Testicular Torsion In Children Research Articles

The Role of Doppler Ultrasound in the Diagnosis of Postnatal Testicular Torsion in Children

The diagnostic significance of the color Doppler study of testicular blood flow in testicular torsion has been studied for about 40 years, however, the prognostic value of the results obtained is ambiguous, as are the actual imaging capabilities of the technique. Our own experience of 110 observations of testicular torsion in children older than the neonatal period allows us to draw statistically reliable conclusions. Made on equipment premium-class research made it possible to evaluate how visualization intratesticular vascular pattern, and whirpool-sign and submit the primitive model of the actual inversion, explaining the impossibility of rendering whirpool-sign with the greatest tight inversion. The dynamics of testicular blood flow was studied immediately after successful and unsuccessful manual detorsion and in the long term after operative detorsion and orchopexy. The publication contains a brief analysis of the literature and is extensively illustrated.

Анатомія, фізіологія, клінічні прояви та лікування перекруту яєчка в дітей (огляд літератури)

У статті наведено сучасні дані вітчизняної та зарубіжної літератури про основні проблеми хірургічної корекції перекруту яєчка в дітей. Розглянуто ефективність різних методів оперативного лікування й можливість їх практичного застосування. Подані нові концепції надання хірургічної допомоги дітям різного віку на етапах лікування.

Testicular torsion in children.

As a family physician caring for a large pediatric population, I evaluate numerous adolescents with testicular pain. Given the gravity of prognosis for late treatment of children with testicular torsion, what are best practices for its assessment and management? The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score has been developed and validated to identify children at risk of testicular torsion. If the TWIST score is 0 and clinical suspicion is low in the office setting, a referral to urology for urgent consultation is not needed. If the TWIST score is 1 or higher or if the clinical presentation suggests torsion, manual detorsion should be attempted and the patient should be urgently sent to the nearest emergency department.

Acute Testicular Torsion in Children: A Tertiary Hospital Experience in a Developing Country

Background: Testicular torsion is a urological emergency in which there is a race against time to salvage the testis. The aim of this study was to evaluate our experience in the management of children who presented with acute testicular torsion. Materials and Methods: This was a retrospective study of children aged 15 years and below who had surgery for acute testicular torsion between January 2013 and December 2017 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Results: Sixty-four children were managed during the study period. The ages of the patients ranged from 2 months to 14 years with a median of 6 years. The right testis was mostly affected and the mean duration from the onset of symptom to presentation was 4 hours. All the patients presented with testicular pain and half of the patients had a prior history of intermittent testicular pain. Four (6.3%) patients had a history of trauma precipitating the testicular torsion and 3 (4.7%) patients had undescended testis. Detorsion and Orchidopexy was the most performed surgical procedure and wound infection was the most common post-operative complication. There was no mortality. Conclusion: Testicular torsion is not uncommon in children and may be associated with testicular loss. The right testis is mostly involved in children. Prior history of intermittent testicular pain, trauma and undescended testis are important considerations. Prompt detorsion and orchidopexy remains the cornerstone of treatment.

Value of Color Doppler Ultrasound in Diagnosis and Differential Diagnosis of Testicular Torsion in Children

Value of Color Doppler Ultrasound in Diagnosis and Differential Diagnosis of Testicular Torsion in Children

Management and Outcome of Testicular Torsion in Children: A Teaching Hospital Experience

Background: Testicular torsion is a common cause of acute scrotum and may lead to ischemia of the testis. The aim of this study was to evaluate our experience in the management of children who had testicular torsion. Materials and Methods: This was a retrospective study of children aged 15 years and younger who were managed for testicular torsion between January 2014 and December 2018 at the pediatric surgery unit of Enugu State University Teaching Hospital Enugu, Nigeria. Results: A total of 79 cases of confirmed testicular torsions were treated during the study period. The median age of the patients was 9 years with a range of 2 weeks to 14 years. Majority of the patients presented 48 hours after onset of their symptoms. The patients received treatment within 24 hours of presentation and abdominal pain was a consistent symptom in all the patients. Half of the patients had a preoperative Doppler ultrasound. Right side of the testis was mostly involved and three-quarters of the patients had orchidopexy whereas one-quarter of the patients had orchidectomy. Surgical site infection was the most common post-operative complication. However, there was no mortality. Conclusion: Delays in presentation may have resulted in testicular loss in 25% of the patients in the present study. We recommend high index of suspicion in children who present with scrotal pain.

