Preliminary Exploration of the Modified Arda Score for Assessing Testicular Viability After Testicular Torsion Detorsion
Luo Guoxiong
Su Qinjun
Yu Chang
Meng Dongdong
Zhang Bin
Chang Dehui
Abstract：Objective:To explore the reliability of the modified Arda scoring system in evaluating testicular viability during testicular torsion surgery and compare it with intraoperative biopsy-based pathological tissue viability grading.Meth-ods:A prospective study was conducted,including 25 cases of testicular torsion diagnosed by clinical and imaging examina-tions who underwent emergency surgical detorsion at the 940th Hospital of the Joint Logistic Support Force from October 2018 to October 2023.After testicular detorsion,testicular tunica albuginea incision and decompression were performed dur-ing the recovery period.Testicular tissue viability was quantitatively evaluated using the Arda scoring system based on the ob-servation of medullary arterial oozing.For patients with Arda Grade Ⅲ,microscopic spermatic vein thrombolysis was further performed.According to the recovery of medullary blood flow after thrombolysis,those with recovered medullary arterial oozing were classified as Arda Ⅲa,and the others as Arda Ⅲb;this classification was used to assess testicular viability and determine testicular salvage or resection.Testes with Arda Grade Ⅰ,Ⅱ,and Ⅲa were preserved,while those with Grade Ⅲb were resected.Meanwhile,intraoperative testicular biopsy was performed,and histopathological diagnosis was used as the reference standard to evaluate testicular viability using the Mikuz classification.Results:Among the 25 patients with testicu-lar torsion,the duration of torsion ranged from 6 to 72 hours(median,12 hours),and the torsion degree ranged from 360° to 1080°.There were 5 cases with Arda Grade Ⅰ and 11 cases with Grade Ⅱ,all of which were preserved and underwent orchido-pexy.Among the 9 cases with Arda Grade Ⅲ,4 were reclassified as Grade Ⅲa after thrombolysis and preserved,while 5 were reclassified as Grade Ⅲb and underwent orchiectomy.Intraoperative biopsy confirmed that among the 4 Arda Ⅲa cases,1 was Mikuz Grade 1 and 3 were Mikuz Grade 2.Compared with direct decision-making based on the original Arda score,the modified method showed a numerical trend of improving testicular salvage rate(64.0%vs.80.0%),but the difference was not statistically significant(P=0.207).There was also no significant difference in the testicular atrophy rate 3 months after sur-gery(31.25%vs.30.0%,P=0.081).Conclusion:Compared with the traditional Arda score,secondary evaluation of testicu-lar viability after microscopic venous thrombolysis may help improve the possibility of testicular salvage after detorsion,with-out an observed increase in complication rates.These results need to be further verified by larger-sample studies.Based on the current evidence level,this modified protocol can be used as an alternative strategy in clinical practice pending higher-level evidence.
Keywords：testicular torsionArda scoretissue viabilityvenous thrombosis
Publication Date：2025-08-28
Online Publishing Date：2025-10-22(First online date of this platform, not the publication date of the document)
Pages：6( 263-268 )