Mp02-14 Challenges in Management of Gonadal Torsion in New York State

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety I (MP02)1 May 2024MP02-14 CHALLENGES IN MANAGEMENT OF GONADAL TORSION IN NEW YORK STATE Eylon J. Arbel, Ajay A. Myneni, Joseph Boccardo, Finn Hennig, Matthew Brennan, Katia Noyes, and Aaron B. Hoffman Eylon J. ArbelEylon J. Arbel , Ajay A. MyneniAjay A. Myneni , Joseph BoccardoJoseph Boccardo , Finn HennigFinn Hennig , Matthew BrennanMatthew Brennan , Katia NoyesKatia Noyes , and Aaron B. HoffmanAaron B. Hoffman View All Author Informationhttps://doi.org/10.1097/01.JU.0001008600.97797.3b.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Diagnosing gonadal torsion (GoT) is a time sensitive decision because of the narrow window to attempt organ-preserving treatments rather than resection. Earlier studies have examined the gender disparities in diagnosing GoT, some of which can be attributed to anatomic differences in reproductive systems, however, there is evidence of significantly higher rates of organ loss in women. The purpose of this study was to examine recent trends in the management of diagnosed GoT cases in New York State (NYS) from a population-based data registry to identify risk factors for organ loss. METHODS: Using New York State hospital inpatient, emergency, and ambulatory centers' data, we identified patients treated for GoT between 2005 and 2019 using ICD and CPT codes. We conducted bivariate and multivariable analyses to examine gonadal resection and gonadal-sparing treatments among male and female patients as well as factors associated with differences in treatment received. We also examined variations in care pathways from initial presentation to treatment to identify factors responsible for potential delays including hospital size, location, and provider specialty. RESULTS: We identified 8,615 male and 10,497 female patients treated for GoT. Among male patients, 29% underwent orchiectomy vs. 94% of female patients who underwent oophorectomy (p<0.01). Orchiectomy was more likely than testicular salvage among ≤12-year (16.4% vs. 9.5%, p<0.01) and≥20 years (30.3% vs. 26.3%, p<0.01) age groups, Black patients (28.4% vs. 24.5%, p<0.01), and those with public insurance (32.6% vs. 23.0%, p<0.01). Oophorectomy was more likely than ovarian salvage among those aged≥20 years (80.6% vs. 57.0%, p<0.01), White patients (56.9% vs. 52.0%, p=0.04), and those residing in rural regions (7.0% vs. 3.4%, p<0.01). Female patients were much more likely to have cysts or tumors (68%) at the time of diagnosis compared to male patients (68% vs. 2%, p<0.01). CONCLUSIONS: Accurate diagnosis of GoT in a timely manner may be the deciding factor between gonad sparing vs. resection treatments. The high rate of oophorectomy in women experiencing gonadal torsion may be a result of more common misdiagnosis. Social factors including age, insurance type, rurality, and race were associated with differing treatments and outcomes for GoT. Improvement in diagnosis practices in acute presentations and identifying higher risk patients with predisposing conditions for organ loss may lead to better outcomes. Future directions for this study include examining the role of hospital and physician factors in treatment among GoT patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e18 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Eylon J. Arbel More articles by this author Ajay A. Myneni More articles by this author Joseph Boccardo More articles by this author Finn Hennig More articles by this author Matthew Brennan More articles by this author Katia Noyes More articles by this author Aaron B. Hoffman More articles by this author Expand All Advertisement PDF downloadLoading ...