Point-of-care ultrasonography for the diagnosis of testicular torsion: a practical resident curriculum

Stringer, Leandra; Cocco, Sarah; Jiang, Alex; Chan, Ernest; Myslik, Frank; Brahm, Gary; Razvi, Hassan; Davé, Sumit; Wang, Peter Zhan Tao

doi:10.1503/cjs.019119

Cited by 10 publications

(13 citation statements)

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“…19 There are also studies delineating the incorporation of testicular POCUS specifically into the curriculum of emergency medicine residents. 3 The mainstreaming of testicular POCUS within the practice of emergency medicine residents is a shift in mindset away from previous methods where patients are imaged by radiologists alone. Likewise, in our study, patients were managed by PEM fellows and attendings alike.…”

Section: Discussionmentioning

confidence: 99%

“…However, a more convenient and readily accessible alternative is point-of-care ultrasonography (POCUS), executed bedside by an emergency medicine physician. 3 The first cases of testicular torsion diagnosed bedside by emergency medicine physicians were published in 2000; however, the literature describing the use of POCUS in adult and pediatric patients remains scarce and has been mostly limited to individual case reports. 4,5 In this study, we sought to illustrate the clinical course of 23 patients presenting with acute scrotal pain to determine if POCUS performed by a pediatric emergency medicine (PEM) physician can potentially rule in testicular torsion and expedite surgical management.…”

mentioning

confidence: 99%

“…Patients presenting to the emergency department with an acute scrotum and concern for torsion typically undergo ultrasonography interpreted by a radiologist (RADUS) before operative management. However, a more convenient and readily accessible alternative is point-of-care ultrasonography (POCUS), executed bedside by an emergency medicine physician 3 . The first cases of testicular torsion diagnosed bedside by emergency medicine physicians were published in 2000; however, the literature describing the use of POCUS in adult and pediatric patients remains scarce and has been mostly limited to individual case reports 4,5 .…”

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confidence: 99%

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Point-of-Care Ultrasound for the Diagnosis of Pediatric Testicular Torsion

2022

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Objectives: Acute testicular torsion is a surgical emergency that warrants prompt treatment. The diagnosis is typically confirmed by ultrasonography interpreted by a radiologist (RADUS); however, in this study, we describe the clinical course of 23 patients for whom point-of-care ultrasound (POCUS) was performed by pediatric emergency medicine physicians during the initial assessment for testicular torsion in the pediatric emergency department (PED).Methods: A retrospective case series analysis of patients aged 0 to 18 years who were diagnosed with acute testicular torsion after undergoing scrotal POCUS through our PED.Results: Between June 2015 and December 2020, 155 boys received an International Classification of Diseases-9 code of Torsion of Testis after presenting to our PED. Seventy-three patients were imaged preoperatively, of which 50 (68.5%) were diagnosed via RADUS alone. Twenty-three patients (31.5%) underwent POCUS (median age 14.1 years [interquartile range {IQR}: 11.4-15.9 years]), of which 14 (60.9%) were imaged by POCUS alone, whereas the remaining 9 patients (39.1%) underwent POCUS before RADUS. Thirteen of the 23 patients (56.5%) who underwent POCUS had intraoperative findings consistent with acute testicular torsion, whereas another 3 patients (13.0%) required manual detorsion in the PED before orchiopexy. Six patients required orchiectomy. All patients for which POCUS findings were suggestive of acute testicular torsion were correctly classified.The median length of stay from time to admission to orchiopexy for those who received RADUS only versus POCUS only was 184 minutes (IQR: 136-255), and 121 minutes (IQR: 80-202), respectively (P = 0.036). Among the patients who experienced POCUS, the median length of stay for those who underwent RADUS in addition to POCUS compared with those who underwent POCUS alone was 202 minutes (IQR: 136-338.4) (P = 0.031).Conclusions: Point-of-care ultrasound performed by pediatric emergency medicine physicians can be used to expedite surgical management and streamline the management of pediatric patients suspected of acute testicular torsion.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Point-of-Care Ultrasound for the Diagnosis of Pediatric Testicular Torsion

