Testicular Torsion and Contralateral Torsion of the Appendix Testis

Testicular torsion is a urological emergency that results in deterioration of the blood supply of the testicle and ischemia as a result of the rotation of the spermatic cord around itself. It may show a wide clinical variety with inflammatory manifestations varying from mild abdominal pain to severe scrotal pain. Orchiectomy may be required in cases which are delayed and cannot be operated urgently. Torsion of the testis and epididymis are other frequently seen causes of acute scrotum in children. Growth of masses and hormonal stimulation in the adolescent age cause an increase in the tendency of the torsion of appendix testis which have a small pedicle and epididymis. In the presence of sudden scrotal pain, testicular torsion should be considered, if there is clinical suspicion, patients should be evaluated with color doppler ultrasound (CDUS) and scrotal exploration should be performed immediately. A 20-year-old male whose clinical picture, and scrotal ultrasonography suggested the presence of testicular torsion is presented in this case report.

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The Diagnostic Accuracy of Testicular Torsion by Doctors on Duty Using Sonographic Evaluation with Color Doppler

American Journal of Men s Health ◽

10.1177/1557988320953003 ◽

2020 ◽

Vol 14 (5) ◽

pp. 155798832095300

Author(s):

Akinori Nakayama ◽

Hisamitsu Ide ◽

Akiyoshi Osaka ◽

Yasuyuki Inoue ◽

Yukihito Shimomura ◽

...

Keyword(s):

Blood Flow ◽

Diagnostic Accuracy ◽

Testicular Torsion ◽

Color Doppler ◽

Ultrasonic Transducer ◽

Color Doppler Ultrasound ◽

Medical Emergency ◽

Acute Scrotum ◽

Scrotal Pain ◽

Testicular Blood Flow

As testicular torsion is a medical emergency, it requires quick diagnosis and treatment. Color Doppler ultrasound (CDUS) is useful for the diagnosis of testicular torsion. An accurate diagnosis can be difficult when CDUS indicates the preservation of blood flow in the testis. We examined the accuracy of testicular torsion diagnosis in patients with acute scrotum made by doctors on duty using CDUS. The subjects included 26 patients who visited our department between January 2016 and June 2018 presenting with acute scrotal pain. Patients were placed into one of three groups based on testicular blood flow evaluated by CDUS. The first group had no testicular blood flow, the second had diminished blood flow, and the last group had normal or increased blood flow. Patients were also diagnosed through scrotal exploration. Finally, patients were further divided into two groups identified by CDUS frequency utilized during diagnosis (12 MHz groups and ≤8 MHz groups), and the diagnostic accuracy of the two groups was compared. Characterizing torsion by either the absence of or diminished, testicular blood flow in the CDUS evaluation, the sensitivity and specificity of the CDUS performed by doctors on duty accounted for 69.2% and 53.8%, respectively. No improvement in diagnostic accuracy was evident despite the usage of a 12-MHz ultrasonic transducer. In this study, the sensitivity of CDUS performed by doctors on duty was about 70%, suggesting that scrotal exploration should be performed promptly even if testicular blood flow is observed and testicular torsion is suspected from medical history and body findings.

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Comparison of demographic and clinical characteristics in distinguishing testicular torsion from torsion of the appendix testis

10.21203/rs.3.rs-461129/v1 ◽

2021 ◽

Author(s):

Zlatan Zvizdic ◽

Amila Aganovic ◽

Emir Milisic ◽

Asmir Jonuzi ◽

Denisa Zvizdic ◽

...

Keyword(s):

