Limitations
ITP, pain
ITP
Initially, our university hospital had only one experienced surgeon with expertise in this approach. The first cases were documented for educational purposes by all the department surgeons. This initial learning curve might have affected our outcomes negatively. Second, owing to the lack of approved medical tools to properly measure the ITP, we adapted a surgical monitor and an invasive pressure tool. Similar to the initial surgical learning curve, pressure measurements might have affected the initial pressure outcomes. Therefore, to minimize this bias, the differences between the pressures of each patient were used. It is not possible to define normal human testicular pressure using this measurement tool. Third, only a few patients were included in the statistical analysis. Regarding the public health system of our city and interhospital transportation needs, few patients reached a urologist within 24 hours of pain onset.To address these initial difficulties, we aim to conduct a multicenter randomized controlled trial in the near future. Perhaps a prospective randomized trial comparing the flap group 