Audit of Compliance With BURST-BAUS FIX-IT Guidelines for Scrotal Exploration in Suspected Testicular Torsion: A Two-Cycle Quality Improvement Study

Introduction Testicular torsion is a urological emergency requiring prompt diagnosis and intervention to salvage testicular viability. The British Association of Urological Surgeons (BAUS) and British Urology Researchers in Surgical Training (BURST) released consensus guidelines known as the Finding Consensus for Orchidopexy in Torsion (FIX-IT) study, to standardize scrotal explorations and improve clinical outcomes. This audit conducted at a district general hospital in Kent aimed to evaluate compliance with these guidelines - over two cycles, identifying areas for improvement. Methods A retrospective review of operation notes was conducted for all scrotal explorations performed in two distinct audit cycles in 2024. The first cycle, which spanned from January to June 2024, included a total of 16 cases. After completing the first cycle, a review in July 2024 highlighted areas for improvement. Based on this feedback, recommendations for practice improvements were made. The second cycle, conducted from August to December 2024, involved 38 cases, with data collection completed at the end of December. The data gathered for both cycles included the initial incision choice, intraoperative decision-making, fixation technique, closure methods, operation note documentation, and follow-up planning. These domains were then compared to the BURST-BAUS consensus guidelines to evaluate compliance and identify areas for improvement. Results A total of 54 scrotal explorations (16 in the first cycle and 38 in the second cycle) were reviewed across both audit cycles. The use of median raphe incisions was universal, with 100% compliance in both cycles. Fixation techniques were fully compliant with the guidelines, with non-absorbable sutures and three-point or four-point fixation being consistently used across both cycles. Closure techniques demonstrated 100% compliance, with all cases employing separate closure of the Dartos and skin layers using continuous and interrupted sutures, respectively, to optimize healing and minimize complications. However, intraoperative decision-making revealed notable divergence from the guidelines, particularly in non-torsion cases where orchidopexy was performed even in the absence of torsion or associated risk factors. In Cycle 1, all non-torsion cases (100%) underwent orchidopexy, whereas in Cycle 2, this was reduced (75%) but still persisted in a significant proportion of cases. Documentation of critical details (such as the degree of torsion and testicular appearance) and follow-up planning remained inconsistent but showed improvement between the two cycles. Conclusion The audit highlights substantial improvement between cycles, particularly in reducing inappropriate orchidopexy and planning follow-up. However, documentation gaps and residual guideline non-adherence indicate the need for ongoing education and standardization of scrotal exploration practice. [Abstract copyright: Copyright © 2025, Safdar et al.]