Cryptorchid testicular torsion in children: characteristics and treatment outcomes.

This study aimed to review and compare the characteristics and treatment outcomes of cryptorchid testicular torsion in pre- and postpubertal children. We reviewed the clinical data of 22 patients with testicular torsion complicated by cryptorchidism who were treated between January 2010 and December 2019. Patients were categorized into prepubertal (1 month to 9 years; n = 12) and postpubertal groups (10–16 years; n = 10). The age at presentation, clinical presentations, physical examination, and operation outcomes were assessed. The common clinical presentations in both groups were inguinal pain and a tender inguinal mass. Patients in the prepubertal group were significantly more likely to present with restlessness (33.3%) than those in the postpubertal group (0%; P = 0.044). After detorsion, testicular blood flow recovered during surgery in 25.0% of the prepubertal and 80.0% of the postpubertal patients (P = 0.010). Orchiectomy was required in 50.0% of the prepubertal and 20.0% of the postpubertal patients (P = 0.145). Of the 22 patients with follow-up data, the rates of testicular salvage were significantly different, at 16.7% in the prepubertal patients and 60.0% in the postpubertal patients (P = 0.035). Cryptorchid testicular torsion has various manifestations. Although an empty hemiscrotum and a painful groin mass were common in both groups, restlessness was more prevalent in the prepubertal patients during early testicular torsion onset than that in the postpubertal patients. Notably, the testicular salvage rate was significantly lower in the prepubertal patients than that in the postpubertal patients.

Duration of symptoms is the only predictor of testicular salvage following testicular torsion in children: A case-control study.

Testicular torsion (TT) is an emergency requiring a prompt diagnosis and surgery to avoid irreversible changes and a complete loss of testis. The present study aimed to identify potential factors that may be predict a testicular salvage after TT in pediatric patients. Consecutive medical records of all children ≤16years old with surgically confirmed TT over a period of five years (2011-2016) were collected. Patients were divided into 2 groups according to testicular viability and the type of treatment: Orchidectomy and orchidopexy. The differences between the two groups and potential predictors of testicular salvage were analyzed. Thirty-one boys with TT met the inclusion criteria and were included in the study. The mean age was 13.6years (range, 10days - 15.8years). Testicular salvage was possible in 18 (58.1%) patients. The duration of symptoms and a lesser degree of torsion indicated a testicular salvage in children and adolescents with testicular torsion, but in multivariate analysis only duration of symptoms (time to surgical detorsion) was significantly associated with the risk of non-salvage. At follow-up, testicular atrophy affected 73.3% of the patients treated with orchidopexy. Duration of symptoms is the only predictor of successful testicular salvage following testicular torsion in children. It is associated with a substantial risk of testicular loss and atrophy.

Validation of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score in the Diagnosis of Testicular Torsion in Children With Acute Scrotum

To validate the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score for the evaluation of children presenting with acute scrotum. This prospective study calculated TWIST score in patients of acute scrotum admitted to a pediatric surgery unit. The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1) and high-riding testis (1). All the patients were examined by a pediatric surgeon. Among 96 children with acute scrotum, 68 (70.8%) patients had testicular torsion. In the testicular torsion group, the mean (SD) TWIST score was 5.7 (1.2) and in no torsion group, it was 1.46 (0.67). In the testicular torsion group, the number of patients with low, intermediate, and high risk was 0, 13, and 55, respectively and in without testicular torsion these were 21, 7, and 0, respectively. TWIST score has high predictive value for testicular torsion, and can be used for clinical diagnosis of testicular torsion.

