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Abstract
Background The annual incidence of testicular torsion is approximately 1 in 4000 males under the age of 25. Despite the 97% testicular salvage rate when surgical intervention is within 6 hours of onset, orchidectomy is required in 40% of cases. These comparatively poor outcomes are driven by delays to intervention, the majority of which take place prior to presentation to healthcare. This study synthesises existing evidence to understand factors leading to delayed presentation to hospital in individuals with acute scrotal pain.
Methods A comprehensive literature search was performed with support from an information scientist. Two authors performed article screening, data extraction and inductive thematic synthesis independently, with disagreements resolved by discussion at each stage. An assessment of confidence in the review findings was performed using the ConQual approach.
Results The search identified 1251 unique articles for screening, with five eligible for inclusion; all included publications were drawn from two PhD projects. Synthesis of these articles revealed five descriptive themes with five subthemes. A lack of knowledge and education about testicular health, embarrassment and reliance on others for access to healthcare are major factors leading to delays in presentation. Societal and cultural impacts on health-seeking behaviour and denial were also causes of delayed presentation to healthcare.
Discussion A lack of knowledge about testicular anatomy and health among both adults and children is amenable to improvement through education, and would likely impact many of the factors identified as contributory to delays. Communication was an overarching factor connecting the descriptive themes.
PROSPERO registration number CRD42023469435.
- uro-genital
- Systematic Review
Data availability statement
No data are available.
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Footnotes
Handling editor Shammi L Ramlakhan
X @WendyJChaplin, @gdj043, @hollyblakenotts, @andrewtabner
Contributors EA: Formal Analysis, Investigation, Data Curation, Writing—Original Draft, Writing—Review and Editing, Visualisation. WJC: Formal Analysis, Investigation, Writing—Review and Editing. CT: Methodology, Investigation, Data Curation, Writing—Review and Editing. GDJ: Conceptualisation, Methodology, Writing—Original Draft, Writing—Review and Editing, Funding Acquisition. HB: Methodology, Writing—Review and Editing, Supervision. AT: Conceptualisation, Methodology, Formal Analysis, Investigation, Data Curation, Writing—Original Draft, Writing—Review and Editing, Supervision, Project Administration, Funding Acquisition. AT is the guarantor for this research.
Funding This work was supported by a grant from Derby and Burton Hospitals Charity, approval number TI240764. The funder had no role in study design, data collection, data analysis, data interpretation, writing of the report, or submission decision.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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