The use of Doppler ultrasound in the clinical management of acute testicular pain

Abstract

To evaluate the reliability and the clinical application of the use of a hand-held Doppler ultrasound flowmeter probe as an aid to differential diagnosis in the assessment of cases with acute testicular pain presenting to a district general hospital. Over a period of 1 year, testicular Doppler ultrasonic assessment was performed on 56 patients admitted with acute scrotal pain. A hand-held Doppler ultrasound probe was used, with a transducer operating at 8 MHz. All the patients were assessed pre-operatively by a single operator in the Accident and Emergency department before transfer to theatre. The decision to explore the testis was made purely on clinical grounds by which ever emergency surgical team was on duty. The operating surgeons were not informed of the result of Doppler examinations before surgical exploration. Twenty-two patients were subsequently shown to have torsion of the testis at surgical exploration, all of whom had no Doppler signal over the affected side. Of the remaining 34 patients, who were subsequently shown not to have torsion at operation, normal testicular blood flow and cord-compression tests were demonstrated confidently in 33 patients when examined pre-operatively. Thus the sensitivity was 100% (22/22) and the specificity 97% (33/34). Testicular Doppler examination using an 8 MHz probe in conjunction with the cord-compression test is a useful, simple and highly accurate clinical tool which can differentiate between testicular torsion and other conditions presenting with acute testicular pain. It is also inexpensive and readily available in the district general hospital situation.