Testicular Torsion Research Articles

Assessment of Parental Awareness and Knowledge Regarding Testicular Torsion in the Aseer Region of Saudi Arabia: A Cross-sectional Study

Abstract Background: Testicular torsion (TT) is a medical emergency that requires immediate attention to prevent testicular injury. It is crucial for parents to be aware of this condition, as early recognition and timely medical attention can significantly improve the outcome for affected individuals. This study aimed to assess the level of awareness and knowledge of TT among parents in the Aseer region of Saudi Arabia using a survey-based approach. Methods: The survey included questions about the participants’ awareness of TT, its symptoms, risk factors, and recommended management. The findings of the study revealed a significant lack of parental awareness and knowledge regarding TT in the Aseer Region of Saudi Arabia. Results: The survey showed that 62.9% of parents were unsure and unable to differentiate a normal testicle. However, the majority (82.0%) believed that society needs to be more aware of TT and 75.6% expressed concern about the possibility of their child experiencing TT. Conclusion: Efforts should be made to educate parents about the condition, its symptoms, and the importance of timely intervention to prevent testicular damage. Increasing awareness can lead to early recognition and appropriate medical care, reducing the risk of complications associated with TT.

Testis torsiyonu ve epididimo-orşit ayırıcı tanısında hematolojik parametrelerin öngörü değeri

OBJECTIVE: Testicular torsion (TT) is a urologic emergency that may result in organ loss. The most common differential diagnosis is epididymo-orchitis (EO). The aim of this study was to evaluate the usefulness of hematologic parameters and inflammatory markers in the differential diagnosis of TT and EO. MATERIAL and METHODS: Data obtained from complete blood counts of patients admitted to the emergency department with acute scrotum and diagnosed with TT and EO between January 2015–2024 were retrospectively evaluated. Demographic characteristics of the patients and the parameters in the complete blood counts at the time of presentation were recorded. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and monocyte/eosinophil ratio (MER) were calculated. The groups were compared in terms of age, hematologic parameters, NLR, PLR and MER. Receiver operating characteristic and areas under the curve of the parameters found significant were determined. Univariate and multiple logistic regression analysis were used to determine the risk factors for differential diagnosis. RESULTS: A total of 149 patients were included in the study. The TT group consisted of 79 patients and the EO group consisted of 70 patients. The median age of all patients was 23 years, the median age in the TT group was 20 years, and the median age in the EO group was 23 years. There was a statistically significant difference between the two groups in terms of age, lymphocyte count, monocyte count, eosinophil count, mean platelet volume (MPV), NLR and PLR (p<0.05). In multiple logistic regression analysis, only MPV value ≤9.35 was found to be an important predictive factor for the differential diagnosis of TT and EO. CONCLUSION: MPV seems to be a useful parameter in the differential diagnosis of TT and EO. In this regard, prospective, multicenter studies as well as meta-analyses with larger sample sizes should be included in guideline recommendations with their contribution to the literature. Keywords: testicular torsion, epididymo-orchitis, acute scrotum, mean platelet volume, hematological inflammatory markers

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.

Long time follow-up for patients with testicular torsion: new findings.

Testicular torsion is the major urologic emergency. If not treated promptly, this condition can result in testicular necrosis or long-term functional impairment. At present, there are few paper about long time follow-up of these patients. The primary objective of our study is to report the long-term clinical-instrumental data (mean follow-up 12 years) of patients treated for testicular torsion. We considered patients treated for testicular torsion during the period between 1997 and 2017. Inclusion and exclusion criteria were created. Patients were contacted by phone between December 2021 and January 2022. Each patient underwent clinical and ultrasonographic evaluation, and in addition, some subjects were offered additional tests (hormonal assays and semen analysis). During the study period, 22 patients were treated for testicular torsion. From the ultrasonographic study, it was found that the volume of the affected testis is reduced and it is associated with microcalcifications and heterogeneous echogenicity. Morphovolumetric recovery seems to be more related to age of onset than to the degree of torsion. Based on our results we can state that affected testes, if preserved, grow less and have altered ultrasonographic morphology. Clinically, the age of onset of torsion seems more important than the degree of torsion.

