Testicular Torsion In Children Research Articles

Diagnostic efficacy and value of ultrasound in children's scrotal testicular torsion: A retrospective analysis.

The purpose of this study is to explore the diagnostic efficacy and value of ultrasound detection for testicular torsion in children with scrotal and testicular diseases. A total of 120 children with acute scrotal swelling and pain who were treated in our hospital from August 2017 to August 2022 were selected for preliminary diagnosis through color Doppler ultrasound diagnostic instrument examination. The final diagnosis was made through surgical or conservative treatment. At the same time, 40 children with acute epididymitis during the same period were selected as the control group, and the clinical treatment of patients with testicular diseases was retrospectively analyzed. A total of 120 children were diagnosed with testicular torsion disease, with 57 cases affecting the left testicle and 63 cases affecting the right testicle. Ultrasound examinations revealed no blood flow signal in 78 cases, a significant reduction in blood flow in 38 cases, and no change in 4 cases. Among the pediatric patients who underwent manual reduction, 79 cases had a favorable prognosis. Surgical reduction was performed in 41 cases, with 35 cases successfully treated and 6 cases resulting in testicular removal. Follow-up examinations conducted 6 months to 1 year postoperatively showed testicular atrophy in 4 out of 35 cases with preserved testicles, while the 6 cases that underwent testicular resection had good outcomes. The non-active subgroup had a longer disease course and a greater degree of torsion (P < .05). There was no statistically significant difference in testicular volume and the ratio of healthy testicular volume between the 2 groups (P > .05). The sensitivity of ultrasound diagnosis was 95.24% (73/77), specificity was 78.57% (34/43), and accuracy was 89.29% (107/120). Ultrasound can effectively diagnose testicular torsion and evaluate the success rate of testicular reduction. Early treatment of patients with testicular torsion leads to better efficacy and higher survival rates.

Paediatric testicular torsion in low- and middle-income countries: an OxPLORE scoping study.

Literature on paediatric surgical conditions in low- and middle-income countries (LMICs) remains limited. As a common emergency, timely treatment of testicular torsion acts as a benchmark of adequate emergency service delivery in paediatric surgery. This scoping study aims to synthesise all existing literature on paediatric testicular torsion in LMICs. A database search was conducted by the OxPLORE global paediatric surgery research group to identify studies containing the terms 'testicular torsion' or 'acute scrotum' originating from LMICs. A thematic analysis was applied to the results of the search and the quality of evidence was appraised for all included articles. This review included 17 studies with 1798 patients. All studies originated from middle-income countries and the majority (76%) had sample sizes smaller than 100 patients. All studies were appraised as providing less than adequate evidence. Included studies identified long delays to treatment and highlighted ongoing debates on the value of scoring systems and Doppler ultrasonography in diagnosing torsion. Major heterogeneity in surgical approaches to treatment of testicular torsion in children was also observed. Literature on paediatric testicular torsion in LMICs is scarce and heterogeneous. Prospective, multi-centre research on the management of this common paediatric surgical emergency is urgently required.

A novel nomogram to predict testicular torsion in children with acute scrotal pain: a single-center retrospective study in western China

A novel nomogram to predict testicular torsion in children with acute scrotal pain: a single-center retrospective study in western China

Pathomorphological and immunohistochemical characteristics of the testicle in children with critical ischemia during acute torsion

