Pd06-08 taking the subjectivity out of intraoperative management of testicular torsion: creating a standardized protocol for use of indocyanine green

You have accessJournal of UrologyCME1 Apr 2023PD06-08 TAKING THE SUBJECTIVITY OUT OF INTRAOPERATIVE MANAGEMENT OF TESTICULAR TORSION: CREATING A STANDARDIZED PROTOCOL FOR USE OF INDOCYANINE GREEN Amanda Raines, Nicolas Fernandez, Jennifer Ahn, Mark Cain, Byron Joyner, Kathleen Kieran, Paul Merguerian, Hailey Silverii, and Margarett Shnorhavorian Amanda RainesAmanda Raines More articles by this author , Nicolas FernandezNicolas Fernandez More articles by this author , Jennifer AhnJennifer Ahn More articles by this author , Mark CainMark Cain More articles by this author , Byron JoynerByron Joyner More articles by this author , Kathleen KieranKathleen Kieran More articles by this author , Paul MerguerianPaul Merguerian More articles by this author , Hailey SilveriiHailey Silverii More articles by this author , and Margarett ShnorhavorianMargarett Shnorhavorian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The current standard of care to determine testicular viability in testicular torsion is surgeon’s subjective assessment. Studies on objective means to assess testicular perfusion after detorsion are lacking. Indocyanine green (ICG) is a fluorescent dye which has been widely used to evaluate tissue perfusion. To date use of ICG in testicular torsion has been limited to case reports with no series or protocols yet published. We aimed to develop and implement a standardized protocol for the use of ICG in testicular torsion and evaluate the effectiveness of ICG as an objective tool to assess testicular perfusion. METHODS: This was a single institution pilot study on the use of ICG in testicular torsion. A useable standardized protocol for use of ICG in testicular torsion was developed and implemented. The Stryker SPY PHI system and novel quantification software, SPY-QP, were used for ICG imaging. The protocol development was an adaptive process. The finalized protocol is detailed in Figure 1. RESULTS: ICG was used in 17 cases of testicular torsion with 13 undergoing orchiopexy and 4 undergoing orchiectomy. Of the 4 testes which were removed, we noted no to very low ICG uptake with SPY-QP measurements of 0-7% when compared to a mean ICG uptake in the orchiopexy group of 74.5% (p= 0.003) (Table 1). The pathology of all four showed hemorrhagic necrosis. At early post operative follow up there was no evidence of testicular atrophy in those that underwent orchiopexy. There were no intraoperative complications or adverse reactions to ICG. CONCLUSIONS: Our institution successfully developed and implemented a standardized protocol for ICG use in testicular torsion. Early results indicate our protocol provides objective and quantitative assessment of testicular perfusion. We think this technology is a useful adjunct in the surgical management of testicular torsion and can aid in surgical decision making particularly in equivocal cases. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e158 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Raines More articles by this author Nicolas Fernandez More articles by this author Jennifer Ahn More articles by this author Mark Cain More articles by this author Byron Joyner More articles by this author Kathleen Kieran More articles by this author Paul Merguerian More articles by this author Hailey Silverii More articles by this author Margarett Shnorhavorian More articles by this author Expand All Advertisement PDF downloadLoading ...