Torsion of the undescended testis in a healthy adult male

Introduction. Torsion of undescended testis (UDT) in adults is rare, with only several published cases so far, and represents a urological emergency. Case outlines. We present a case of UDT torsion in 31-year-old, otherwise healthy, man who had right-side inguinal pain for six hours before he was admitted to hospital. Swelling was palpable in the area of the right groin region. The diagnosis was established based on Doppler ultrasound and exploratory surgery findings. A right-sided orchiectomy was performed. According to the available data, there are no published cases on this topic in the region. Conclusion. Although torsion of the UDT is a rare condition, it must be considered when symptoms of abdominal pain or swelling and pain in the groin region occur. Orchiectomy is suggested.

Is there any effect of lidocaine on ischemia/reperfusion injury in testicular torsion? An experimental study.

This experimental study aimed to evaluate the potential protective effects of lidocaine on ischemia-reperfusion injury resulting from testicular torsion/detorsion in rats. A total of 18 male rats were randomized into three groups. Group 1 served as the control group. Group 2 was designed to evaluate testicular ischemia-reperfusion injury using a torsion/detorsion model. In Group 3, the treatment group, a similar ischemia-reperfusion model was used as in Group 2. Additionally, lidocaine at a dose of 15 mg/kg was administered intraperitoneally five minutes before reperfusion. Blood biochemical analyses and testicular histopathological evaluations were conducted. Blood biochemical analysis showed that malondialdehyde (MDA) and protein carbonyl (PC) levels were significantly higher in Group 2 compared to the other groups (p<0.001 and p=0.008, respectively). Proinflammatory cytokine levels, including interleu-kin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha), were lower in Group 3 than in Group 2 (p<0.001, p=0.007, and p=0.026, respectively). Antioxidant enzyme activities, including glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD), were higher in Group 3 compared to Group 2 (p=0.005 and p=0.025, respectively). Histopathological evaluations revealed significant improvements in all testicular damage scores, including hemorrhage, edema, vasocongestion, and inflammation in Group 3 compared to Group 2 (p=0.015, p=0.035, p=0.015, and p=0.034, respectively). Additionally, there was a notable improvement in the Johnsen score in Group 3 compared to Group 2 (p=0.034). Lidocaine, an effective local anesthetic, significantly alleviates the effects of testicular ischemia-reperfusion injury.

Testicular Torsion with Delayed Presentation: Should It Be Explored as an Emergency?

Testicular Torsion with Delayed Presentation: Should It Be Explored as an Emergency?

The potential prophylactic and therapeutic impacts of niacin on ischemia/reperfusion injury of testis

The testicular ischemia-reperfusion (I/R) injury is characterized by the excessive aggregation of un-scavenged reactive oxygen species, leading to the heightened levels of oxidative stress. This phenomenon plays a pivotal role in the pathophysiology of testicular torsion damage. The current study aimed to detect the prophylactic and therapeutic effects of niacin on testicular I/R injury. Twenty-four healthy adult male Sprague Dawley rats were randomly allocated into three groups as follows: (1) sham group, (2) torsion/detorsion (T/D) group, and (3) treatment group which received 200mg/kg niacin along with testicular T/D. Torsion/detorsion was induced by 2h of torsion followed by 10 days of reperfusion period. In the treatment group, niacin was injected 30min before the reperfusion period intraperitoneally and continued for 10 days by oral gavage. T/D was associated with marked decreases in terms of sperm count, viability, and kinematic parameters versus the sham group (P<0.05), which niacin significantly reverted the kinematic parameters (P<0.05). I/R injury caused a significant increase in the number of abnormal epididymal sperms compared to the sham group (P<0.05). Niacin decreased the epididymal sperm abnormality significantly compared to the T/D group (P<0.05). Tissue abnormalities in T/D group, such as edema, hyperemia, inflammation, and necrosis were completely visible histopathologically, while the histological changes in the niacin-treated group were better than those in the T/D group. Regarding the pathological parametric evaluations, I/R injury significantly reduced the mean testicular biopsy score (MTBS), germinal epithelial cell thickness (GECT), and mean seminiferous tubular diameter (MSTD), and increased the tubular hypoplasia/atrophy (THA) compared to the sham group (P<0.05), which niacin treatment significantly improved the MTBS and GECT compared to the T/D group (P<0.05). T/D significantly increased the oxidative stress index (OSI) and lipid peroxidation (MDA) (P<0.05). Niacin significantly reduced the OSI and MDA levels compared to the T/D group (P<0.05). The current study found that niacin has preventive/therapeutic effects against the elevation of oxidative stress markers and depletion of antioxidants during I/R injury. Following administration of niacin, a reduction in histologic injury was observed in rats. In our study, we showed the antioxidant properties of niacin and its capacity to protect against I/R damage. The findings of the present investigation revealed that niacin, as an antioxidant agent, can suppress the oxidative stress induced by testicular I/R injury, and can be used as a supplementary agent in the treatment of those undergoing testicular torsion surgery.

