Objective To compare the survival outcomes of bladder cancer with non-pure urothelium(BCa with n-pU)and bladder cancer with pure urothelium(BCa with pU)treated with robot-assisted radical cystectomy(RARC).Methods Clinical data of BCa patients treated with RARC in Nanjing Drum Tower Hospital during Oct.2014 and Mar.2022 were retrospectively analyzed.The patients were divided into n-pU group and pU group.After the baseline differences between groups were balanced with propensity score matching(PSM),the overall survival(OS)and recurrence-free survival(RFS)curve were plotted using Kaplan-Meier method and compared using Log-rank test.Univariate and multivariate analysis were performed with Cox model to identify the influencing factors of prognosis.Based on the results,a secondary grouping was performed to compare the survival differences between subgroups and further investigate the prognostic factors.Results After PSM,there were 53 pairs of BCa patients.There were no significant differences in the baseline data between the pU and n-pU groups(P＜0.05).Regardless of T stage,there were no significant differences in OS and RFS between the two groups(P=0.217,P=0.109).Univariate Cox regression analysis showed that T stage(＞T2)was a significant risk factor of OS and RFS(P＜0.05).In the early pathological stage(≤T2),there were no significant differences in OS and RFS(P=0.565,P=0.344).In the advanced pathological stage(＞T2),the OS and RFS of n-pU were significantly worse than those of pU patients(P=0.025,P=0.034).Conclusion The prognosis of BCa patients with n-pU who received RARC is significantly correlated with pathological status.At＞T2 stage,n-pU patients have worse prognosis than pU patients in the same pathological status.

Objective:To analyze the prognostic factors of robot-assisted radical cystectomy (RARC).Methods:The clinical data of 224 patients underwent RARC from December 2014 to December 2018 in Nanjing Drum Hospital were reviewed. There were 193 males and 31 females, aged 36-92 years, with mean of 68 years. There were 7 patients(3.1%)undergoing neoadjuvant chemotherapy, the ASA scores of 125 patients (55.8%) were more than 2, and the mean body mass index was 23.4(15.4-35.5)kg/m 2. All patients were treated with RARC, with 72(32.1%) patients undergoing intraoperative blood transfusion. Kaplan-Meier method was used to analyze recurrence-free survival rate (RFS), cancer-specific survival rate (CSS) and overall survival rate (OS). Cox multivariate risk ratio model was used to evaluate the correlation between survival outcome and perioperative and pathological factors in patients treated with RARC. Results:For pathological status, there were 82 of ≤T 1, 64 of T 2, 57 of T 3 and 21 of T 4. Of all the patients, 49(21.9%) had lymph node metastasis, 12(5.4%) had positive surgical margin, 82(36.6%) had lymphovascular invasion(LVI), and 41(18.3%) underwent adjuvant chemotherapy. Follow-up time was between 11-60 months, and the median follow-up time was 24 months. The 5-year cumulative OS, RFS and CSS were 57.15%, 48.84% and 59.60%, respectively. Univariate Cox regression analysis showed that T stage( HR=5.764, 95% CI 1.926-17.249, P=0.002; HR=4.086, 95% CI 1.611-10.364, P=0.003; HR=9.391, 95% CI 2.118-41.637, P=0.003), N stage( HR=6.446, 95% CI 3.438-12.087, P<0.001; HR=5.661, 95% CI 3.086-10.385, P<0.001; HR=5.980, 95% CI 2.982-11.992, P<0.001), LVI( HR=3.319, 95% CI 2.008-5.486, P<0.001; HR=2.894, 95% CI 1.782-4.701, P<0.001; HR=3.471, 95% CI 2.017-5.974, P<0.001), American Society of Anesthesia (ASA)score( HR=2.888, 95% CI 1.619-5.150, P<0.001; HR=1.765, 95% CI 1.060-2.940, P=0.029; HR=2.612, 95% CI 1.424-4.792, P=0.002), body mass index( HR=0.886, 95% CI 0.819-0.957, P=0.002; HR=0.885, 95% CI 0.819-0.955, P=0.002; HR=0.862, 95% CI 0.792-0.938, P=0.001), age( HR=1.580, 95% CI 1.250-1.997, P<0.001; HR=1.362, 95% CI 1.088-1.705, P=0.007; HR=1.530, 95% CI 1.190-1.968, P=0.001) and intraoperative blood transfusion( HR=1.899, 95% CI 1.160-3.108, P=0.011; HR=2.218, 95% CI 1.371-3.587, P=0.001; HR=2.227, 95% CI 1.312-3.782, P=0.003) were significantly related to survival outcome. Multivariate Cox regression analysis showed that T stage( HR=4.506, 95% CI 1.433-14.175, P=0.01; HR=3.159, 95% CI 1.180-8.454, P=0.022; HR=7.810, 95% CI 1.674-36.444, P=0.009), N stage( HR=6.096, 95% CI 2.981-12.467, P<0.001; HR=5.368, 95% CI 2.683-10.740, P<0.001; HR=5.539, 95% CI 2.497-12.288, P<0.001) and ASA score( HR=6.180, 95% CI 2.371-16.110, P<0.001; HR=2.702, 95% CI 1.175-6.215, P=0.019; HR=6.471, 95% CI 2.290-18.286, P<0.001) were independent predictors of RFS, CSS and OS, and adjuvant chemotherapy( R=0.434, 95% CI 0.202-0.930, P=0.032) could only predict OS. Conclusion:T stage, N stage and ASA were main independent predictors of postoperative survival outcomes, and adjuvant chemotherapy was independent predictor of OS.