Background. The occurrence of acute torsion of the testicle in children leads to ischemia of the testicle, and in the absence of timely medical assistance - to the loss of the organ. The period from 12 hours to 24 hours from the onset of the disease leaves only a 20% chance of saving the genital gonad. There are still no exact signs of viability of the affected gonad in case of critical ischemia of the testicle due to its torsion. Therefore, the study of the dynamics of changes in morphological structures in the course of acute testicular torsion, morphological and functional disorders resulting from torsion, is of great practical interest, because there is no consensus on the nature and degree of these changes in the affected gonad. Objective: study of the nature and severity of pathomorphological changes and immunohistochemical features of the acute torsion testicle in children within 12.1-24 hours or more from the onset of the disease. Methods. A histological, histochemical, and immunohistochemical study of testicular tissue biopsies taken during the operation of detorsion and orchiopexy, and orchidectomy within 12.1–24 hours or more from the onset of clinical symptoms of acute unilateral torsion in 16 patients was conducted. Results. The morphological study of the gonads showed that the duration of acute torsion of 12.1–24 hours or more is characterized by severe pathological changes found in the testicles. After 18 hours of acute ischemia, tubules were visualized in many fields of view in the form of shadows with the impossibility of identifying the structures due to hemorrhagic or ischemic infarcts. Immunohistochemical typing demonstrated the absence of expression of vimentin and calretinin, which indicated the death of sustentocytes (Sertoli cells) and Leydig cells. With a duration of acute torsion of 12.1-18 hours, a histochemical study of glycogen in the cytoplasm of spermatogonia, spermatocytes, and sustentocytes using the PAS-reaction showed that some cells of the spermatogenic epithelium were characterized by irreversible changes preceding necrosis, although giant multinucleated spermatids with relatively preserved glycogen, which meant there was a minimal chance for saving the gonad. Conclusion. Total duration of symptoms and degree of male gonadal torsion are the main prognostic factors for testicular preservation or necrosis in episodes of torsion. The duration of an acute torsion of 12.1-18 hours, according to morphological research, leaves in 42,9% of cases the presence of a minimal chance of saving the genital gonad. After 18 hours from the onset of acute complete testicular torsion in children, the operation of choice is orchidectomy.

Follow‐up results regarding fixation of contralateral testis after testicular torsion in children

AbstractThe aim is to investigate the possible advantages and disadvantages of contralateral testicular fixation (CTF) for boys with testicular torsion (TT) by long‐term clinical follow‐up results. A retrospective cohort study was conducted on TT boys at Children’s Hospital of Chongqing Medical University from September 2005 to December 2020. The baseline characteristics, intraoperative findings, and clinical follow‐up results were compared between TT patients underwent orchiopexy with or without CTF, and orchiectomy with or without CTF, respectively. The χ2 test and the Fisher’s Exact test were used to compare dichotomous outcomes, and the Mann‐Whitney U test was used to compare continuous outcomes without normal distribution. A total of 140 cases were included in this study. The bell clapper deformity was found in 30.4% of all torsed testes underwent orchiopexy, 16.4% during contralateral testicular exploration, and only 10.9% in bilateral sides. Contralateral testicular volume, adverse events, and paternity rates were comparable between patients underwent orchiopexy with or without CTF, and no subsequent contralateral TT observed during follow‐up. However, those patients underwent orchiectomy without CTF had more incidence of scrotal discomfort than those had orchiectomy with CTF (P = 0.027). In addition, one boy suffered subsequent contralateral TT after orchiectomy without CTF. The incidence of bell clapper deformity was lower in this research than that of literature reports. CTF would not induce testicular volume loss, atrophy or scrotal pain. Contralateral testicular discomfort and even subsequent TT could be more easily observed during follow‐up in patients without CTF. We still recommend routine surgical fixation of contralateral testicle during surgery.

The impact of ultrasound on testicular loss in cases of testicular torsion in children

PurposeUltrasound as a diagnostic tool in suspicion of testicular torsion is still highly debated. In this investigation, we aimed to evaluate whether time spent on scrotal ultrasonography had a negative impact on testicular loss.MethodsPatients’ records containing a scrotal ultrasound and/or surgical procedure codes for testicular interventions on suspicion of testicular torsion were examined. Patients aged 0–15 years admitted during 2015–2019 at Copenhagen University Hospital, Rigshospitalet were included.ResultsIn total, 1566 patients underwent an ultrasound and 142 of these proceeded to surgery while 13 patients proceeded directly to surgery without an ultrasound. The rate of testicular loss with a preceding ultrasound was 23% versus 42% without (p = 0.18). Four cases of testicular torsion were misdiagnosed by ultrasound resulting in a sensitivity of 95.4% and specificity of 95.6%. The mean diagnostic delay from ultrasound examination was 55 ± 39 min, and the mean time from ultrasound to surgery was at 169 ± 76 min versus 171 ± 72 min without ultrasound.ConclusionIn a clinical setting, ultrasound provided a reliable tool for the diagnosis of testicular torsion and did not seem to increase the orchiectomy rate.