Perinatal testiküler torsiyon

Early detection of perinatal testicular torsion (PTT), early use of Doppler US, and a shorter decision-making process achieved with early involvement of pediatric surgery/urology may affect prognosis, especially in the postpartum PTT setting. Considering that 3% asynchronous bilateral PTT rates have been reported in the literature, early consultation and ultrasonography are recommended for early diagnosis in suspected cases. Frequent follow-up or orchiopexy should be performed to protect the contralateral testis, if necessary, in order to avoid anorchic situation in the future. Keywords: perinatal, testicular torsion, newborn, ultrasonography, treatment

Protective effect of astaxanthin on testis torsion/detorsion injury through modulation of autophagy.

A significant clinical condition known as testicular torsion leads to permanent ischemic damage to the testicular tissue and consequent loss of function in the testicles. In this study, it was aimed to evaluate the protective effects of Astaxanthin (ASTX) on testicular damage in rats with testicular torsion/detorsion in the light of biochemical and histopathological data. Spraque Dawley rats of 21 were randomly divided into three groups; sham, testicular torsion/detorsion (TTD) and astaxanthin + testicular torsion/detorsion (ASTX + TTD). TTD and ASTX + TTD groups underwent testicular torsion for 2 hours and then detorsion for 4 hours. Rats in the ASTX + TTD group were given 1 mg/kg/day astaxanthin by oral gavage for 7 days before torsion. Following the detorsion process, oxidative stress parameters and histopathological changes in testicular tissue were evaluated. Malondialdehyde (MDA) and total oxidant status (TOS) levels were significantly decreased in the ASTX group compared to the TTD group, while superoxide dismutase (SOD), glutathione (GSH) and total antioxidant status (TAS) levels were increased (p < 0.05). Moreover, histopathological changes were significantly reduced in the group given ASTX (p < 0.0001). It was determined that ASTX administration increased Beclin-1 immunoreactivity in ischemic testicular tissue, while decreasing caspase-3 immunoreactivity (p < 0.0001). Our study is the first to investigate the antiautophagic and antiapoptotic properties of astaxanthin after testicular torsion/detorsion based on the close relationship of Beclin-1 and caspase-3 in ischemic tissues. Our results clearly demonstrate the protective effects of ASTX against ischemic damage in testicular tissue. In ischemic testicular tissue, ASTX contributes to the survival of cells by inducing autophagy and inhibiting the apoptosis.

Long-term impact of commonly performed operations in pediatric urology on reproductive and sexual health.

