Detection of Normal Intratesticular Perfusion Using Color Coded Duplex Sonography Obviates Need for Scrotal Exploration in Patients with Suspected Testicular Torsion

Abstract

Although color coded duplex sonography is useful for visualizing testicular perfusion in patients with clinical suspicion of testicular torsion, fear of overlooking the condition itself remains. Thus, routine scrotal exploration in every patient with acute scrotal pain is common at many centers. We assessed the efficacy of color coded duplex sonography in predicting the need for scrotal exploration in patients with clinical suspicion of testicular torsion. We prospectively assessed the diagnostic value of color coded duplex sonography in 236 patients (median age 13 years, range 0 to 53) with clinical suspicion of testicular torsion between 1995 and 2012. All patients were evaluated by sonography and subsequently underwent exploration, whereby the surgeon was blinded to the ultrasound results. The sensitivity, specificity, and positive and negative predictive values of color coded duplex sonography for diagnosing testicular torsion were calculated based on preoperative ultrasound findings, and compared to the final diagnosis after surgical exploration. Testicular torsion was the most common cause of impaired intratesticular blood flow (119 cases, 50.4%), followed by torsion of the testicular appendages (82, 34.8%), epididymo-orchitis (18, 7.6%) and various other conditions (17, 7.2%). The sensitivity, specificity, and positive and negative predictive values of color coded duplex sonography for detecting testicular torsion were 100%, 75.2%, 80.4% and 100%, respectively. Our data provide evidence that routine surgical exploration is no longer justified in patients with clinical suspicion of testicular torsion if color coded duplex sonography has revealed normal intratesticular perfusion.