Comparison of clinical features and outcomes between two age groups of cryptorchidism testicular torsion in children: a retrospective study in single center.

The purpose of this study was to compare the clinical characteristics and outcomes of children with cryptorchidism testicular torsion between the younger age group and the older age group. We collected the clinical data of children with cryptorchidism complicated with testicular torsion in our hospital from January 1, 2013 to January 1, 2023. The patients were divided into two groups: the younger age group (1month∼4 years old, n = 7) and the older age group (4∼18 years old, n = 7). The differences of clinical manifestations and surgical results between the two groups were compared. A total of 14 patients with unilateral cryptorchidism testicular torsion were included in this study, including 9 on the left side and 5 on the right side. The main clinical manifestations were pain /swelling of groin. The rate of crying in the younger age group was significantly higher than those in the older age group [(5,71.4%) vs. (0,0.0%), P < 0.05]. The median duration of symptoms of the younger group was less than the older group [42(7,96) h vs. 70(24, 96) h, P > 0.05]. The ipsilateral testicular salvage rate in the younger age group was 14.3% (1/7), which was lower than the older age group 57.1% [(4/7), P > 0.05]. The degree of testicular torsion in younger age group was more severe than the older age group [720(360, 1,080)° vs. 360(270, 360)°, P > 0.05]. The overall salvage rate of cryptorchidism testicular torsion is low. Although the duration of symptoms in the older age group was longer, the salvage rate of the older age group seemed to be higher than that in the younger age group. In addition, physical and imaging examination of the reproductive system should be carried out in time to identify the children with cryptorchidism testicular torsion in the early stage.

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

This study aimed to establish a nomogram for predicting the probability of testicular salvage after testicular torsion in children. We 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. Using 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. This 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.

Clinical and hematological analysis of testicular torsion in children.

Analyze the clinical manifestations, laboratory tests, and imaging data of testicular torsion to provide clinical insights for timely and accurate diagnosis and treatment of testicular torsion. A retrospective analysis was conducted on the clinical data of 67 pediatric patients suspected of testicular torsion, admitted and subjected to surgical exploration from June 2018 to June 2023. Based on whether the torsed testicle was excised during surgery, the patients were divided into orchiectomy group (40 cases) and orchidopexy group (27 cases). Combining clinical symptoms, signs, ultrasound examinations, and laboratory tests, the study aimed to summarize the influencing factors on the onset, diagnosis, and treatment of testicular torsion. The clinical manifestations of all 67 pediatric patients were generally typical. Color Doppler Flow Imaging (CDFI) and surgical exploration were performed for all cases, and the results were consistent. Testicular color doppler ultrasound suggested reduced or absent blood flow, leading to surgical treatment in all cases. All patients had unilateral testicular torsion, with 46 cases (68.66%) on the left side and 21 cases (31.34%) on the right side. Intrafunicular torsion occurred in 60 cases (89.55%), while extrafunicular torsion occurred in 7 cases (10.45%). The onset distribution was as follows: 20 cases in spring, 16 cases in summer, 16 cases in autumn, and 15 cases in winter. Univariate analysis indicated significant statistical differences in age, degree of testicular torsion, duration of symptoms, NEUT, NLR, and occurrence of tunica fluid between the two groups of patients. Multivariate logistic regression analysis showed that the duration of symptoms and the occurrence of hydrocele were independent risk factors for determining testicular viability. Testicular torsion is more common in children and adolescents, with clinical manifestations including scrotal pain, scrotal redness and swelling, abdominal pain, nausea, and vomiting. In the early stages of testicular torsion, inflammatory markers in the blood increase, and preoperative ultrasound indicates hydrocele. This suggests that the testicle is in an early twisted state, with good viability and potential for preservation.

The diagnosis and treatment of testicular torsion in children with non-scrotal initial symptoms.

