Abstract
Background: Testicular torsion poses a pediatric surgical emergency that necessitates rapid diagnosis and surgery to prevent testicular loss. We sought to determine whether any particular findings on Doppler ultrasound (US) were predictive of testicular viability in pediatric patients with testicular torsion.Materials and methods: We identified males between ages one and 18 years who experienced testicular torsion over a six-year period (January 1, 2015-December 31, 2020). All patients were evaluated at our institution’s emergency department by a pediatric urologist and underwent a Doppler scrotal US.Results: Of the 140 patients with testicular torsion, 56 (40%) had a non-viable testis and underwent an orchiectomy, while 84 (60%) had a viable testis and orchiopexy. Testicular heterogeneity (47 [84%] vs 48 [57%], p = 0.001), epididymis heterogeneity (23 [41%] vs 21 [25%], p = 0.063), and scrotal wall thickening (25 [45%] vs 5 [6%], p < 0.001) were significantly associated with a non-viable testis. Epididymis heterogeneity (adj. odds ratio [OR] = 0.33 [0.13, 0.79], p = 0.013) and scrotal wall thickening (adj. OR = 0.08 [0.03, 0.24], p < 0.001) exhibited significantly lower odds for viability. Testicular heterogeneity and scrotal wall thickening were more likely to develop with a longer duration of symptoms (both p < 0.001).Conclusion: Our study determined that certain Doppler scrotal US findings, specifically, testicular and epididymal heterogeneity as well as a thickened scrotal wall, are associated with testicular demise in patients with testicular torsion. As testicular heterogeneity and scrotal wall thickening are more likely to arise with a longer symptom duration, an urgent diagnosis and prompt surgical intervention are imperative to avert testicular loss.
Highlights
With an incidence of 1/1500 or 3.8% of males < 18 years, testicular torsion may develop when the spermatic cord rotates on its own axis resulting in decreased or absent blood flow to the testes [1-5]
The present study investigated whether specific findings on the US are more likely to be predictive of testicular viability in pediatric patients with testicular torsion
Three variables observed on the US were significantly associated with a non-viable testis by univariate analysis, including testicular heterogeneity (47 [84%] vs 48 [57%], p = 0.001), epididymis heterogeneity (23 [41%] vs 21 [25%], p = 0.063), and thickened scrotal wall (25 [45%] vs 5 [6%], p < 0.001) (Table 1)
Summary
With an incidence of 1/1500 or 3.8% of males < 18 years, testicular torsion may develop when the spermatic cord rotates on its own axis resulting in decreased or absent blood flow to the testes [1-5]. Surgery within six hours of pain onset boasts a testicular salvage rate of >90%, which plunges to 50% after 12 hours and
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