Testicular Torsion: An Analysis of Rural Geography and Socioeconomic Status
Abstract
Background Testicular torsion is a time-critical, organ-threatening diagnosis requiring prompt surgical intervention
for successful salvage of the organ. In Australia, 28% of individuals live in rural and remote areas and face barriers
to health care such as greater distance, lower socioeconomic status, (SES), and limited health infrastructure. We
hypothesize that these barriers would delay intervention and access to surgical care, and lead to higher orchidectomy
rates.
Objectives A 12-year retrospective audit was conducted at a large rural referral center in Australia, focusing
on patients undergoing scrotal exploration for testicular torsion. Primary outcomes were orchidectomy rate, time
to operation, and ultrasound (US) and their relationship with patient distance, SES, age, and peripheral hospital
attendance. Data on SES for geographic postcodes was obtained from the Australian Government Socio-Economic
Indexes for Areas 2016. Statistical analysis was performed using IBM SPSS Statistics software, and a P value < 0.05 was
considered significant.
Results The study involved 107 patients, of whom 46% had left-sided pathology. The median age of the patients
was 14 years. Median SES was in the 37% to 41% centile range, median distance from travelled was 62 kilometers,
and median time to operation from triage was 194 minutes. Of the patients, 34 attended a peripheral hospital. No
significant risk factors for orchidectomy were identified. US was used in 65% of cases, with torsion detected in 50% of
those cases, and orchidectomy performed in 11 patients. US had a sensitivity of 86.1% and specificity of 52.9%.
Conclusion Despite significant differences in geographical distance, SES, age, and access to health care, patients in
rural and remote areas of Australia experienced equivalent outcomes in testicular torsion management. Testicular
torsion was safely managed at a central referral center using a peripheral hospital catchment in rural and remote areas
of Australia, despite significant time delays due to greater distance or lower SES.
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