To explore the clinical characteristics of testicular torsion in children with non-scrotal initial symptoms who were misdiagnosed. A retrospective analysis of 73 cases children with testicular torsion and non-scrotal symptoms who were admitted to our department from October 2013 to December 2021 was performed. Patients were divided into misdiagnosis (27 cases) and clear diagnosis at first visit (46 cases) groups. Clinical data, including age at surgery, clinical presentation, physical examination, number of visits (≥2 times), affected side, time from initial symptoms to surgery, and surgical outcomes, were collected. The TWIST (Testicular Workup for Ischemia and Suspected Torsion) score was calculated and analyzed. Statistically significant differences between the misdiagnosis and clear diagnosis groups were seen in the time from initial symptoms to surgery, the number of visits, the degree of testicular torsion, and the rate of orchiectomy (P < 0.05). There were no statistically significant differences (P > 0.05) in age, affected side, TWIST score, guardian, direction of testicular torsion, intra-vaginal or extra-vaginal torsion, and Arda classification. Postoperative follow-up was 6-40 months. Of the 36 patients who required an orchiopexy, 1 had testicular atrophy at six months and 2 were lost to follow-up. The contralateral testis of the 37 children who underwent orchiectomies developed normally without torsion. The clinical manifestations of testicular torsion in children are diverse and can easily lead to misdiagnosis. Guardians should be aware of this pathology and seek timely medical attention. When the initial diagnosis and treatment of testicular torsion is difficult, the TWIST score during the physical examination may be useful, especially for patients with intermediate-to-high risk scores. Color Doppler ultrasound can assist in making the diagnosis, but when testicular torsion is highly suspected, routine ultrasound is not necessary as it may lead to delayed surgical treatment.

Testicular Torsion in Children. Diagnostic and Prognostic Potential of Ultrasonography

Introduction: Testicular torsion is the most urgent case in pediatric andrology that requires emergency care due to the high sensitivity of testicular tissue to hypoxia.Objective: To determine statistically significant parameters indicating diagnostic significance of some ultrasonographic testicular torsion symptoms in children.Materials and methods: Ultrasonography was performed in 202 children with testicular torsion (main group) and 449 patients (control group) aged from 2 months to 17 years 11 months and 28 days. During statistical processing we determined the mean values, their standard deviation, sampling errors, significance of differences in the mean values, correlation coefficient and did ROC analysis. For an objective ultrasonographic assessment of testicular shape, we implemented the coefficient of rounding – ko = (testicular length – testicular thickness) / testicular length – and the parameter Δko calculated as the difference between ko for the affected side and the contralateral one.Results and discussion: Testicular torsion was more common in children above 12 years of age (84.7%). The ko was 0.160 ± 0.007 in the group of children with testicular torsion and 0.037±0.003 in the control group (t = 16.92, p &gt;&gt; .001). The ROC analysis proved the Δko to be highly informative: AUC was 0.886. The Δko was 0.130 ± 0.008 for patients with favorable treatment outcomes and 0.19 ± 0.01 (p &lt; 0.001) for those with unfavorable outcomes. In most cases (71), the whirlpool sign was visualized with preserved blood flow. In such a case, the probability of the favorable treatment outcome was 74.6%. The whirlpool sign visualization was significantly less common (31 cases) without Doppler ultrasonography; favorable treatment outcomes were achieved in 54.8%. Of 22 patients with the undetected whirlpool sign, favorable treatment outcomes were possible only in 40.9%.Conclusions: The coefficient of rounding ko can be used as an auxiliary criterion for the early diagnosis of testicular torsion. With Δko = 0.08, the sensitivity of the parameter in respect of testicular torsion is 79.2%, and specificity is 85.7%. With Δko = 0.16, the specificity of the parameter is almost 100% with a 45.0% decrease of the sensitivity. Whirlpool sign detection using color Doppler ultrasonography is a positive prognostic factor.

Clinical characteristics and identification of risk factors of testicular torsion in children: Aretrospective study in a singleinstitution.