Objective:To compare the perioperative complications and prognosis of intracorporeal and extracorporea lileal conduit urinary diversion(ICUD or ECUD)following robot-assisted radical cystectomy(RARC).Methods:The data of 95 patients who underwent RARC treatment in Nanjing Drum Tower Hospital from March 2016 to June 2019 were retrospectively analyzed. Among them, 37 underwent ICUD and 58 underwent ECUD. In the ICUD group, there were 32 males and 5 females, aged(68.0±7.8) years, body mass index (BMI) of (24.1±3.4) kg/m 2, American Society of Anesthesiologists(ASA)score of 1-2 in 4 cases(10.8%), ASA score of 3-5 in 33 cases(89.2%), preoperative hemoglobin of(126.5±14.2)g/L, albumin of(39.0±2.2)g/L, and C-reactive protein of 4.0(2.0-8.5) mg/L. In the ECUD group, there were 53 males and 5 females, aged(67.5±9.0)years, BMI of(24.2±3.6)kg/m 2, ASA score of 1-2 in 16 cases(27.6%), ASA score of 3-5 in 42 cases (72.4%) , preoperative hemoglobin of(129.0±12.4)g/L, albumin (38.2±3.1) g/L, and C-reactive protein of 4.9 (3.1-14.4) mg/L. There was no significant difference in preoperative data between the two groups ( P>0.05). The two groups underwent RARC and pelvic lymph node dissection similarly. The ICUD group underwent a total intracorporeal ileal conduit and the ECUD group underwent extracorporeal ileal conduit with direct vision through a median incision in the lower abdomen.There were 32 cases (86.5%) and 46 cases (79.3%) undergoing expanded pelvic lymph node dissection in the ICUD group and the ECUD group respectively, and the difference was not statistically significant ( P=0.374). The complications were graded according to the Clavien-Dindo grading system. The perioperative complications and prognosis of the two groups were compared. Results:The operation time of the ICUD group and the ECUD group were (430±63) min vs. (410±69) min, respectively ( P=0.163). The estimated blood loss were (435±233) ml vs. (388±277) ml, respectively ( P=0.182). Intraoperative blood transfusion were 10 cases (27.0%) and 12 cases (20.7%)( P=0.475). None of the above differences were statistically significant. Postoperative albumin of the ICUD group and the ECUD group were (31.5±2.4) g/L vs. (31.0±2.8) g/L ( P=0.387), postoperative C-reactive protein were 30.9 (10.4-52.1) mg/L vs.29.5 (14.4-58.5) mg/L ( P=0.655) and postoperative hemoglobin were (110.0±13.8) g/L vs. (113.7±13.4) g/L ( P=0.187). The postoperative feeding recovery were 4(3-5) d vs. 4(3-5) d ( P=0.752) and the postoperative hospital stay were 13(10-19) d vs. 13(11-18) d ( P=1.000). There was no statistically significant difference in perioperative data. The postoperative pathological examination results of ICUD group and ECUD group showed that there were 17 cases (45.9%) vs.19 cases (32.8%) in T a/T 1/Tis stage, 12 cases (32.4%) vs. 18 cases (31.0%) in T 2 stage, 5 cases (13.5%) vs. 19 cases (32.8%) in T 3 stage, 3 cases (8.1%) vs. 2 cases (3.4%) in T 4 stage, respectively and the difference was not statistically significant( P=0.166). The number of lymph nodes removed were (18.2±6.7) vs.(16.5±7.9)( P=0.178) and the number of patients with positive lymph nodes were 6(16.2%) vs.11(19.0%), respectively( P=0.733). None of the patients had positive margins. There was no statistically significant difference in pathological examination overall. There were 14 cases (37.8%) in the ICUD group and 21 cases (36.2%) in the ECUD group experiencing complications within 30 days after operation and the difference was not statistically significant( P=0.872). The complications within 90 days after operation were 14 cases (37.8%) vs. 24 cases (41.4%) respectively and the difference was not statistically significant( P=0.731). Clavien-Dindo grade Ⅲ-Ⅴ complications in the two groups were 1 case (2.7%) vs.1 case (1.7%) respectively, with no significant difference ( P=0.849). One patient in the ICUD group developed an intestinal anastomotic leakage and underwent reoperation for repairing and 1 patient in the ECUD group developed mechanical intestinal obstruction and underwent reoperation. The rate of readmission within 90 days after operation of the ICUD group was lower than that of the ECUD group, but the difference was not statistically significant [3 cases (8.1%) vs. 11 cases (19.0%), P=0.090]. Postoperative follow-up was 13-53 months and the median follow-up of ICUD group and ECUD group were 19 months and 31 months respectively. There was no significant difference in the survival curve between the two groups( P=0.746). The 1-year survival rate was 91.9% in the ICUD group and 91.4% in the ECUD group. Routine re-examination of urinary system CT or B-ultrasound was performed 3 months, 6 months and 1 year after surgery. The incidence of ureteral dilatation/hydronephrosis in the ICUD group was lower than that of the ECUD group, with 4.1%(3 sides) vs. 14.7%(17 sides)( P=0.020). Conclusion:Compared with RARC+ ECUD, RARC+ ICUD does not increase the incidence of complications within 90 days after surgery and may reduce the risk of upper urinary tract dilatation.

