Going, gonad, gone. Gender inequalities in the management of gonadal torsion: a cohort study

Abstract

Gonadal torsion (when the gonad twists on its ligamentous supports) is a surgical emergency in both men and women. Prompt management is essential to preserve gonadal function. Our aim was to compare the timeliness with which men and women who underwent surgery for suspected gonadal torsion are managed. All adult patients who underwent surgery for suspected gonadal torsion between 1/4/16 and 31/3/18 were reviewed and the following times recorded: symptom onset; hospital presentation; gynaecological/surgical review; decision for theatre; and knife-to-skin (KTS). The surgical procedure(s) and intra-operative findings were also documented. In total, 31 women (mean age 29.4 ± 7.1yrs) and 49 men (mean age 23.2 ± 7.0yrs) were identified. Women waited significantly longer than men at every stage (p < 0.01). Time intervals between hospital presentation and review, review and decision for theatre, and decision and KTS were 1.6 (1.2–2.6 hrs), 0.3 (0.0–0.9 hrs) and 1.7 (1.5–2.5 hrs) for men and 4.3 (3.1–15.3 hrs), 10.3 hrs (2.4–20.7 hrs) and 4.7 (2.3–9.3 hrs) for women, respectively. Torsion was confirmed in 20 (64.5%) women and 25 (51.0%) men. Intraoperatively, 13(65%) ovaries were reportedly necrotic compared to only 6 (24%) testes (p = 0.0076). All necrotic gonads were removed despite conservative surgery being recommended practice during the study period. Women with suspected gonadal torsion received suboptimal care compared to their male counterparts, which has potentially catastrophic consequences for the subsequent fertility of this predominantly young population.

Keywords:

• Gonadal torsion
• gender
• oophorectomy
• gonadectomy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

AR conceived and planned the study, assisted with data collection, analyzed the data and wrote the manuscript. JE and JN assisted with data collection and contributed to revision of the manuscript. AB and NEB helped conceive and plan the study and contributed to revision of the manuscript. All authors approved the final version of the manuscript prior to submission.