Segmental Testicular Infarction Associated to Torsion: First Case Report in Childhood

Testicular torsion in children is not uncommon emergency problem which occur due to twist in the spermatic cord leading to ischemia or infarction to testicle. Hemorrhagic infarction can occur following testicular torsion is globally; however, in extremely rare situation, such infarction can be segmental. Segmental testicular infarction (STI) was reported in an infant due to epididymitis and a newborn with STI in 1 testicle with complete infarction in the contralateral testicle due to birth trauma. To best of our knowledge, our case of STI in a child associated with testicular torsion is the first described in the literature.

Does Elastography Have a Place in Evaluating Tissue Stiffness in Testicular Torsion?

Background: One of the most important urologic emergencies is testicular torsion in children. Elastography is as an objective method in diagnosis and treatment of testicular torsion, with grayscale and colored images. Our study presents an original framework, which may guide certain research and practices in this field. Objectives: The aim of this study was to evaluate the effectiveness of ultrasound (US)-elastography for the diagnostic performance of testicular torsion. Materials and Methods: In this experimental study, 16 male white New Zealand rabbits of the same weight and age were selected and divided into two groups. In group I, the right testicle was fixed, and in group II, the right testicle underwent 720° torsion in a counterclockwise direction and fixed. Following 1 and 2 hours of ischemia, measurements of the right and left testicles were performed simultaneously. The left testicle was measured again after 24 hours in order to better observe the changes that right testicular ischemia might have had on the left testicle. Results: A statistically significant increase was detected in the elastography values of the right testicle at 1, 2, and 24 hours (P < 0.05). Elastography values were significantly increased in the left testicle after 24 hours (P < 0.05). The elastographic measurement values of the testicular tissue increased significantly with the increase in the duration of ischemia. Conclusion: With the width of its imaging window and healthy evaluation opportunity, elastography is a method in determining tissue stiffness of unilateral and contralateral testicular structures. In this study, the efficacy of elastography was evaluated. As a future research, further studies are needed to evaluate the elastography values in epididmo-orchitis and other causes of acute scrotum.

Acute scrotum and testicular torsion in children: a retrospective study in a single institution

Testicular torsion (TT), as per the reported incidences in children and preadolescents, is an emergency medical condition that requires prompt surgical treatment. In cases of TT, early and accurate diagnosis of acute scrotum (AS) is important to preserve testicular fertility. In this study, the authors aimed to determine the incidence, clinical examination, etiology, clinical predictors, and treatment of patients with AS and TT. The authors retrospectively reviewed all children (age, ≤15 years) with AS who visited their hospital between January 2012 and June 2019. Data on age and diagnosis, clinical findings, mode of treatment, and blood examination results were collected. The authors examined 165 children aged between 0 days and 15 years (mean age, 9.4 years). Final diagnosis identified 72 patients with torsion of the appendix testis, 44 patients with epididymitis, and 38 patients with TT. Testes were salvaged in 23 of the 38 patients with TT (60.5%). Statistically significant variables revealed that the risk factors of TT were age (older than 12 years), white blood cell (WBC) count (>12,000cells/mm3), and laterality (left side). The level of C-reactive protein (CRP), duration of symptoms, and degree of torsion were significantly higher in the non-salvageable testis group than in the salvageable testis group. Furthermore, the significant predictive factor for non-salvageable testis was the level of CRP >1.0mg/dl. The study results indicates that age, WBC count, and laterality are key factors to distinguish TT from AS. Salvageability largely depended on the duration of symptoms and the degree of TT. The salvage rate of the testis can be improved by educating pediatricians, parents, patients, and medical staff about the early diagnosis and treatment of torsion.

