Ultrasound evaluation of long-term outcome in boys operated on due to testicular torsion

Abstract

We aimed at verifying the usefulness of spectral Doppler ultrasonography in determining development of the testis after torsion in boys.The study involved 28 patients and 30 control cases divided into 3 developmental groups: pre-pubertal, early pubertal, and pubertal. It presented surgical management in testicular torsion (TT), volume, and echogenicity of testes, as well as peak-systolic velocity (PSV), end-diastolic velocity (EDV), and vascular resistance index (RI) in the capsular and intra-testicular arteries, regarding developmental groups, detorsed testes, uninvolved ones, and testes in the control group.Orchiectomy was performed in 13 boys with complete TT, in 11 lasting for over 24 hours, and in 2 lasting for 9 and 10 hours, respectively. Orchiectomy mainly involved patients aged up to 6 years, who at the time of the follow-up ultrasound belonged to the pre-pubertal group.There is no clear correlation between the type of testicular torsion, its duration, and the echogenicity of the testis. Testicular torsion has a negative effect on the volume of detorsed testis with compensatory hypertrophy of the uninvolved testis. The study represents a new approach to the issue of long-term gonadal blood supply abnormalities after treatment of testicular torsion in childhood.

Shear wave elastography for the evaluation of testicular salvage after testicular torsion

“…The evaluation of vascularity with colour Doppler ultrasound (US) is a standard method used in the diagnosis of testicular torsion. In the follow‐up of these cases, there are studies evaluating grey‐scale US and Doppler US characteristics (Baker et al, 2000; Osemlak et al, 2021; Yang et al, 2011). Real‐time shear wave elastography (SWE), which emerged as a new technology in the sonographic evaluation of tissue stiffness, is now used for testicular pathologies, such as the testicular microlithiasis, undescended testes, testicular masses, and varicocele (Bayramoglu et al, 2001; Fang et al, 2019; Rocher et al, 2019; Roy et al, 2020; Turna & Aybar, 2020; Ucar et al, 2017).…”

Testicular torsion; clinical diagnosis or imaging diagnosis?

“…The high investment of the tunica vaginalis (intravaginal) over the cord causing the testis to hang within the tunica like a clapper in a bell, is the most common cause especially in adolescents as well as in neonates. Whereas, the torsion of the entire cord occurring before fixation of the tunica vaginalis and the dartos within the scrotum (extra vaginal), commonly occurs in perinatal infants [1] , [2] .…”

“…Physical examination may reveal a high-riding transversely oriented tender testicle, an anterior epididymis with an absent cremasteric reflex. In contrast, torsion of the appendix testis or appendix epididymis often presents with localized tenderness at the superior pole of the testis or caput epididymis with reactive hydrocele [1] , [2] .…”

“…Despite its high sensitivity and specificity, both false-negative and false-positive findings occur. However, Testis with color Doppler flow signals might be an obstacle for surgical exploration with resultant testicular loss in the false-negative cases [2] , [3] .…”

“…Heterogeneity of the testis with swelling and edema suggests no viability, whereas a homogenous echotexture suggests testicular viability on gray scale sonography [2] , [3] .…”