Sexual dysfunction is highly prevalent among men of reproductive age. Clinical practice guidelines have been established to assist providers in identification and education of patients who are at increased risk for infertility and sexual dysfunction with certain congenital and acquired urogenital disorders. The authors sought to review the reproductive and sexual health implications of treating common childhood urological conditions with commonly performed surgical procedures. To ensure the inclusion of influential and highly regarded research, we prioritized citations from the most-frequently cited articles on our respective review topics. Our inclusion criteria considered studies with substantial sample sizes and rigorously designed methodologies. Several topics were reviewed, including penile chordee, hypospadias, posterior urethral valves, varicoceles, undescended testicles, and testicular torsion. For chordee, surgical plication or corporal grafting may be employed. Erectile function remains unaltered post-surgery, while penile length may decrease after repair, which may be avoided using dermal grafts. Hypospadias repair hinges on severity and availability of the urethral plate. Those who underwent hypospadias repair report decreased penile length, but sexual satisfaction, libido, and semen quality are comparable to controls. Posterior urethral valves are usually treated with valve ablation. While valve ablation and bladder neck incision have not been found to affect ejaculatory function, high degree of concurrent renal dysfunction related to nephrogenic and bladder dysfunction may impact semen parameters and erectile function. Regarding varicocele, earlier management has been associated with better long-term fertility outcomes, and surgical intervention is advisable if there is observable testicular atrophy. Earlier repair of undescended testicle with orchiopexy has been found to improve fertility rates as well as decrease malignancy rates. Unilateral orchiectomy for testicular torsion without the ability for salvage has been shown to have decreased semen parameters but unaffected fertility rates. Infertility and sexual dysfunction are multivariable entities, with etiologies both congenital and acquired. At the same time, many common pediatric urology surgeries are performed to correct anatomic pathology that may lead to reproductive dysfunction in adulthood. This review highlights the need for diagnosis and management of pediatric urologic conditions as these conditions may impact long-term sexual function post-operatively.

Investigation of the Knowledge Levels of Physicians Working in the Emergency Department About Testicular Torsion: Observational Study

Investigation of the Knowledge Levels of Physicians Working in the Emergency Department About Testicular Torsion: Observational Study

The management of testicular torsion: A survey of Turkish pediatric surgeons and pediatric urologists.

This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline. A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023. Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle. While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle.

Importance of Genital Examination: The Case of Overlooked Testicular Torsion

Importance of Genital Examination: The Case of Overlooked Testicular Torsion

Distúrbios do trato reprodutivo masculino em equídeos: 87 casos (2014-2022)

ABSTRACT: Male reproductive tract disorders (MRTDs) are common in equids and may represent a significant proportion of the caseload of equine practitioners. Herein, we determined the frequency, clinico-pathological findings, and therapeutics of MRTDs in equids from a 9-year survey of the clinical records of a Veterinary Teaching Hospital in Midwestern Brazil. During this period, 87 affected equids presented 100 MRTDs distributed in 17 different diagnoses. Forty-three (49.4%) equids presented MRTDs affecting the glans penis or preputial skin fold. Testicles, scrotum, and spermatic cords disorders were diagnosed in 32 (36.8%) horses. Of the remaining 12 (13.8%) horses, six presented two different MRTDs on two distinct anatomical areas, and five animals exhibited the same disease, affecting two different anatomical locations. Only one horse presented three distinct MRTDs on two anatomical regions. Habronemiasis was the most frequent MRTD detected in 26% of the diagnoses, followed by miscellaneous wounds (14%), cryptorchidism (13%), inguinal hernia (13%), funiculitis (9%), paraphimosis (6%), squamous cell carcinoma (5%), urethrolithiasis (3%), preputial abscesses, and orchitis (2% each). Phimosis, ulcerative posthitis, epididymitis, hydrocele, papillomatosis, teratoma, and testicular torsion accounted for 1% each. Sixty-three (72.5%) equids received hospital discharge, 18 (20.6%) were humanely euthanized, and six (6.9%) died. This study detected the most relevant MRTDs that affected over 7.5% in a survey of 1,154 equids referred for hospital care. Our finding highlights that MRTDs may be debilitating and life-threatening conditions, and they can potentially impact the reproduction of equids in the region. This knowledge may support equine practitioners in elaborating proper sanitary and management protocols to prevent and reduce the incidence of most MRTDs recorded, improving equid production and welfare.

Amyand hernia with perforated appendix simulating as testicular torsion in a neonate: A case report

Background: Amyand hernia is defined as the presence of the vermiform appendix within the hernial sac. A perforated appendix is an uncommon complication of Amyand hernia. Rarely it may simulate a testicular torsion. Case Presentation: A twenty-five-day-old male infant presented with right-sided scrotal swelling, exhibiting symptoms of crying, irritability, and poor feeding over a two-day duration. The swelling was non-reducible, confined to the scrotum, and the spermatic cord showed thickening with erythematous scrotal skin. Following preparation, an inguinal incision was made, and an appendectomy and herniotomy were performed. Conclusion: Amyand hernia, a rare type of inguinal hernia, poses challenges in preoperative diagnosis. The occurrence of a perforated appendix is especially rare in neonates with Amyand hernia. Surgical management entails appendectomy through an inguinal incision coupled with meticulous hernia repair.

