Abstract
Aim
British Paediatric surgery guidelines (2019) state ‘immediate surgery should be performed if testicular torsion is suspected’. However, imaging ‘may be considered for a small number of children under the guidance of a senior clinician in late presenters or in those with atypical features. This study reviewed current practice in our hospital.
Method
Boys aged 16 and under in 2017-2019 who underwent scrotal exploration for suspected testicular torsion were reviewed. Outcomes assessed were number having ultrasound prior to theatre, pathological findings, number who had an orchidectomy, and post-op complications. Additionally, all testicular ultrasounds in those aged under 16 were screened to establish how many were requested for possible or missed torsion.
Results
46 patients underwent surgical exploration of which 18 had a confirmed torsion. Six patients had imaging prior to surgery, of which five suggested torsions and four of these were confirmed in theatre. 202 boys under 16 had a testicular ultrasound; 26 of these were for late presentation or those with atypical features of torsion. Three underwent scrotal exploration two of whom had reports suggestive of torsion which was confirmed on exploration.
Conclusions
Most testicular torsions occur around the age of puberty with no torsion identified in patients under 10. Ultrasound is a useful tool for identification of vascularity or alternative pathology in late or atypical presentations of torsion; but does not replace clinical judgement. Imaging may have prevented unnecessary exploration in 23 cases, although negative imaging did not always preclude exploration.
Scrotal cystic mass as a late presentation of neonatal testicular torsion