Sutured point-fixation versus Jaboulay fixation for salvaged testicular torsion in children

BackgroundSurgical techniques for fixation of the testis are varied and subject to ongoing debate. Non-sutured techniques may avoid the theoretical morbidities of sutured fixation of the testis yet are criticized for insufficient prophylaxis against future torsion. This study aims to compare outcomes between sutured (point-fixation) versus Jaboulay fixation. MethodsEmergency scrotal explorations performed at a tertiary hospital in the state of South Australia between February 2002 and December 2017 were analyzed to identify cases of testicular torsion. Primary outcome measures included future testicular torsions and return to theater episodes following initial testicular fixation. Secondary outcome measures included re-presentations and post-operative complications. ResultsA total of 482 scrotal compartments were explored in 244 boys with acute testicular torsion. Testis fixation was performed using sutured point-fixation in 58.4% and Jaboulay tunica plication in 41.6%. No future testicular torsion occurred regardless of fixation technique. There were no significant differences in returns to theater (0.4% versus 1.2%, p = 0.12), re-presentations (6.9% versus 6.0%, p = 0.83), and post-operative complications (1.7% versus 1.8%, p = 1.0) in testes that previously underwent sutured or Jaboulay fixation, respectively. ConclusionJaboulay testicular fixation techniques are comparable with sutured point-fixation techniques in effectiveness and morbidity. Type of StudyTreatment Study. Level of EvidenceLevel III.

Accuracy of point-of-care ultrasound by pediatric emergency physicians for testicular torsion

Acute scrotum is a common presentation to the pediatric emergency department, and ultrasound is frequently used to narrow the differential diagnosis. Point-of-care ultrasound (POCUS) is increasingly used by urologists and emergency physicians and could potentially be used to detect pediatric testicular torsion. This study aimed to determine the accuracy of POCUS by pediatric emergency physicians in diagnosing testicular torsion and the agreement between point-of-care ultrasound and final diagnosis for other causes of acute scrotum. A chart review of patients presenting to the study emergency department who received POCUS by a pediatric emergency physician, as well as radiology department ultrasound and/or surgery, was performed. Charts were reviewed for POCUS diagnoses, final diagnoses, and imaging time metrics. A total of 120 patients met study criteria, with 12 cases of testicular torsion. The diagnostic accuracy of POCUS for testicular torsion is described in the summary table. For all causes of acute scrotum, point-of-care ultrasound agreed with final diagnosis in 70% (95% confidence interval [CI] 62-78%) of cases, and more experienced point-of-care ultrasound users displayed higher agreement with final diagnosis. Point-of-care ultrasound results were generated a median of 73min (Q1=51, Q3=112) before radiology department ultrasound results. Scrotal POCUS performed by pediatric emergency physicians appears to be an accurate tool to detect testicular torsion in children with acute scrotum and saves time compared with radiology ultrasound. The study results may not be generalizable to hospitals without a multidisciplinary POCUS system for quality assurance and image sharing. Future work on POCUS for acute scrotum should investigate its impact on patient outcomes, cost-effectiveness, and family satisfaction. Point-of-care ultrasound by pediatric emergency physicians is accurate for detecting testicular torsion in children with acute scrotum and could expedite diagnosis of this time-sensitive condition.

Parents' awareness and knowledge of testicular torsion: A cross-sectional study.

Background:Testicular torsion (TT) is one of the most common emergencies in pediatric urology. Family awareness of this condition could lead to early diagnosis and intervention and salvage of the effected testicle. The purpose of this study is to assess parental awareness about TT and their source of knowledge. We also evaluated the response of the parents to their children's scrotal pain.Methods:A quantitative, observational, cross-sectional study was conducted from March 2017 to September 2017 at our institution. The study target were parents attending the pediatric urology clinic and the comparison group included parents attending the general pediatric clinic in the same period. We distributed a questionnaire and then compared the results in both groups.Results:A total of 200 parents participated in this study (100 parents from each clinic). Nineteen percent of pediatric urology clinic parents were aware and 14% of general pediatric clinic parents were aware about TT with no statistically significant difference observed (P = 0.341). The parents in urology clinic choose doctor as their main source of knowledge (42.1%), while in general pediatric clinic, doctor and through a friend as the main source of knowledge had the same percentage (28.6%). Response of the parents to their children's scrotal pain during working hours in urology and general pediatric clinics was to drive their children to the emergency room immediately with 85% and 82%, respectively. The response of the parents after working hours in both clinics did not show difference, with 83% of parents in pediatric urology clinic and 85% in general pediatric clinic driving their children immediately to the emergency room.Conclusion:TT in boys is a common problem we face as pediatric urologists and it may lead to testicular loss if not diagnosed and treated early. We found that the awareness of TT in children is low in our community and it is our responsibility to raise it to improve our children's well-being.