Objective: To report our initial experience with extraperitoneal approach Robotic-Assisted Urethra-sparing simple prostatectomy(US-RASP)on large-gland (>100 ml) benign prostatic hyperplasia(BPH). Methods: From August 2015 to April 2018, 32 patients with large volume prostate underwent US-RASP performed by single surgical team were retrospectively reviewed. The patient's median age was 73 (range 59-80) years, and median BMI was 24.9 (19.3-34.8 ) kg/m^2, The estimated prostate volume(V), postvoid residual volume(PV) by transrectal ultrasonography and PSA were 152.0(119.0-223.1)ml, 145(0-280)ml and 13.7(5.2-27.3)ng/ml, respectively. Four of 32 patients underwent preoperative urinary catheterization. The perioperative functional parameters including international prostate symptom score (IPSS) questionnaire, maximum flow rate (Q_max), maximum voided volume(V_max), quality of life questionnaires (QOL) and International Index of erectile function-erectile function (IIEF-EF) were 27(23-33), 5.9 (2.5-7.8) ml/s, 110 (80-210)ml, 5(3-6), and 27(26-29), respectively. Functional parameters including IPSS, QOL, Qmax, Vmax, PV and IIEF-EF were compared and analyzed at 3 and 12 months postoperatively during the following-up. Results: The US-RASP was completed in all 32 patients and no open conversion. Median operation time was 180 (115-240) min, the estimated blood loss was 300(range 100 to 400)ml, Hemoglobin loss was 17(5-38)g/L. The median Foley catheterization time was 7 (5-12) days and drainage was removed after a median of 5 (4-7) days with median hospital stay of 8(6-14)days. Median specimen weight on pathological examination was 107.7 (79.8-147.4)g with median of 64.2% (49.4%-86.2%) resection ratio. At 3-mo follow-up, median IPSS score, Q_max, V_max, PV and QOL were 6(4-18), 17.3 (13.8-21.1)ml/s, 167(140-310)ml, 50(0-61)ml, 1(0-3) , respectively. At 12-mo follow-up, median IPSS score, Q_max, V_max, PV and QOL were 4(1-9), 20.1 (17.9-24.1)ml/s, 205(176-305)ml, 24(0-35)ml and 1(0-2) , respectively. All patients showed great improvement of IPSS, Q_max, V_max, PV and QOL after median 17 (12-44) months follow-up compared with preoperative parameters (P<0.05). Erectile function was not impaired in 17 patients who have normal erectile function pre-operatively and 14 cases (82.4%) preserved satisfactory anterograde ejaculation. No significant complication occurred during the procedure. No patient developed permanent urinary incontinence. Conclusions US-RASP is a safe and effective treatment option for selected patients with large-gland obstructive BPH(>100 ml). Our data showed significant improvement in voiding function and maintaining satisfactory anterograde ejaculation following urethral-sparing technique. It may be a new alternative method in the future for large-volume symptomatic BPH.