Testicular torsion (TT) is a common urological emergency posing serious health problem in children. Prompt diagnosis and treatment of TT are very important for children to protect the affected testis. The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. We conducted a retrospective record of clinical findings, laboratory data, ultrasound findings, operating results, and the results of follow-up in hospitalized children with TT from November 2004 to December 2021. A multivariable logistic regression model was used to identify predictors of testicular salvage. A total 102 hospitalized children who presented with TT were included. Patients were aged from 1 month to 16 years, with a median age of 7.71 years. TT is significantly more common in the winter. Of these patients, 77 torsions were left-sided, 24 were on the right side, and only 1 was on bilateral sides. Meanwhile, we detected that 88 children suffering from TT had intravaginal torsion of the spermatic cord, and the rest were outside. Anticlockwise torsion was found in 65 cases (63.73%) and clockwise torsion in 37 (36.27%). As a result, 60 underwent orchidectomy, while 42 had a scrotal exploration with fixation of the testis. Multivariate analysis showed that cause of TT, time to intervention, white blood cell (WBC), and mean platelet volume (MPV) were correlated with the risk of a surgical outcome. Only a small proportion of TT children received timely surgical management. Testicular salvage can be predicted by cause of TT, time to intervention, WBC, and MPV. Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. A certain percentage of children with TT presenting with scrotal trauma or epididymo-orchitis should have their testicles checked to make sure that they do not have torsion, especially those who visit in the cold season.

Is There A Correlation Between Testicular Torsion in Children and the Climate Factors?

Is There A Correlation Between Testicular Torsion in Children and the Climate Factors?

Use of TWIST Score and BAL Score in Diagnosing Testicular Torsion in Children with Acute Scrotum: A Retrospective Study

Introduction: Early diagnosis and management of Torsion Testis (TT) in children is challenging. To improve the reliability of diagnosis, various clinical scoring systems have been proposed. Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score and Boettcher Alert (BAL) score have been used for the diagnosis of TT in children with acute scrotum. Aim: To find the utility of TWIST and BAL score for diagnosing testicular torsion in children with acute scrotum. Materials and Methods: This was a retrospective recordbased study that included medical records of children with acute scrotum who underwent surgery between January 2019 and December 2021 in a tertiary care hospital. A total of 112 patients were included in the study. TWIST and BAL scores were calculated, retrospectively. Univariate analysis of the clinical features were done using Chi-square test. Sensitivity, specificity, Positive Predicitive Value (PPV) and Negative Predicitive Value (NPV) for scoring systems were calculated. Results: There were 73 patients in TT group and 39 in Non Torsion Testis (NTT) group. The mean age was 4.5±2.98 years in torsion group and 5.2±2.2 years in non torsion group. Among the components of TWIST and BAL score, absent cremasteric reflex, hard testicle, high riding testis, nausea/vomiting and pain duration &lt;24 hours were found to be statistically significant. PPV and specificity of TWIST score ≥5 were 98.15% and 97.44%, respectively whereas NPV and sensitivity of BAL score ≥2 group was 100%. Conclusion: TWIST and BAL scores are reliable bedside and easy to perform clinical diagnostic tools for TT. These scores can help in early detection and plan surgical intervention to reduce ischaemia time of TT.

Delayed Care Seeking and Outcomes of Testicular Torsion among Children during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Since the onset of coronavirus disease 2019 (COVID-19), stay-at-home orders and fear caused by the pandemic have had a significant effect on the timing and outcomes of testicular torsion. However, the evidence was limited since the study results were inconsistent. This study aims to examine the hospitalization rates, timing, and outcomes of testicular torsion in children before and during the pandemic. Using PubMed, Embase, and Google Scholar databases, we conducted a systematic search and meta-analysis of studies reporting the timing and outcomes of children admitted with testicular torsion before and during the COVID-19 pandemic. Subgroup analyses were conducted to explore possible sources of heterogeneity. The outcomes of 899 testicular torsion patients from eight studies were evaluated. Our study found an increased hospitalization rate for patients with testicular torsion (incidence rate ratio = 1.60, 95% confidence interval [CI]: 1.27-2.03; p = 0.001). Despite a significant increase in the duration of symptoms during the COVID-19 pandemic (weighted mean difference = 11.04, 95% CI: 2.75-19.33; p = 0.009), orchiectomy rates did not increase (odds ratio = 1.33, 95% CI: 0.85-2.10; p = 0.147). During the COVID-19 pandemic, hospitalization rates for testicular torsion and the duration of symptoms among children increased significantly. Moreover, the rate of orchiectomy did not increase during the pandemic, indicating that pediatric emergency services have remained efficient and have prevented an increase in the number of orchiectomies performed despite pandemic-related closures and delays in transporting patients to medical care.