Suspected testicular torsion in children: diagnostic dilemma and recommendation for a lower threshold for initiation of surgical exploration.

PurposeTesticular torsion (TT) represents a clinical challenge that needs emergency surgical assessment. It is common to have negative scrotal exploration due to confounding symptoms and signs which makes it sometimes difficult to differentiate from similar surgical emergencies that do not warrant surgery. At the same time, several occasions of misdiagnoses or late interventions occur with devastating effects. We aim at delineating the significance of the different clinical, laboratory, and radiological variables in the detection of TT.MethodsWe retrospectively reviewed the charts of 52 patients who were surgically explored with a preoperative working diagnosis of suspected TT in our center over the period from 2011 to 2015. All the patients were examined by pediatric surgeons in the emergency room and had undergone ultrasound imaging of the testes. The ultrasound images were retrospectively reviewed by a pediatric radiologist who was blinded to the intraoperative findings. Univariate and multivariate and logistic regression analyses were performed.ResultsOf the studied group of patients, the majority (84.6%) had TT upon surgical exploration. The most frequently presented symptom was pain (80.8%), and only a minority (11.5%) presented with vomiting. Radiological findings with the highest sensitivity were heterogeneous echogenicity in favor of TT and enlarged epididymis indicating that TT is unlikely. However, the predictability of TT by any of the assessed clinical and imaging factors was statistically insignificant.ConclusionIt is important to gather all relevant data from clinical, laboratory, and imaging sources when assessing pediatric patients with suspected TT given the inaccuracy of each single one of them if used alone. Keeping this in mind, Doppler ultrasound has a significant role to aid in the accuracy of the diagnosis and hence the appropriate decision-making thereafter. However, we found no single clinical or imaging sign that is sensitive enough to prove or rule out TT. Therefore, surgical exploration should take place in a timely manner. Moreover, further research is necessary to construct scoring systems where different predictors collectively have higher reliability.

Acquired undescended testis and possibly associated testicular torsion in children with cerebral palsy or neuromuscular disease

Torsion of an undescended testis (UDT) associated with cerebral palsy (CP) and neuromuscular disease (NMD) is an uncommon condition that is not well recognized by primary care physicians or healthcare providers. The objective of this study was to highlight the clinical importance of torsion of a UDT in children with CP and NMD. Eleven children with testicular torsion of a UDT operated on at the study institute between 1991 and 2015 were identified. The records of seven children (63.6%) associated with CP or NMD were retrospectively reviewed. Clinical findings of testicular torsion were assessed along with the treatment outcome and testicular salvageability. All seven children were not identified with a UDT by public health checkup for infant and young children. No children with CP or NMD had torsion of a descended testis during the present study period. Median age at surgery was 15 years (range, 1-20 years). The testis location was at the external inguinal ring in five patients, in the inguinal canal in one, and in the superficial inguinal pouch in one. Of the contralateral testes, four were a UDT, one was a retractile testis, and two were descended testes. Orchiectomy was performed in six patients (85.7%). In the remaining patients, the testis was preserved but became atrophic. This study demonstrated that children with CP or NMD may be affected with torsion of a UDT with peak at around puberty with the poor salvage rate, even if the testes appear descended in infancy and young children. Shortcomings of this study were the retrospective design and a small series of children undergoing surgery for torsion of a UDT. Pediatric urologists need to educate primary care physicians and healthcare providers in the recognition of acquired UDTs and possibly associated testicular torsion in children with CP and NMD. Genital examination should be continued regularly until adolescence in these children to detect acquired UDT. These children should be referred to pediatric urologists to promote surgery as soon as the diagnosis of acquired UDT is carried out. It is believed that it is perhaps the best approach to prevent loss of the testis in children with CP and NMD.