2022

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“…There is one unique Canadian POCUS course for both emergency medicine and urology residents in its early stages; however, the program focuses only on the diagnosis of testicular torsion. 17 Given the lack of POCUS training options for urology residents, the objective of this pilot study was to develop and evaluate a low-cost, feasible, and guidelinebased introductory POCUS curriculum for Canadian urology residents, with a focus on familiarization of foundational technical skills and theoretical knowledge through the application of several urology-specific examinations.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care ultrasound in urology: Design and evaluation of a feasible introductory training program for Canadian residents

Lovatt

Hoogenes

et al. 2020

CUAJ

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Introduction: Point-of-care ultrasound (POCUS) is an increasingly used bedside tool. Applications in urology include the assessment of an undifferentiated acute scrotum, renal colic, and the guidance of suprapubic catheter placement. However, the user-dependent nature of this modality necessitates appropriate use and competence. The objective of this study was to develop and evaluate a low-cost, feasible, and guideline-based introductory POCUS program for Canadian urology residents. Methods: Residents from McMaster University’s urology program completed a three-hour online course, followed by a three-hour hands-on seminar. Course material was developed by ultrasound educators based on national guidelines. Low-cost testicular phantoms and suprapubic catheter insertion models were constructed. Pre- and post-course surveys focused on participant skill confidence, while multiple-choice questionnaires assessed theoretical knowledge. Results: Fourteen residents participated in the course. Theoretical knowledge in POCUS improved significantly (p<0.001, d=2.2) and mean confidence scores improved for all skills, including performing kidney, bladder, and testicular POCUS (all p<0.001; d=3.4, 1.9, 2.9, respectively). Participants indicated that the course increased their confidence and likelihood of using POCUS in clinical practice, and that POCUS training should be integrated into urology training curricula. Conclusions: This novel study included the development of an inexpensive, feasible, guideline-based introductory training program for urological POCUS, developed in collaboration with ultrasound educators. Participants significantly improved in theoretical knowledge and skill confidence. Although this study was limited to one residency program, the basis of this course may serve as a foundation for the development of competency-based training for urological POCUS in Canada.

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“…physicians using a condensed program [14]. Despite adequate training, it is important to be aware of the pitfalls when performing POC testicular ultrasound that could lead to a misdiagnosis.…”

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Real-time Point-of-care Ultrasound for the Diagnosis and Treatment of Testicular Torsion

Nene

Subramony

Marcias

et al. 2021

pocus

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Background: Testicular torsion is a surgical emergency that needs prompt diagnosis and treatment. Point-of-Care ultrasound (POCUS) can not only establish the diagnosis but also guide the Emergency Physician in evaluating the response to manual detorsion. Case Report: We describe the case of a 13-year-old male who presented with acute scrotal pain. We demonstrate how bedside ultrasound was used to make the diagnosis of testicular torsion, guide the technique for manual detorsion, and confirm adequate return of blood flow. Our case illustrates the ease with which POCUS can be used in real time to diagnose and treat organ-threatening pathology, but more importantly, it shows how real-time POCUS was used to detorse a testicle that was refractory to the standard detorsion technique. Conclusion: The acute scrotum is a time-sensitive presentation and if testicular torsion is present, the diagnosis should be made as soon as possible. Many Emergency Departments do not have 24-hour coverage of ultrasound technicians, which would delay the diagnosis and treatment. Moreover, when manual detorsion is attempted, it often does not work because the testicle may need more than the standard 180 degree medial to lateral rotation. POCUS provides real-time analysis of return of blood flow and can thus guide further rotation, or opposite direction rotation, as needed.

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Point-of-care ultrasonography for the diagnosis of testicular torsion: a practical resident curriculum

Cited by 10 publications

References 10 publications

Point-of-Care Ultrasound for the Diagnosis of Pediatric Testicular Torsion

Point-of-Care Ultrasound for the Diagnosis of Pediatric Testicular Torsion

Point-of-care ultrasound in urology: Design and evaluation of a feasible introductory training program for Canadian residents

Real-time Point-of-care Ultrasound for the Diagnosis and Treatment of Testicular Torsion

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