Abdominal Pain ◽

Clinical Characteristics ◽

Testicular Torsion ◽

Pediatric Population ◽

Color Doppler ◽

Medical Emergency ◽

Acute Scrotum ◽

Scrotal Pain ◽

Duration Of Symptoms ◽

Appendix Testis

Abstract Purpose The acute scrotum (AS) in the pediatric population is a medical emergency. The most common causes of AS include testicular torsion (TT) and torsion of the appendix testis (TAT). Their distinction may be clinically challenging. The purpose of our study was to compare demographic and clinical characteristics of the pediatric cases of TT and TAT and thus provide clinical evidence for distinguishing these two conditions. Methods We retrospectively analyzed all children ≤ 16 years who underwent surgical exploration for AS. The patients were divided into Group 1 or TT and Group 2 or TAT groups. Results Ninety patients were included in the study (24 with TT and 66 with TAT). Patients with TT were significantly older than those with TAT (p < 0.001). The peak incidence of TT was in the age of 12–16 years (p < 0.001), whereas the peak of TAT was in the age group of 7–11 years (p < 0.001). Scrotal pain was more prevalent in patients with TAT (p = 0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p = 0.003 and p < 0.001, respectively). The mean duration of symptoms was significantly longer in the TAT group than in the TT group (p < 0.001). Color-Doppler Ultrasound (CDUS) findings of absent or decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p < 0.001). Conclusion Our data indicate that the older age, shorter duration of symptoms, systemic signs (nausea/vomiting and abdominal pain), and characteristics CDUS findings can help distinguish between the two most common acute scrotum causes.

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Acute testicular vein thrombosis in a young patient with a solitary testicle: a rare urological emergency

Yeni Üroloji Dergisi ◽

10.33719/yud.2021;16-2-769944 ◽

2021 ◽

pp. 195-199

Author(s):

Ali Kumcu ◽

Ferhat Yakup Suçeken ◽

Metin Mod ◽

Alper Kerem Aksoy ◽

Abdurrahman İnkaya ◽

...

Keyword(s):

Case Reports ◽

Color Doppler ◽

Rare Condition ◽

Current Treatment ◽

Acute Scrotum ◽

Scrotal Pain ◽

Testicular Vein ◽

Vein Thrombosis ◽

First Choice ◽

Urological Emergency

Acute scrotal pain due to testicular vein thrombosis is a rare condition. Thrombosis is defined as clot formation within the blood vessels and as a result, it interrupts the blood supply of the peripheral organs. In routine urology practice, the incidence of thromboembolic diseases is <1%, and it is mostly encountered in patients at the postoperative period. Nevertheless, testicular vein thrombosis should also be remembered in the differential diagnosis of patients admitted to the emergency department due to acute scrotum. In general, conservative treatment is the first choice in treatment management, but surgical intervention may also be required in some cases. Since the available data on this subject are based on the information obtained from case reports, a standard treatment approach should be developed by examining the current treatment methods. We aim to present the case report of testicular vein thrombosis in the light of the literature, which is one of the rarely seen emergencies of urology. Keywords: acute pain; color doppler ultrasonography; venous thrombosis; testicular diseases

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Acute scrotum: differential diagnosis and treatment

Revista de Medicina ◽

10.11606/issn.1679-9836.v97i3p278-282 ◽

2018 ◽

Vol 97 (3) ◽

pp. 278-282

Author(s):

João Arthur Brunhara Alves Barbosa ◽

Marco Antonio Arap

Keyword(s):

Blood Flow ◽

Differential Diagnosis ◽

Testicular Torsion ◽

Color Doppler ◽

Testicular Tumor ◽

Signs And Symptoms ◽

Clinical Syndrome ◽

Acute Scrotum ◽

Viral Etiology ◽

Scrotal Pain

Acute scrotum (AS) is a clinical syndrome characterized by scrotal pain of acute onset, often accompanied by scrotal swelling and other local and systemic signs and symptoms. It may be the initial presentation of several diseases including testicular torsion, orchitis, epididymitis, hydatid torsion, strangulated hernia and, less frequently, scrotal hematoma and testicular tumor. In the setting of emergency services, physicians should be extremely careful with the possibility of testicular torsion. This condition consists in the torsion of the spermatic cord, leading to an interruption of the testicular blood flow, with ischemia and ultimately necrosis. It is associated with acute severe pain, nausea, absence of the cremasteric reflex, and a high-riding testis. Physical examination may help diagnosis. However, a color Doppler ultrasound of the scrotum is usually required for a definitive diagnosis. Ultrasound will reveal a reduction or no blood flow to the affected testis; surgical treatment is mandatory and should be performed as early as possible. A differential diagnosis is orchiepididymitis. It may be of viral etiology in early childhood and bacterial after the beginning of sexual activity. The most specific sign associated with this condition is the relief of pain after elevation of the testis, known as Prehn’s sign. Treatment for bacterial cases requires antibiotics, while cases of viral etiology require only symptomatics. Hydatid torsion, including torsion of appendix testicularis and appendix epididymis may mimic testicular torsion but on ultrasound, blood flow is preserved, and a twisted appendix is often seen. Treatment for this condition consists only in symptomatic control. Testicular torsion should be treated as early as possible, since a delay of 6 hours may result in organ loss. Surgery consists of bilateral orchiopexy in case of a viable testicle and orchiectomy of a necrotic organ, always with fixation of the contralateral testicle.