Objective To compare the postoperative outcomes and early continence rate between conventional robot-assisted laparoscopic radical prostatectomy (RARP) and Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RSRARP).Methods The date from 50 patients who underwent RSRARP and 122 patients who underwent conventional RARP between 2016 September to 2017 included study.Ninety-two patients (forty-six patients in RARP group and forty-six patients in RSRARP group) were collected by propensity-score matching which were performed using eight preoperative variables.Preoperative data of patients in RSRARP group [patients age (67.1 ± 5.7) years,BMI (24.6 ± 2.7) kg/m2,tPSA 10.7 ng/ml (0-40.7 ng/ml),Gleason score 7 points (6-9 points),prostate volume 31.9 ml (10.0-95.4 ml),ECOG score 0 points (0-1 points),urinary domain of EPIC 94.8 points (63.9-100 points),clinical stage from T1cN0 M0 to T3a N0 M0] and conventional RARP group [patients age (67.2 ± 6.7) years,BMI (25.2 ± 3.1) kg/m2,tPSA 10.7 ng/ml (0-40.7 ng/ml),Gleason score 7 points (6-9 points),prostate volume 36.8 ml (8.9-81.0 ml),ECOG score 0 points (0-1 points),urinary domain of EPIC 95.8 points (63.9-100.0 points),clinical stage from T1c N0Mo to T3a N0M0] had no significant differences.We reviewed console time,estimated blood loss,the rate of leakage,complications,average daily drainage,pathological result,continence,urinary domain of EPIC one month,two months and three months after operation.Results All 92 cases were successfully performed robotically.Mean operation time was significantly more in RARP group than in RSRARP group [(223.9 ±48.9) min vs.(198.91 ±34.2)min,P ＜ 0.05)].There was no significant difference between the postoperative data of patients in RSRARP group [estimated blood loss 200 ml (50-1 200 ml),average daily drainage 82.5 ml (11.7-571.0 ml),the rate of leakage 6％,Clavien-Dindo grade Ⅰ (9％),Clavien-Dindo grade Ⅱ (4％),pathological stage pT1 (2％),pT2 (52％),pT3 (46％)] and RARP group [estimated blood loss 200 ml (100-1 200 ml),average daily drainage 102.9 ml (23.3-534.7 ml),the rate of leakage 4％,Clavien-Dindo grade Ⅰ (9％),Clavien-Dindo grade Ⅱ (2％),pathological stage pT1 (0),pT2 (46％),pT3 (54％)] (P ＞ 0.05).Early continence rate one week and one month after surgery was significantly higher in RSRARP group than in RARP group (78％ vs.35％,91％ vs.79％,P＜0.05).Urinary domain of EPIC one month and two months after surgery was significantly more in RSRARP group than in RARP group [(91.4±8.3) vs.(84.6±10.9),(95.0±7.5) vs.(91.6±7.8),P＜0.05].There was no significant difference in the rate of positive surgical margin between RSRARP group and RARP group (22％ vs.17％,P ＞ 0.05).Conclusions RSRARP were time-saving,safe and effective for the surgical treatment of localized prostate cancer.It seemed to yield a better outcome regarding early return to urinary continence postoperatively.

