The Use of Doppler Ultrasound for Suspected Testicular Torsion: Lessons Learned from a 15-Year Multicentre Retrospective Study of 2922 Patients

Pinar, Ugo; Duquesne, Igor; Bardet, F.; Kaulanjan, K.; Michiels, C.; Mazancourt, E. Seizilles de; Dominique, I.; Vallée, M.; Felber, M.; Freton, L.; Gondran-Tellier, Bastien; Matillon, X.; Khene, Z.; Pradère, Benjamin

doi:10.1016/j.euf.2021.02.011

Cited by 17 publications

(15 citation statements)

References 21 publications

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“…15 The sensitivity of Doppler ultrasound in testicular torsion was 69%-91%, and the specificity was 87%-100%. 16 If the ultrasonic texture of the twisted testis is normal, the possibility of testicular salvage could be higher. If some or all testes are hypoechoic, this suggests that there is an infarct in the testes.…”

Section: Resultsmentioning

confidence: 99%

A nomogram for predicting risk factors of testicular salvage after testicular torsion in children

Chen,

Huang,

et al. 2024

Int J of Urology

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ObjectivesThis study aimed to establish a nomogram for predicting the probability of testicular salvage after testicular torsion in children.MethodsWe retrospectively collected data of children with testicular torsion who were treated at Shenzhen Children's Hospital between September 2005 and August 2022. Of the training cohort, 113 patients who underwent orchiectomy and five with testicular atrophy after orchiopexy were included in the failed testicular salvage group. Additionally, 37 patients who underwent orchiopexy without postoperative testicular atrophy were included in the successful testicular salvage group. The predictive factors affecting testicular salvage were determined using univariate and multivariate logistic regression analyses; a nomogram was constructed. The nomogram was verified using data from the validation group.ResultsUsing multivariate logistic regression analysis, the independent risk factors of testicular salvage after testicular torsion were symptom duration (p = 0.034), intratesticular blood flow (p = 0.003), spermatic cord torsion degree (p = 0.037), and monocyte count (odds ratio: 0.012, p = 0.036). A nomogram was established based on these four risk factors. In the training cohort, the area under the receiver operating characteristic curve was 0.969. The area under the receiver operating characteristic curve of the verification cohort was 0.965, indicating good discrimination ability of the nomogram. Increased symptom duration without intratesticular blood flow increased the monocyte count and spermatic cord torsion degree and decreased the success rate of testicular salvage.ConclusionThis prediction model could obtain the corresponding probability of testicular salvage according to the clinical characteristics of different patients with testicular torsion, providing reference for clinicians and parents.

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Section: Resultsmentioning

confidence: 99%

A nomogram for predicting risk factors of testicular salvage after testicular torsion in children

Chen,

Huang,

et al. 2024

Int J of Urology

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“…The results should not deter surgical exploration when clinical suspicion of torsion is high. [ 16 ] In this study, all patients suspected of acute scrotum underwent a Doppler ultrasound. Ultrasound confirmed testicular torsion in 87.5% of cases.…”

Section: Discussionmentioning

confidence: 99%

Retrospective review of patients with testicular torsion in a University Hospital in Bahrain

et al. 2023

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Introduction: Testicular torsion is a surgical emergency that, with delayed treatment, may be associated with loss of the testis. It commonly presents with sudden onset testicular pain, vague lower abdominal pain, nausea, and vomiting. Management often requires emergent surgical scrotal exploration, detorsion, and fixation or removal of the affected testis. Materials and Methods: Retrospective review of all the patients in a hospital covering the Muharraq district in Bahrain presenting with testicular pain. Results: During the six-year period from 2015 to 2021, 48 patients with testicular torsion were managed, with a mean age of 18.4 (± 9.2) years. Most patients (54.7%) presented within 6 hours of the onset of symptoms. All 48 patients underwent a doppler ultrasound, which confirmed the presence of testicular torsion in 87.5% of patients, with a sensitivity of 87% and specificity of 98.5%. Fourteen patients had non-viable testis on surgical exploration, with an average age of 16.6 (± 6.8) years and took an average of 13 to 24 hours to present to the emergency department after the start of pain. Most patients underwent scrotal ultrasound 60 minutes from the presentation to the emergency department and surgical exploration within 120 to 179 minutes. The rate of testicular torsion in patients who underwent diagnostic ultrasound at 60 minutes or more from presentation was 40%, compared to an overall rate of 29%. All detected cases of testicular torsion, except for one case, underwent bilateral fixation of the testes. Of those patients who underwent contralateral fixation, none presented with contralateral torsion, supporting the recommendation of contralateral fixation. Conclusion: Patients underwent comprehensive assessment of their complaint and emergent surgical intervention, including an ultrasound that did not delay the surgical intervention. We agree that clinical judgment is the primary tool for assessment of patients with acute scrotum and an adjunct emergent ultrasound does not significantly cause delays. We concur with the current recommendations for contralateral fixation and prompt surgical management as the anatomical anomaly is present bilaterally.

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“…Recent studies have indicated delays of 48–119 minutes when ultrasound was performed. 29–31 Furthermore, overreliance on imaging stresses hospital radiology services where ultrasonography often remains a limited resource. TWIST aims to streamline this decision-making process and allow for rapid triaging based on physical findings.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score

Qin

2022

Journal of Urology

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Purpose:The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score is a 7-point tool to evaluate acute scrotal pain. Parameters include testicular swelling (2 points), hard testis (2), high-riding testis (1), absent cremasteric reflex (1) and nausea/vomiting (1). This review aimed to determine the diagnostic utility of TWIST and its role in risk stratification.Materials and Methods:A systematic review and meta-analysis of diagnostic test accuracy was conducted. Five risk stratification systems were explored, including the Barbosa (0–2, 3–4, 5–7) and Sheth (0, 1–5, 6–7) scoring systems, to obtain sensitivity, specificity and area under the receiver operating curve.Results:Thirteen studies were identified, 9 prospective studies proceeded to meta-analysis of diagnostic test accuracy and 5 pediatric studies (1,060 patients, 199 torsions) were included in the primary analysis. The most accurate risk stratification system was Barbosa (0–2, 3–4, 5–7), with an AUC of 0.924 (95% CI: 0.865, 0.956). Barbosa showed favorable sensitivity in low-risk patients (0.984), facilitating rule out of torsion, and favorable specificity (0.975) in high-risk patients, facilitating urgent surgical exploration. Sensitivity and specificity in intermediate-risk patients were 0.922 and 0.682, respectively, indicating a need for further workup with ultrasound. Using this stratification, 65.2% of patients were low-risk, 19.9% were intermediate-risk and 14.9% were high-risk. Per 100 presentations of acute scrotum, there was a missed torsion rate of 1.6/100, ultrasound rate of 19.9/100 and negative exploration rate of 2.5/100.Conclusions:TWIST is an effective tool for suspected testicular torsion and is appropriate for widespread adoption. The Barbosa scoring system is reliable and reduces reliance on scrotal ultrasound.

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The Use of Doppler Ultrasound for Suspected Testicular Torsion: Lessons Learned from a 15-Year Multicentre Retrospective Study of 2922 Patients

Cited by 17 publications

References 21 publications

A nomogram for predicting risk factors of testicular salvage after testicular torsion in children

A nomogram for predicting risk factors of testicular salvage after testicular torsion in children

Retrospective review of patients with testicular torsion in a University Hospital in Bahrain

Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score

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