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Causes of delayed exploration of the acute scrotum in a regional tertiary centre

Journal of Clinical Urology ◽

10.1177/2051415820981196 ◽

2020 ◽

pp. 205141582098119

Author(s):

Benjamin Storey ◽

Nathan Shugg ◽

Alison Blatt

Keyword(s):

Retrospective Review ◽

Testicular Torsion ◽

Tertiary Hospital ◽

Adverse Outcomes ◽

Acute Scrotum ◽

Tertiary Institution ◽

Level Of Evidence ◽

Scrotal Pain ◽

Surgical Exploration ◽

Significant Difference

Background: Testicular torsion is an organ-threatening surgical emergency with a limited timeframe for intervention. Objective: To identify the delays to surgical exploration of patients with an acute scrotum in a tertiary hospital to prevent adverse outcomes associated with this time critical emergency. Methods: A retrospective review of medical records for all patients who underwent scrotal exploration for acute scrotal pain in a tertiary hospital in regional New South Wales between January 2008 to December 2018 was performed. Results: Retrospective review identified 242 patients, of whom 161 had testicular torsion and 56 resultant orchidectomies. No statistically significant difference in pre-hospital delays between paediatric or adult populations was found. The average time from presentation to theatre was 4 h 36 min. Patients who were delayed > 6 h from presentation to surgical exploration had significantly increased rates of orchidectomy. Delays that significantly affected rates of orchidectomy were transfer from peripheral sites, late presentation, misdiagnosis and representation after discharge. Conclusion: The most common reason for delay was diagnostic error with the patient later re-presenting to hospital. Patient transfer from the primary hospital to a tertiary institution and subsequent delayed surgical exploration also contributed to significantly higher rates of orchidectomy. Level of Evidence: 3

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Ultrasonological evaluation of acute scrotum

Nepalese Journal of Radiology ◽

10.3126/njr.v6i1-2.19207 ◽

2018 ◽

Vol 6 (1-2) ◽

pp. 11-14

Author(s):

Prakash Sharma ◽

Merina Gyawali ◽

Sristi Singh

Keyword(s):

Statistical Analysis ◽

Color Doppler ◽

Descriptive Analysis ◽

Power Doppler ◽

Rank Correlation ◽

Final Diagnosis ◽

Acute Scrotum ◽

Age Group ◽

Scrotal Pain ◽

Kendall Rank Correlation

Introduction: Acute scrotum is a common surgical condition. Ultrasound along with Doppler plays an important role in differentiating the various causes. Purpose of this study was to evaluate the role of ultrasound in identifying the various causes of acute scrotum.Methods: All patients with history of acute scrotum presenting to the Department of Radiology were included in the study. Scrotal ultrasound was performed with a linear 7.5 to 12-MHz transducer with abundant acoustic gel. Imaging was done in longitudinal and transverse planes with Power Doppler and Color Doppler. The testes, epididymis, spermatic cord, scrotal wall and inguinal region were evaluated. Kidney, Ureter and Bladder region was evaluated for possibility of calculus. Final diagnosis was made based on clinical outcome, follow up, intraoperative findings and histopathology when available. Statistical analysis was done using SPSS version 18 for windows. Descriptive analysis was done. Non parametric correlation between side and torsion was done using Kendall Rank Correlation Coefficient.Results: There were altogether 50 patients available for statistical analysis. Age of the patients ranged from 14 to 65 years with mean age of 34.7±14.7 years. Most common age group was 21 to 40 years. Inflammatory pathology was the most common pathology of actual scrotal pain. There was no significant correlation between side of pain and testicular torsion.Conclusion: Inflammatory pathology was the most common cause for actual scrotal pain. The most common age group was 21 to 40 years.

