Khalid AKKOUR, Eman ALSHEHRI, Mais Mohammed ALHULWAH, Ghadeer AL-SHAIKH, Hani ALHALAL, Nada ALAYED, Mujahid BUKHARI, Mansour ALSHAMARI, Assem KALANTAN, Abdulrahman BOGIS, Lolowah ALGHUSON, Ahmed Sherif ABDELWAHAB, Maged ELSHOURBAGY
Pelviperineology - 2025;44(3):109-115
Objective: Adnexal masses in adolescents present unique clinical challenges, particularly regarding fertility preservation. This study aimed to characterize the clinical profile, management, and outcomes of adolescents with surgically treated adnexal masses, with a specific focus on identifying risk factors for torsion and evaluating rates of ovarian conservation. Materials and Methods: This retrospective cohort study included 92 adolescents (10-21 years) who underwent surgery for adnexal masses at a tertiary University Hospital between 2008 and 2018. Data on demographics, clinical presentation, imaging (IOTA classification), surgical details, and pathology were analyzed. A comparative analysis between torsion (n=29) and non-torsion (n=63) groups was performed, followed by multivariate logistic regression to identify independent predictors of torsion. Results: The mean age was 17.3 years, and abdominal pain was the most common symptom (43.5%). Torsion occurred in 31.5% of cases. Younger age was the only independent risk factor for torsion (aOR =0.85 per year, p=0.018). Laparoscopy was the primary surgical approach (68.5%), and cystectomy was the most frequently performed procedure (68.5%). Final pathology was benign in 89.1% of cases, with cystadenofibroma (20.7%), hemorrhagic cyst (19.6%), and dermoid cyst (14.1%) being the most common. Malignancy was identified in 10.9% of cases. Conclusion: Adnexal torsion is common in adolescents, and due to low cancer risk and advances in minimally invasive techniques, laparoscopy has become the gold standard, aligning with patient and parent preferences for less aggressive surgeries. Adnexal torsion is common in adolescents, and due to low cancer risk and advances in minimally invasive techniques, laparoscopy has become the gold standard, aligning with patient and parent preferences for less aggressive surgeries.
