1134 Improving Testicular Torsion Outcomes: Adherence to Evidence-Based Surgical Guidelines

Abstract Aim To evaluate adherence to modern clinical guidelines, outlined in the British Journal of Urology International (BJU International, 2022), for the management of testicular torsion, focusing on reducing unnecessary interventions and optimizing outcomes. Method A retrospective audit was conducted over six months on patients presenting with acute testicular pain. Cases were classified into three scenarios based on intraoperative findings: (1) testicular torsion (Scenario A), (2) normal testicles without pathology or bell clapper deformity (Scenario B), and (3) benign pathologies such as torted appendages (Scenario C). Adherence and deviations to the modern guidelines for ipsilateral orchidopexy, contralateral exploration, and contralateral orchidopexy were assessed. Results A total of 45 cases were included:Scenario A: Ipsilateral orchidopexy was performed in all 7 viable cases (100% adherence). Contralateral exploration was conducted in 9/9 cases (100%), and contralateral orchidopexy in 8/9 cases (89%).Scenario B: Ipsilateral orchidopexy was unnecessarily performed in 13/15 cases (13% adherence). Contralateral exploration and orchidopexy were avoided in 93% of cases.Scenario C: Ipsilateral orchidopexy was unnecessarily performed in all 21 cases (0% adherence). Contralateral exploration and orchidopexy were avoided in 81% and 86% of cases, respectively. Overall adherence was highest in Scenario A (96%) and lowest in Scenario C (0%). Conclusions Adherence to modern guidelines was highest in torsion cases (Scenario A), reflecting appropriate management of viable and non-viable testes. However, significant deviations were noted in Scenarios B and C, primarily due to unnecessary ipsilateral orchidopexy. This highlights the need for increased awareness of contemporary guidelines and regular audits to ensure optimal surgical practice.