Objective To investigate the clinical characteristics and prognosis of primary diffuse large B-cell lymphoma of central nervous system ( PCNS DLBCL). Methods The data of 70 patients with PCNS DLBCL confirmed by pathology were retrospectively analyzed. Survival and prognostic analyses were further conducted in the 66 follow-up patients. Results Median age at diagnosis was 57 years old. The ratio of male and female was 1.3∶1. The time from having symptoms to seeking medical advice was less than 2 months in 54 (77.1%) patients. 44 (62.9 %) patients had increased intracranial pressure, and 26 (37.1 %) patients had limb weakness or hemiplegia symptoms. 37 (52.9%) patients were multiple lesions, 59 (84.3%) cases were supratentorial, and 46 (65.7%) cases showed involvement of deep-brain tissues. Among 66 follow-up patients 7 cases received supportive and palliative care, 27 cases received surgery, 6 cases received radiotherapy, 9 cases received chemotherapy alone, and 21 cases received radiotherapy in addition to chemotherapy. The median overall survival (OS) was 9 months (95 % CI 1-16 months), and the 2-year survival rate was 36.1 %. The median OSs of the supportive and palliative therapy group and the surgery group were 2 months and 3 months, respectively. The median OS of the chemotherapy, radiotherapy or combination group was 33 months (95%CI 22-43 months) and the 2-year OS rate was 56.9 %. The Cox multivariate regression analysis showed that the involvement of deep-brain tissues (P=0.04) and not receiving radiotherapy or chemotherapy (P=0.00) were related to poor prognosis. Conclusions PCNS DLBCL is a highly aggressive and malignant tumor. Patients undergoing only surgery have poor effect and short survival. The patients with involvement of deep brain tissues have a poor prognosis. The chemotherapy, radiotherapy or combination of them may improve the prognosis.

OBJECTIVETo initially explore the clinical effect of cool-tip radiofrequency ablation combined with enucleation for the giant hamartoma of kidney with narrow base and export-oriented way of growth.

METHODSThe clinical date of 15 patients including 6 male and 9 female with special hamartoma of kidney underwent cool-tip radiofrequency ablation assisted enucleation from July 2011 to October 2014 were reviewed.The median age was 49 years (ranging from 35 to 71 years). There were 6 cases with left renal tumor, 8 cases with right renal tumor and 1 case with solitary kidney tumor.All patients were confirmed by B ultrasound or CT scan, the mean diameter of hamartoma of kidney was 9.7 cm(8.5-12.7)cm, all tumors were located distant from the collecting system and presents with a special way of growth.The preoperative hemoglobin was (129±18)g/L, SCr was (92±41)μmol/L, glomerular filtration rate (GFR) was (32±12)ml·min(-1)·1.73 m(-2).

RESULTSCool-tip radiofrequency ablation assisted enucleation was technically successful in all patients.The mean operative duration was (115±31)minutes, and the average intraoperative bleeding was (72±21)ml with no blooding transfusion.The postoperative hospital stay was(7±2)days, and the postoperative hemoglobin was(129±18)g/L, SCr (92±41)μmol/L, GFR(30±15)ml·min(-1)·1.73 m(-2). No statistic change of hemoglobin and SCr or glomerular filtration rate after operations(all P>0.05). Postoperative pathology showed that all cases were hamartoma of kidney.During a mean follow-up period of 19.5 months, none of them had local tumor recurrence or chronic renal insufficiency.

CONCLUSIONSCool-tip radiofrequency ablation assisted enucleation is both safe and effective in the treatment of huge hamartoma of kidney with a narrow base and export-oriented way of growth. The short-term follow-up shows a satisfactory therapeutic effect.

Adult ; Aged ; Angiomyolipoma ; surgery ; Blood Transfusion ; Catheter Ablation ; methods ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Neoplasms ; surgery ; Length of Stay ; Lipoma ; therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Postoperative Period ; Treatment Outcome

Objective To analyze the features of diagnosis, treatment and prognosis of primary renal neuroendocrine tumors, and to improve the understanding of primary renal neuroendocrine tumors. Methods From January 2008 to June 2015, 5 cases of primary renal neuroendocrine tumors were hospitalized and their data was analyzed retrospectively, with 1 male 4 females, aged 40-73 years with the middle age of 48 years.Tumors were all located in the left kidney, whose diameters arranged from 4 to 9 cm, with an average of 6.5cm.One case presented with hematuria, one case was identified because of abdominal pain, and the other three cases were identified via physical examination.Four cases underwent a renal contrast-enhanced ultrasound, which indicated a medium-hypoechoic mass in three cases and a hyperechoic mass in one case.All five cases underwent CT scan, presenting irregularly shape and density. Calcification was found in three cases on plain scanning.Significantly heterogeneous enhancement was found in three cases and moderate heterogeneous enhancement was found in one case on enhanced scanning. Results All five cases underwent operations, with two cases undergoing radical nephrectomy and three cases undergoing partial nephrectomy.Pathological examination showed three cases of tumor cells arranged in a nest slug or ribbon-like infiltrative growth, with no or rare mitosis and no necrosis, which is consistent with renal carcinoids.Three out of 4 renal hilar lymph nodes containing tumor cells were identified in one case. The tumor cells in another case exhibited a ribbon-like arrangement, with some round nuclei, no significant atypia, and rare mitosis, which is consistent with renal atypical carcinoid.Two out of two renal hilar lymph nodes containing tumor cells were identified in this case. The tumor tissue of one case showed morphologically uniform, medium-sized cells arranged in nest slug form with necrosis, a high nuclear cytoplasm ratio, an obvious allotype and frequent mitosis, which is consistent with renal small cell carcinoma.The immunohistochemistry of the five cases indicated synaptophysin( Syn) and chromogranin A ( CgA) positive in varying degree.One case of renal carcinoid relapsed approximately 78 months after partial nephrectomy, following with radical surgery.The other two cases were followed up for 8 or 27 months and no recurrence or metastasis was detected.One case of renal atypical carcinoid was followed up for 4 months after radical nephrectomy and no recurrence or metastasis was detected.One case of renal small cell carcinoma died of multiple organ failure 11 months after radical nephrectomy plus hepatic metastatic carcinoma radio-frequency ablation approximately.Conclusions Primary renal neuroendocrine tumors are rare clinically. Renal neuroendocrine tumors may be expressed as carcinoid, atypical carcinoid or small cell carcinoma, and the clinical manifestations, pathological characteristics and prognosis varied.Primary renal carcinoids may be treated by surgery with a nice prognosis.Patients with primary renal small cell carcinoma require comprehensive treatment, and their prognosis is poor.

