring 0.5 to 23 years after the initial episode.

The mean patient age was 18.5 years and right-sided torsions outnumbered left-sided torsions five to three. Half of the torsions involved the initially affected teste and half involved the previously unaffected teste.

Aside from two cases in which spontaneous detorsion occurred and elective surgery was later performed, urgent surgical exploration was performed in all cases.

The previous orchiopexy method involved suturing the tunica albuginea to the dartos layer on each side with two sutures. In all cases, except one in which orchiectomy was performed, a bilateral fixation procedure was performed. In the three earliest cases and four subsequent cases, chromic and polyglactin sutures, both absorbable, were used, respectively. In the most recent case, however, nonabsorbable polypropylene sutures were used.

The 8th edition of Campell's Urology, a principal textbook for the discipline, recommends a non-suture fixation method for treating testicular torsion. "It remains to be seen whether (this approach) will eliminate the chances of recurrent torsion in patients with previous orchiopexy," Dr. Laurence Baskin, from UCSF Children's Hospital in San Francisco, comments in a related editorial.

J Urol 2005;175:171-174

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