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Acute Testicular Torsion: Presentation and Diagnosis

10.2310/uro.11031 ◽

2019 ◽

Author(s):

Claudia Berrondo ◽

Robert A. Mevorach ◽

Jimena Cubillos

Keyword(s):

Testicular Torsion ◽

Near Infrared ◽

Color Doppler ◽

Bimodal Distribution ◽

Long Term Effects ◽

Scrotal Pain ◽

Unique Challenge ◽

Acute Infarction ◽

Hormonal Function ◽

Acute Scrotal Pain

Testicular torsion is the most common pediatric urologic emergency and is a common cause of acute scrotal pain. Timely diagnosis is important for testicular salvage,as treatment delayed beyond 6 hours from the onset of symptoms is the most predictive factor of testicular death. There is a bimodal distribution of age with extravaginal torsion most commonly presenting in the neonatal period and intravaginal torsion most commonly presenting around the onset of puberty. Intermittent testicular torsion presents a unique challenge in making an accurate diagnosis, as patients most often present when asymptomatic. Several risk factors exist, although bell-clapper deformity is the most important. The diagnosis is made largely on history or physical examination. In equivocal cases, imaging with color Doppler ultrasonography may be helpful in making the diagnosis. Additional tools including near-infrared spectroscopy and Testicular Workup for Ischemia and Suspected Torsion score may be helpful in diagnosing testicular torsion. Possible long-term effects on fertility and hormonal function are also often a concern for the patient and clinician. This review contains 6 figures, 5 tables, and 34 references. Keywords: acute, infarction, ischemia, orchidopexy, scrotum, spermatic cord, testis, torsion

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Approach to Male Urologic Emergencies

10.2310/em.4367 ◽

2019 ◽

Author(s):

Jonathan E. Davis ◽

Jeffrey S. Dubin

Keyword(s):

Emergency Department ◽

Inguinal Hernia ◽

Necrotizing Fasciitis ◽

Testicular Torsion ◽

Diagnosis And Treatment ◽

Acute Scrotum ◽

Scrotal Pain ◽

Penile Pain ◽

Emergency Department Setting ◽

Acute Scrotal Pain

This review details the evaluation and management of the acute scrotum in the emergency department setting and emergent penile complaints in adults, with an emphasis on the most serious and most common conditions. Other emergent conditions include necrotizing fasciitis of the perineum (Fournier disease), incarcerated or strangulated inguinal hernia, and genitourinary (GU) trauma. Emergency practitioners need to be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis. Basic anatomy and bedside evaluation are reviewed. Acute scrotal and penile pain and GU trauma are discussed in terms of assessment and stabilization, diagnosis, and treatment and disposition. This review contains 5 figures, 19 tables, and 71 references. Keywords: Acute scrotal pain, testicular torsion, priapism, Peyronie disease, paraphimosis, phimosis, balanitis, posthitis, epididymitis

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Reliability of colour Doppler ultrasound in the differential diagnosis of acute scrotum

Orvosi Hetilap ◽

10.1556/oh.2011.29129 ◽

2011 ◽

Vol 152 (23) ◽

pp. 909-912 ◽

Cited By ~ 4

Author(s):

Laura Sándor ◽

Tímea Gajda ◽

Vanda Aranyi ◽

István Csízy ◽

Tamás Cserni

Keyword(s):

Differential Diagnosis ◽

Doppler Ultrasound ◽

Predictive Value ◽

Testicular Torsion ◽

Color Doppler ◽

False Negative ◽

Acute Scrotum ◽

Colour Doppler ◽

Colour Doppler Ultrasound ◽

Operative Notes

Acute scrotum, when testicular torsion is suspected, needs emergency exploration. However, acute scrotum caused by torsion of the Morgagni hydatid and epididymitis can be managed conservatively. Real time colour Doppler ultrasound is becoming a more and more popular tool in the differential diagnosis, however, its reliability is still not widely accepted and exploration is preferred. Material and methods: Case notes of 124 patients treated with acute scrotum during the last 10 years have been reviewed, and the result of physical examination, color Doppler ultrasound, operative notes and clinical outcome were analysed. Results: The final diagnosis was torsion of Morgagni hydatid in 100 cases, furthermore 11 testicular torsion, 8 epididymitis and 10 idiopathic cases were identified. Preoperative colour Doppler ultrasound was done in 45 cases, and exploration was performed in 111 cases. In 38 cases the colour Doppler ultrasound excluded and in 7 cases verified the possibility of testicular torsion. Two false positive and 0 false negative cases were identified. The specificity was 95.0%, sensitivity 100.0%, negative predictive value 100.0%, and positive predictive value 71.4%. Discussion: Colour Doppler ultrasound seems to be a reliable tool in the differential diagnosis of acute scrotum. Its routine use could reduce the number of emergency explorations. Orv. Hetil., 2011, 152, 909–912.

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