Objective To evaluate the clinical and pathological features of eosinophilic cystitis (EC),and to discuss its diagnosis and treatment.Methods The clinical and pathological data of one case of eosinophilic cystitis were reported.An 86-year-old male with gross hematuria and urinary urgency for 15 days was admitted on 16 March 2015.A computed tomography scan showed uneven thickening of the bladder wall and a nodular soft tissue on the anterior wall protruding into the bladder cavity.Results Cystoscopic examination showed diffuse thickening of the bladder with polypoid red lesions on the anterior wall.Transurethral biopsies revealed infiltrating eosinophils,which was consistent with the diagnosis of EC.The patient was then treated with anti-inflammatory drugs,corticosteroids and anti-histamine drugs.At 6 months of follow-up,the patient was asymptomatic and had no evidence of local recurrence by ultrasonography.Conclusions Eosinophilic cystitis is a rare disease without specific clinical and imaging features,which can mimic bladder tumor.The final diagnosis of this disease depends on the pathology.Transurethral resection of the lesion along with postoperative hormone and antihistamines administration are the main choices of treatment.

OBJECTIVETo improve the diagnosis and treatment of testicular torsion.

METHODSThe clinical features of 49 testicular torsion patients admitted to Department of Urology Nanjing Drum Tower Hospital from April 2008 to March 2014 were retrospectively analyzed, the average age was (21 ± 6) years (range 13-52 years).Forty-four cases underwent the color Doppler flow imaging of scrotum, demonstrated reduction of the testicular blood supply in 9 cases and loss of the testicular blood supply in 35 cases. Orchiectomy or orchiopexy was performed according to the testicular blood supply, the contralateral testis fixation was performed in all patients. A two-tailed Student's t-test was used to compare the data between two groups, Pearson correlation analysis was used to analyze the correlation of diurnal temperature and number of cases.

RESULTSAll the patients with testicular torsion were Tunica-reversed, 38 (77.5%) cases occurred from November to April. The monthly incidence of testicular torsion was positively correlated with diurnal temperature (r = 0.6434, P = 0.024). Forty-four cases underwent the color Doppler flow imaging, demonstrated the reduction or loss of the testicular blood supply, and these patients were confirmed to be testicular torsion by surgical exploration. The salvage rates of testis in patients with testicular torsion were 2/2, 5/15, 2/9 and 4.2% (1/24) in those seeking medical attention within 6, 12, 24 hours and over 24 hours after the onset of pain. All the patients were followed up for 3 to 75 months, and no one experienced recurrent torsion.

CONCLUSIONSThe incidence of testicular torsion is higher during the spring and winter, diurnal temperature change is associated with testicular torsion. The diagnostic rate of color Doppler flow imaging is high, which can be chosen as the primary method. Prompt recognition and treatment are necessary for testicular salvage.

Adolescent ; Adult ; Humans ; Incidence ; Male ; Middle Aged ; Orchiectomy ; Retrospective Studies ; Scrotum ; surgery ; Seasons ; Spermatic Cord Torsion ; diagnosis ; epidemiology ; Temperature ; Testis ; surgery ; Young Adult