A novel approach for manual de-torsion of an atypical (outward) testicular torsion with bedside Doppler ultrasonography guidance

Güneş, Mustafa; Umul, Mehmet; Çelik, Ahmet; Armağan, Hamit Hakan; Değirmenci, Bumin

doi:10.5489/cuaj.2849

Cited by 8 publications

(11 citation statements)

References 8 publications

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“…However, immediately upon resolution of scrotal pain and restoration of blood flow after MD, there was greater confidence in performing this procedure [7, 8, 16]. Many successful MD procedures have been reported in the literature [7–13]. Knowing the direction of torsion before the MD may ease the implementation of this procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Knowing the direction of torsion before the MD may ease the implementation of this procedure. While the direction may be determined in certain cases [13], spermatic cord assessments are often overlooked or ignored since the radiologist and urologist focus on scrotal exploration.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the execution of MD under general anesthesia in this study might have contributed to the occurrence of this error because a sudden removal of the pain in humans was accepted as the proof of performing MD in the correct direction. Therefore, general anesthesia has not been used during this procedure [7, 8, 10–13]. …”

Section: Discussionmentioning

confidence: 99%

“…Testicular fixation is recommended to prevent intermittent torsion, since MD has not been a enough therapy, even in the cases of successful MD [6]. Although many successful results have been reported [7–13], MD is not widely implemented. Owing to the risk of recurrence and the possibility of MD failure, surgical orchiopexy is recommended in patients after MD.…”

Section: Introductionmentioning

confidence: 99%

“…These data might be the underlying reason for use of MD rarely in the clinical practice. However, MD may be important for testicular viability, especially in patients who has not undergone the operation immediately [13]. …”

Section: Introductionmentioning

confidence: 99%

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The effectiveness of extra-scrotal fixation following manual detorsion for testicular torsion: a pilot study in a rabbit model

Güneş

Altok

Özmen

et al. 2016

CEJU

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IntroductionTo investigate the effectiveness of manual detorsion (MD) and applicability of extra-scrotal fixation for testicular torsion in a rabbit model.Material and methodsTwelve New Zealand male rabbits were randomized into six groups of two rabbits each. A single-side testicular torsion (TT) model (different degrees, time and sides) was performed in all groups except the Sham group. The groups included: Group 1 (180°; 4 h), Group 2 (720°; 6 h), Group 3 (1080°; 9 h), Group 4 (540°; 1 h), Group 5 (900°; 2 h), and Group 6 (sham-only). Testes were examined by another urologist and radiologist with Color Doppler Ultrasonography (CDU). MD was performed with CDU until blood flow was observed in the affected testis.Extra-scrotal fixation was then conducted in these animals. The testes were then harvested for blinded histopathological examinations.ResultsTT was detected in all animals except the control group. The CDU examination detected decreased blood flow only in Group 1. An opposite rate was observed between the spermatic cord diameter and torsion degree. A wrong direction of MD in the first step was observed in two rabbits in Groups 4 and 5. Torsion signs were observed only in Group 3. Rest torsion was observed in Groups 3 and 5 after extra-scrotal fixation. Histopathological examinations showed that testicular damage increased in parallel to torsion duration.ConclusionsExtra-scrotal fixation after MD along with CDU may be a simple and minimally invasive treatment option in TT therapy. However, this must be verified with further studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The effectiveness of extra-scrotal fixation following manual detorsion for testicular torsion: a pilot study in a rabbit model

Güneş

Altok

Özmen

et al. 2016

CEJU

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Prediction of testicular atrophy based on sonographic findings immediately after successful manual detorsion

Hosokawa

Urushibara

Tanami

et al. 2022

Australas J Ultrason Med

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Purpose To investigate and determine the sonographic findings obtained from manually distorted testes to predict testicular atrophy following manual detorsion. Materials and methods Twenty‐two patients who had been diagnosed with testicular torsion and undergone manual detorsion were included. These patients were classified according to the presence or absence of testicular atrophy. The duration of symptoms, presence or absence of hyperperfusion within the entire affected testis, and echogenicity (homogeneous or heterogeneous) within the affected testis were compared using the Mann–Whitney U‐test or Fisher's exact test, as appropriate. Results Testicular atrophy was detected in seven patients. There was a significant difference in the frequency of hyperperfusion within the entire affected testis (with atrophy [present/absent] vs. without atrophy [present/absent] = 0/7 vs. 8/7, P = 0.023) between patients with and without testicular atrophy. No significant differences in the duration of symptoms (with atrophy vs. without atrophy = 7 ± 3.3 h vs. 4.7 ± 3.6 h, P = 0.075) or frequency of echogenicity within the testis (with atrophy [heterogeneous/homogeneous] vs. without atrophy [heterogeneous/homogeneous] = 2/5 vs. 2/13, P = 0.565) were observed between the groups. Conclusions This small cohort study suggests that the presence of hyperperfusion within the entire affected testis immediately after successful manual detorsion is useful in predicting the avoidance of testicular atrophy.

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Point-of-care ultrasonography for the diagnosis and manual detorsion of testicular torsion

Hosokawa,

Tanami,

Sato

et al. 2023

J Med Ultrasonics

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Testicular torsion is a urological emergency caused by the loss of testicular tissue due to ischemic damage. Rapid diagnosis and urgent treatment play a crucial role in the management of testicular torsion. Manual detorsion can be performed at the bedside, thereby reducing the duration of ischemia. Recent studies have reported the use of point-of-care ultrasonography for diagnosing testicular torsion; however, no review article has focused on the ultrasonographic findings pertaining to manual detorsion. This review describes the diagnosis of testicular torsion and the ultrasonographic indications for manual detorsion. Spermatic cord twisting or the whirlpool sign, absence of or decreased blood flow within the affected testis, abnormal testicular axis, abnormal echogenicity, and enlargement of the affected testis and epididymis due to ischemia are the sonographic findings associated with testicular torsion. The following findings are considered indications for manual detorsion: direction of testicular torsion, i.e., inner or outer direction (ultrasonographic accuracy of 70%), and the degree of spermatic cord twist. The following sonographic findings are used to determine whether the treatment was successful: presence of the whirlpool sign and the degree and extent of perfusion of the affected testis. Misdiagnosis of the direction of manual detorsion, a high degree of spermatic cord twisting and insufficient detorsion, testicular compartment syndrome, and testicular necrosis were found to result in treatment failure. The success of manual detorsion is determined based on the symptoms and sonographic findings. Subsequent surgical exploration is recommended in all cases, regardless of the success of manual detorsion.

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A novel approach for manual de-torsion of an atypical (outward) testicular torsion with bedside Doppler ultrasonography guidance

Cited by 8 publications

References 8 publications

The effectiveness of extra-scrotal fixation following manual detorsion for testicular torsion: a pilot study in a rabbit model

The effectiveness of extra-scrotal fixation following manual detorsion for testicular torsion: a pilot study in a rabbit model

Prediction of testicular atrophy based on sonographic findings immediately after successful manual detorsion

Point-of-care ultrasonography for the diagnosis and manual detorsion of testicular torsion

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