Prediction of testicular atrophy based on sonographic findings immediately after successful manual detorsion

Abstract

Purpose To investigate and determine the sonographic findings obtained from manually distorted testes to predict testicular atrophy following manual detorsion. Materials and methods Twenty‐two patients who had been diagnosed with testicular torsion and undergone manual detorsion were included. These patients were classified according to the presence or absence of testicular atrophy. The duration of symptoms, presence or absence of hyperperfusion within the entire affected testis, and echogenicity (homogeneous or heterogeneous) within the affected testis were compared using the Mann–Whitney U‐test or Fisher's exact test, as appropriate. Results Testicular atrophy was detected in seven patients. There was a significant difference in the frequency of hyperperfusion within the entire affected testis (with atrophy [present/absent] vs. without atrophy [present/absent] = 0/7 vs. 8/7, P = 0.023) between patients with and without testicular atrophy. No significant differences in the duration of symptoms (with atrophy vs. without atrophy = 7 ± 3.3 h vs. 4.7 ± 3.6 h, P = 0.075) or frequency of echogenicity within the testis (with atrophy [heterogeneous/homogeneous] vs. without atrophy [heterogeneous/homogeneous] = 2/5 vs. 2/13, P = 0.565) were observed between the groups. Conclusions This small cohort study suggests that the presence of hyperperfusion within the entire affected testis immediately after successful manual detorsion is useful in predicting the avoidance of testicular atrophy.

Point-of-care ultrasonography for the diagnosis and manual detorsion of testicular torsion

“…Therefore, rapid detorsion is critical, and rapid diagnosis and treatment via manual or surgical detorsion play a crucial role in recovering testicular blood flow [ 7 – 9 ]. Unlike surgical detorsion, manual detorsion can be performed immediately after diagnosing testicular torsion, thereby decreasing the duration of testicular ischemia [ 7 , 10 – 16 ]. Reports on the use of point-of-care ultrasonography for the diagnosis of testicular torsion have increased in recent years [ 7 , 12 , 13 , 16 – 22 ]; however, no review article has described its use for manual detorsion and determined its success rates.…”

“…Torsion can result in obstruction of venous blood return, which can lead to enlargement of the testis and edema [ 20 , 24 , 28 – 30 ]. Testicular necrosis may also occur in some cases, with the affected testis exhibiting heterogeneous echogenicity [ 16 , 29 – 33 ]. Abnormal echogenicity can be detected by carefully comparing the echogenicity within the affected and unaffected testes.…”

“…Only detorsion is performed during manual detorsion; orchiopexy, which prevents the recurrence of testicular torsion, and fasciotomy, which prevents testicular compartment syndrome due to reperfusion, cannot be performed during manual detorsion [ 16 , 20 , 67 , 68 ]. Hypervascularity of the whole testis indicates successful manual detorsion.…”

Clinical ultrasound research influences clinical ultrasound practice

“…One of the simplest clinical research designs is a case series, such as presented by Hosokawa et al 4 who investigated the role of ultrasound in predicting a successful management of testicular torsion. They found that the presence of hyperperfusion in the affected testes after manual detorsion predicted a successful outcome (avoidance of testicular atrophy).…”

“…One of the simplest clinical research designs is a case series, such as presented by Hosokawa et al 4 . who investigated the role of ultrasound in predicting a successful management of testicular torsion.…”