The role of neutrophil-to-lymphocyte ratio as a predictor of testicular torsion in children

Doppler ultrasound constitutes the gold standard for the diagnosis of testicular torsion (TT), although sometimes the spermatic cord twisting and absence of testicular flow are difficult to visualize. To date, no laboratory markers have been shown to be useful for preoperative TT diagnosis. Our aim is to analyze the role of the neutrophil-to-lymphocyte ratio (NLR) as a predictor of pediatric TT. A retrospective single-center case-control study was performed in patients with ultrasound suspicion of TT, in whom surgical testicular examination was performed between 2016 and 2020. Patients were divided into two groups according to the intraoperative findings: TT group (testicular torsion), defined as spermatic cord twisting on itself around its longitudinal axis at least 360°, and non-TT group (no torsion). Demographics, clinical, ultrasound and laboratory features at admission were analyzed. Sensitivity and specificity were determined by the area under the curve (AUC) represented on the receiver operating characteristic (ROC) curves. A total of 159 patients were included (117TT group; 42 non-TT group), with no demographic or clinical differences. TT group patients presented significantly shorter median time since symptoms onset (4 vs. 8h; p<0.012). Laboratory inflammatory test were significantly higher in TT group: Leukocytes (10,900×103/μl vs. 7,980×103/μl; p<0.001), neutrophils (8,050×103/μl vs. 3,350×103/μl; p<0.001) and NLR (4.6 vs. 1.1; p<0.001). In ROC curve analysis, NLR presented the highest AUC (0.903), significantly higher than all other laboratory and ultrasound parameters. NLR of 2.3 was the cut-off point with maximum sensitivity (86.9%) and specificity (94.8%). This is, to the best of our knowledge, the first study to analyze the usefulness of NLR in predicting the diagnosis of TT in patients with clinical and ultrasound suspicion. The limitations are mainly derived from being a single-center retrospective study. For this reason, multicenter studies with a higher number of patients and prospective design may be useful to minimize these biases. The sample size of our study, although not large, has allowed us to identify significant differences between the distinct parameters analyzed as predictors of TT. However, the absence of other similar studies in pediatric patients has hindered the comparison of our results. NLR should be considered as a predictor of pediatric TT in cases with nuclear ultrasound suspicion that may help to anticipate the urgent surgical treatment in these patients.

Validation of TWIST score in the diagnosis of testicular torsion in children: A Prospective study

Early diagnosis is key in testicular torsion. This study is to validate the diagnostic value of the “Testicular Workup for Ischemia and Suspected Torsion (TWIST)” score for evaluating acute scrotum in children. Patients from 1 month old to 16 years old presented to Children’s hospital No.1 with acute scrotum between June 1 st, 2020, and May 31 st, 2021 were prospectively studied. General surgeons performed an examination and recorded signs and symptoms in the collection form. After that, all patients had Scrotal Doppler Ultrasound (DUS). We calculated the sensitivity, specificity, positive predictive, and negative predictive values of the TWIST score. The ROC curve was used to find out the optimal cut-off in diagnosing Testicular torsion (TT) in Children. Among 68 children with acute scrotum, 16 cases had TT (23.5%). The median age was 12.5 years in the TT group and 9 years in the non-TT group. None of 32 patients with the TWIST score ≤ 2 had TT and among 20 patients with a score of 3 – 4, only one had TT. More importantly, in the high-risk group with a score ≥ 5, 15 had TT (93.8%). ROC curve revealed an AUC of 0.987 (p&lt;0,001) representing a high diagnostic value. The sensitivity and specificity for TT at 5-point cut-off were 93.7% and 98.1%, respectively. The TWIST scoring system has high sensitivity and specificity values. Therefore, it should be used as a useful tool for the diagnosis of testicular torsion. The score ≥ 5 is an indicator of testicular torsion, hence emergency surgical intervention is required.

