Management Of Paediatric Testicular Torsion In Low- And Middle-income Countries: Results Of A Round 1 Delphi Study

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Aims: Literature on paediatric testicular torsion in low- and middle-income countries (LMICs) is scarce and heterogenous. We developed a Delphi survey to better characterise the paediatric testicular torsion patient pathway in LMICs. Methods: A mixed-methods Delphi survey was developed using data from a previously published scoping review conducted by the authors. Questions covered all aspects of testicular torsion in children including prevalence, access to care, diagnosis, management and follow-up. The survey was distributed to members of international professional colleges including the Global Initiative for Children’s Surgery (GICS), College of Surgeons of East, Central and Southern Africa (COSECSA), West African College of Surgeons (WACS), and Pan African Paediatric Surgical Association (PAPSA). Results: There were 42 respondents, mostly Consultant Paediatric Surgeons (n=27 (64.2%)) in large public teaching hospitals across South-East Asia and Sub-Saharan Africa. Delayed access to care was consistently identified as the main barrier, with over half (n=22 (51.2%)) of respondents reporting delays from symptom onset to treatment exceeding 6 hours. Lack of awareness of symptoms was identified as the primary barrier to accessing care, followed by reliance on community-level care and distance from hospital. Consensus was observed on clinical features and complications. Conflicting views were reported on the diagnostic value of Doppler ultrasonography, contralateral orchidopexy and frequency and length of follow-up. Conclusions: Lack of awareness on symptoms of testicular torsion is a barrier to delivery of timely surgical care in low-resource settings. We also propose that emergent testicular detorsion is a bellwether procedure for emergency paediatric surgery.

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