HISTOPATHOLOGICAL CHANGES AND IMMUNOHISTOCHEMICAL CHARACTERISTICS OF THE TESTICLE IN CHILDREN WITH SUBCOMPENSATED ISCHEMIA DURING ACUTE TORSION

Background. Acute testicular torsion is a urological emergency in adolescent boys and young men characterized by twisting of the spermatic cord, along with its vessels, around a vertical or horizontal axis. The occurrence of this condition leads to testicular ischemia, and timely diagnosis and appropriate treatment are critical to prevent loss of the organ.&#x0D; Aim: to investigate the histopathological changes and immunohistochemical characteristics of testicles in children with acute torsion within 6.1 to 12 hours from the onset of clinical symptoms.&#x0D; Materials and methods. A histological, histochemical, and immunohistochemical study of testicular tissue biopsies taken during detorsion and orchiopexy surgery within 6.1 to 12 hours from the onset of clinical symptoms of acute unilateral torsion in 7 patients was conducted.&#x0D; Results. According to our data, with each hour of the disease in the period from 6.1 to 12 hours after acute torsion of the testicle, negative dynamics of changes in the morphological structures of the affected genital gonad were observed. If at the limit of 6-7 hours from the onset of the disease, we observed reversible damage to testicular tissues in almost 100% of cases, then in patients with 12-hour torsion, irreversible focal changes in the testicle were diagnosed in almost 28,6% of cases. Morphological signs of loss of viability were focal death of incretory (steroidogenesis) and excretory (spermatogenesis) cells of the testis, severe damage to the spermatogenic epithelium of the seminiferous tubules. Morphologically, large hemorrhages and diffuse blood penetration of the interstitium, thrombi, single leukocytes were observed, pyknosis of the nuclei of the spermatogenic epithelium and desquamation of cells were determined, and deformed seminiferous tubules with their partial or complete devastation were diagnosed. In some histological slides, Leydig cells were absent or shadow cells were diagnosed, especially around devastated and necrotic tubules. However, a small number of cells of the spermatogenic epithelium in the seminiferous tubules were characterized by a PAS-positive reaction to glycogen and glycoproteins, which meant their functional preservation.&#x0D; Conclusion. It was established that progressive morphological changes in the gonad develop with increasing time of acute complete testicular torsion. In patients with 12-hour torsion, irreversible focal changes in the testicle were diagnosed in almost 28,6% of cases, characterized by focal death of incretory (steroidogenesis) and excretory (spermatogenesis) cells of the testicle, damage to cells of the spermatogenic epithelium.&#x0D; With the aim of unifying and systematizing pathological changes in the testicle by its torsion depending on the time since the onset of the disease, we propose to disintegrate testicular ischemia as compensated (the first 6 hours from the onset of the disease), subcompensated ischemia (6.1-12 hours from the onset of the disease) and critical ischemia (12.1-24 hours or more from the onset of the disease).

Amyand’s Hernia in an Infant: A Case Report and Review of Literature

Introduction: Inguinal hernia is a common surgical disease among a pediatric population with patent processus vaginalis being the major risk factor. Omentum and small intestine loops are the oftenencountered hernia sac contents, however in a rare instance (1% of cases), a vermiform appendix is found in the sac, and it is referred as Amyand’s hernia (AH). The appendix can be normal, inflamed, strangulated, or perforated. Case presentation: 7-week-old male baby with 2-week history of right groin swelling, excessive crying and restlessness. He was clinically stable with irreducible right inguinoscrotal swelling. An ultrasonography confirmed a 1.5 cm abdominal wall defect with bowels in the sac. A clinical diagnosis of incarcerated inguinal hernia was made, and the patient was prepared for surgery. A standard herniotomy incision was done, hernia sac was found and opened and appendix and cecum were found. The contents were reduced, the sac was ligated and transected, and the incision was closed in layers. The post-operative follow ups were uneventful. Discussion: AH is a rare condition, with estimated prevalence of 0.19% to 1.7% and 0.1% occurrence of appendicitis. The clinical presentations of AH include painful groin swelling, inguino-scrotal erythema, tenderness, and features of obstructed or strangulated inguinal hernia. Diagnosis is often made during surgery as it is exceedingly difficult to diagnose it pre-operatively as it resembles inguinal hernia, and it can mimic testicular torsion or inflammation in case of erythema and tenderness. The surgical approach depends on the status of appendix, and it can be reduction of appendix or appendectomy if inflamed. Conclusions: Although rare, an index of suspicion should be kept in all inguinal hernia repairs. The appendix should be preserved if normal as with emergence of novel surgical technologies, the appendix can be of significant use especially for the children.