Diagnosis and treatment of cryptorchid testicular torsion in children: A 12-year retrospective study.

PurposeTo investigate the clinical characteristics, treatment, and prognosis of cryptorchid testicular torsion in children.MethodsThe clinical data of 25 children who received treatment for cryptorchid testicular torsion between January 2010 and December 2021 were retrospectively reviewed. The median age of the patients was 64.5 months (range: 2 months to 15 years). All patients had unilateral torsion, and the duration of symptoms ranged from 3 to 192 h.ResultsAmong the 25 patients, five underwent orchidopexy, while the remaining 20 underwent orchiectomy. After 6 months to 8 years of follow up, the 20 patients who had undergone orchiectomy had a well-developed testis on the healthy side. Four of the five patients who had undergone orchidopexy of the affected testis had well-developed testes bilaterally, while one experienced testicular atrophy.ConclusionCryptorchid testicular torsion is a rare urological emergency that displays a delayed presentation and is often misdiagnosed. Clinicians need to carefully review the patient's medical history and ultrasound findings and perform a thorough physical examination to make a correct diagnosis. Active testicular exploration is required for patients suspected to have cryptorchid testicular torsion, and the decision to perform orchidopexy or orchiectomy depends on the intraoperative situation.

Long-term follow-up results of testicular torsion in children.

A retrospective cohort study was conducted at the Children's Hospital of Chongqing Medical University from November 2004 to December 2020 to investigate the long-term follow-up results after testicular torsion (TT) in children. Boys with TT were divided into the salvage orchiopexy group and the orchiectomy group, and the baseline characteristics, ultrasonographic indications, intraoperative findings, testicular volumes, and adverse events during follow-up were compared. A total of 145 cases were included in this study. Approximately 56.6% of patients who underwent salvage orchiopexy had testicular atrophy (TA), and the median testicular volume loss of the testes was 57.4%. Age less than 6 years, delayed surgery, and intraoperative poor blood supply were associated with TA in pediatric TT after orchiopexy. Most atrophied testes appeared within 3-6 months after surgery. Compared with the corresponding age-matched healthy controls, the contralateral testicular volumes were larger in the orchiopexy (P = 0.001 without TA, and P = 0.042 with TA) and orchiectomy groups (P = 0.033). The adverse events were comparable in patients with orchiectomy or orchiopexy. In summary, follow-up before 3 months after surgery may not offer sufficient clinical value, while that 3 months after surgery should be regarded as the first follow-up time for testicular monitoring. The contralateral testes of patients with TT showed compensatory hypertrophy. We suggest performing orchiectomy when torsed testes are surgically assessed as Arda grade III or inviable.

The Role of Gray-Scale Ultrasound in the Diagnosis of Postnatal Testicular Torsion in Children

Testicular torsion is a severe variant of postnatal gonad pathology in children. The speed of development of irreversible ischemic disorders determines not only the medical, but also the social significance of the problem and determines the need for accurate and rapid diagnosis and prompt provision of adequate care to the patient. The only objective method for diagnosing testicular torsion in children is ultrasound. At the same time, the characteristics of the child’s body: the small size of the object of study, low rates of intratesticular blood flow and restless behavior during the study sharply reduce the diagnostic value of the Doppler study or make it technically impossible. Thus, seroshkal ultrasound is the first stage of diagnosis of this complex emergency pathology, based on the results of which it is possible to diagnose testicular torsion with great accuracy. The publication summarizes our own experience of 110 echographic observations of postnatal testicular torsion in children older than 2 months, all cases were verified intraoperatively. A quantitative method for estimating the deformity of a twisted testicle is proposed and its statistical reliability is proved. The options presented for gray-scale changes in the structure of damaged gonads and determined their prognostic significance. The publication contains a review of the literature and is extensively illustrated.