Clinical and sonographic features predict testicular torsion in children: a prospective study

Abstract

Objective• To test the clinical and sonographic predictors of testicular torsion (TT) with the aim of reducing negative exploration rates. Patients and Methods• We performed a prospective study of all boys treated for 'acute scrotum' at our institute between January 2001 and April 2012 and clinical findings were documented.• If available, ultrasonography (US) was added to the diagnostic evaluation.• A prediction of the diagnosis was based on clinical and sonographic features, and was followed by surgical exploration in all patients. Results• A total of 104 patients were included in the 16-month period of the study.• No single finding excluded TT. The clinical features (pain <24 h, nausea/vomiting, abnormal cremasteric reflex, high position of the testis) appeared predictive (100% sensitivity) and the clinical scoring system was proven to be reliable, reducing the negative exploration rate by >55%.• Ultrasound predictors alone were not able to identify all boys with TT. Conclusions• It is safe to refrain from routine surgical exploration in every child with acute scrotum if the clinical score is applied, which results in a marked reduction of negative explorations.• A reliable diagnosis could not be obtained based on US alone. As scrotal US is unpleasant for the child, we propose to refrain from this if the clinical score is positive. Patients with a negative clinical score are suitable candidates for US to establish and secure diagnosis.

Testicular and paratesticular tumors and tumor-like lesions in the first 2 decades

“…The left testis is involved in 60-66% of cases. 244,245 On gross examination the testis is usually diffusely hemorrhagic and edematous. In a case where an intra-abdominal testis in a 3-month-old infant underwent torsion, the cut surface showed multiple cystic cavities, one to several centimeters in diameter, corresponding to areas of hemorrhagic necrosis of the parenchyma.…”

Surgical management of testicular torsion

“…Several studies have demonstrated that the most reliable physical signs of TT include (a) a high-riding testis, (b) absent cremasteric reflex, and (c) an anteriorly rotated epididymis or abnormally oriented testis. 18,19,24 High-resolution ultrasound (HRUS) with color-flow Doppler ultrasonography (CDS) and radionuclide imaging can provide information about blood flow to the testes. 25 Absent arterial flow within the suspect testis on CDS is indicative of testicular torsion.…”

Testicular torsion and the acute scrotum: current emergency management

“…Several studies have shown that the most reliable physical signs of TT include (a) a high-riding testis, (b) absent cremasteric reflex and (c) an anteriorly rotated epididymis or abnormally oriented testis [18,19,24].…”