Evaluation of scrotal pathology: an observational study

Background: Scrotal issues often prompt patients to seek evaluation through physical examinations and scrotal ultrasonography. Accurate diagnosis requires a comprehensive exploration of potential conditions, with both grayscale ultrasonography (USG) and duplex Color Doppler ultrasonography employed for assessment. Methods: This prospective observational study, conducted at Dhaka Medical College Hospital in Bangladesh from July 2004 to June 2005, aimed to compare the effectiveness of grayscale ultrasonography and duplex color Doppler ultrasonography in evaluating scrotal pathology. Fifty-two patients with intra-scrotal disease were included using purposive sampling. Grayscale USG and duplex color Doppler ultrasonography were performed, and demographic and clinical data were processed using MS Excel and SPSS version 23.0. Results: Grayscale ultrasonography identified hydrocele, varicocele, and epididymitis in 21%, 15%, and 13.5% of cases, respectively. Color Doppler imaging revealed various pathologies, with varicocele and hydrocele most common (21.20%). Diagnostic accuracy varied between the two techniques, with Color Doppler excelling in specific conditions such as testicular torsion (100% accuracy, sensitivity, and specificity). Overall, Color Doppler demonstrated superior accuracy (96.10%) compared to grayscale (80%). Conclusions: While both grayscale ultrasonography and duplex Color Doppler ultrasonography are valuable tools for evaluating scrotal pathology, the latter demonstrates superiority in terms of accuracy, sensitivity, and specificity. Color Doppler's effectiveness in diagnosing specific conditions suggests its preference for comprehensive scrotal assessments.

Hypothesis and Holistic Knowledge of Testicular Torsion Among the General Population of the Kingdom of Saudi Arabia.

Background Testicular torsion is a serious condition that requires immediate medical attention. It occurs when the spermatic cord, which carries blood to the testicles, twists, reducing blood flow and oxygen to the testicle. This can lead to tissue death and loss of the testis if not treated promptly. It is important to seek medical attention immediately when symptoms of testicular torsion arise, as prompt treatment can help prevent permanent damage to the testicle. This study aimed to explore the level of knowledge about testicular torsion among the general population in the Kingdom of Saudi Arabia. Methodology A descriptive cross-sectional study was conducted using a convenience sample recruited from the general population who fulfilled the inclusion criteria. The data were collected from participants using an electronic pre-structured questionnaire. The researchers developed the questionnaire through expert consultation and after an intensive literature review. The questionnaire was reviewed by a panel of three experts for validation and applicability. After a pilot study, the reliability coefficient (Cronbach's alpha) was 0.74. The data were analyzed using SSPS version 25 (IBM Corp., Armonk, NY, USA) and presented as percentages and frequencies. Chi-square and logistic regression were conducted. P-values ≤0.05 were considered statistically significant. Results A total of 732 participants were recruited, most of whom were male (486, 66.4%), with ages ranging between 18 and 30 years (452, 61.7%). Regarding testicular torsion knowledge, more than half of the participants had good knowledge (406, 55.5%) and knew about the signs, symptoms, and risk factors of testicular torsion. There was a statistically significant relationship between age and knowledge (p < 0.001) and an insignificant relationship between sex and knowledge (p > 0.05). Conclusions The study participants were found to have good knowledge. Fortunately, most participants knew that testicular torsion is an emergency and they must immediately visit the hospital. With further awareness programs, the overall knowledge level can be improved.