Life Satisfaction is a Protective Factor against the Onset of Type 2 Diabetes in Men but not in Women: Findings from the MONICA/KORA Cohort Study

A rapid test for testicular torsion in children may obviate the delay for testicular ultrasound. In this study we assessed testicular tissue percent oxygen saturation (%StO2) measured by transscrotal near infrared spectroscopy as a diagnostic test for pediatric testicular torsion.This was a prospective comparison to a gold standard diagnostic test study that evaluated near infrared spectroscopy %StO2 readings to diagnose testicular torsion. The gold standard for torsion diagnosis was standard clinical care. From 2013 to 2015 males with acute scrotum for more than 1 month and who were less than 18 years old were recruited. Near infrared spectroscopy %StO2 readings were obtained for affected and unaffected testes. Near infrared spectroscopy Δ%StO2 was calculated as unaffected minus affected reading. The utility of near infrared spectroscopy Δ%StO2 to diagnose testis torsion was described with ROC curves.Of 154 eligible patients 121 had near infrared spectroscopy readings. Median near infrared spectroscopy Δ%StO2 in the 36 patients with torsion was 2.0 (IQR −4.2 to 9.8) vs −1.7 (IQR −8.7 to 2.0) in the 85 without torsion (p=0.004). AUC for near infrared spectroscopy as a diagnostic test was 0.66 (95% CI 0.55–0.78). Near infrared spectroscopy Δ%StO2 of 20 or greater had a positive predictive value of 100% and a sensitivity of 22.2%. Tanner stage 3-5 cases without scrotal edema or with pain for 12 hours or less had an AUC of 0.91 (95% CI 0.86–1.0) and 0.80 (95% CI 0.62–0.99), respectively.In all children near infrared spectroscopy readings had limited utility in diagnosing torsion. However, in Tanner 3-5 cases without scrotal edema or with pain 12 hours or less, near infrared spectroscopy discriminated well between torsion and nontorsion.

Closed manual detorsion in case of a testicular torsion in children

Aim of study. To evaluate the effectiveness of closed manual detorsion in case of testicular torsion in children of different age groups. Materials and methods. Manual detorsion was carried out according to the classical technique (Yudin Ya.B. et al., 1987) by 79 patients with a testicular torsion at the age from the neonatal period to 18 years. A comparative analysis of the effectiveness of detorsion depending on various factors (the age of the patient, the duration of ischemia, the presence of a secondary hydrocele) was performed. Results. The effectiveness of the detorsion depended on the duration of the ischemia period before manipulation in patients of all ages. The effectiveness of the detorsion is more pronounced in adolescents, which is due to the more advanced structures of the spermatic cord and the larger testicle mass. A hydrocele of a secondary nature is a factor complicating detorsion, but its puncture emptying increases the efficiency of manipulation. Conclusions. The effectiveness of manual detorsion is directly proportional to the age of the patient and inversely proportional to the duration of ischemia before the manipulation is performed. The frequency of residual torsion does not allow us to consider the method as independent in the treatment of testicular torsion, and ultrasound and ultrasound dopplerography are completely reliable evaluation criteria. The effectiveness of the method allows you to recommend it in the first day of the disease in patients of all age groups, except for newborns, but emergency surgery should be performed as soon as possible after the detorsion. Carrying out a discharge puncture in patients with a secondary hydrocele against a background of testicular vesicle significantly improves the effectiveness of manual detorsion. (For citation: Shormanov IS, Shchedrov DN. Closed manual detorsion in case of a testicular torsion in children. Urologicheskie vedomosti. 2018;8(1):34-39. doi: 10.17816/uroved8134-39).

Treatment of testicular torsion in children: One surgeonexperience

Treatment of testicular torsion in children: One surgeonexperience