The Role of Doppler Ultrasound in the Diagnosis of Postnatal Testicular Torsion in Children

The diagnostic significance of the color Doppler study of testicular blood flow in testicular torsion has been studied for about 40 years, however, the prognostic value of the results obtained is ambiguous, as are the actual imaging capabilities of the technique. Our own experience of 110 observations of testicular torsion in children older than the neonatal period allows us to draw statistically reliable conclusions. Made on equipment premium-class research made it possible to evaluate how visualization intratesticular vascular pattern, and whirpool-sign and submit the primitive model of the actual inversion, explaining the impossibility of rendering whirpool-sign with the greatest tight inversion. The dynamics of testicular blood flow was studied immediately after successful and unsuccessful manual detorsion and in the long term after operative detorsion and orchopexy. The publication contains a brief analysis of the literature and is extensively illustrated.

Testicular microvascular flow is altered in Klinefelter syndrome and predicts circulating testosterone

Context Experimental studies on Klinefelter syndrome (KS) reported increased intratesticular testosterone (T) levels coexisting with reduced circulating levels. Abnormalities in testicular microcirculation have been claimed; however, no studies investigated in vivo testicular blood flow dynamics in humans with KS. Objective To analyze the testicular microcirculation in KS by contrast-enhanced ultrasonography (CEUS) and correlate vascular parameters with endocrine function. Design and Setting Prospective study. University Setting. Patients 68 testicular scans, 34 testes from 19 T-naïve subjects with KS and 34 testes from age-matched eugonadal men (CNT) who underwent CEUS for incidental nonpalpable testicular lesions. Main Outcomes. CEUS kinetic parameters. Results CEUS revealed slower testicular perfusion kinetics in subjects with KS than in age-matched CNT. Specifically, the wash-in time (Tin, p = 0.018), mean transit time (MTT, p = 0.035), time to peak (TTP, p < 0.001), and washout time (Tout 50%, p = 0.004) were all prolonged. Faster testicular blood flow was associated with higher total T levels. Principal component analysis and multiple linear regression analyses confirmed the findings, and supported a role for reduced venous blood flow as independent predictor of total T levels. Conclusions Testicular venous blood flow is altered in KS and independently predicts T peripheral release.

Testicular microvascular flow is altered in Klinefelter syndrome and predicts circulating testosterone

ABSTRACTContextExperimental studies on Klinefelter syndrome (KS) reported increased intratesticular testosterone (T) levels coexisting with reduced circulating levels. Abnormalities in testicular microcirculation have been claimed; however, no studies investigated in vivo testicular blood flow dynamics in humans with KS.ObjectiveTo analyze the testicular microcirculation in KS by contrast-enhanced ultrasonography (CEUS) and correlate vascular parameters with endocrine function.Design and SettingProspective study. University Settings.Patients51 testicular scans, 17 testes from 10 T-naïve subjects with KS and 34 testes from age-matched eugonadal men (CNT) who underwent CEUS for incidental nonpalpable testicular lesions.Main OutcomesCEUS kinetic parameters.ResultsCEUS revealed slower testicular perfusion kinetics in subjects with KS than in age-matched CNT. Specifically, the wash-in time (Tin, p = 0.008), mean transit time (MTT, p = 0.008), time to peak (TTP, p < 0.001), and washout time (Tout 50%, p = 0.008) were all prolonged. Faster testicular blood flow was associated with higher total T levels. Principal component analysis and multiple linear regression analyses confirmed the findings, and supported a role for reduced venous blood flow as independent predictor of total T levels.ConclusionsTesticular venous blood flow is altered in KS and independently predicts T peripheral release.

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

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.

Infrared thermography and Doppler ultrasonography to evaluate the effects of scrotal insulation on testicular blood flow dynamics in bulls

The aim of this study was to evaluate the dynamics of the scrotal temperature, sperm quality and testicular blood flow by using infrared thermography and Doppler ultrasonography in bulls submitted to scrotal insulation. Braford bulls (n = 8) at 18 months of age, were assigned into the following groups: insulated for 72 h (G 72; n = 2), 96 h (G 96, n = 2), 120 h (G 120, n = 2), and control animals (CON; n = 2) that remained without insulation. Infrared thermography and Doppler ultrasonography parameters were measured at four different time points: immediately after the scrotal insulation (M0), within 10 min (M10), 30 min (M30) and 60 min (M60) after scrotal insulation. The sperm quality was evaluated weekly (S1/S12). The data were analyzed by ANOVA, t-test (paired) and Pearson's correlation with a significance level of 5%. None of the observed variables were different between the insulated groups (P > 0.05). Insulated animals showed higher scrotal temperature in M0 compared to that in the M10, M30 and M60 periods (P < 0.05). There was no difference in the pulsatility and resistive indexes after scrotal insulation. However, blood flow velocity was higher in M10 compared to that in the M0, M30 and M60 periods (P < 0.05). The sperm quality was higher (P < 0.05) in all twelve collections from the control group compared with the insulated groups. Scrotal insulation resulted in changes in the sperm quality, scrotal temperature and testicular blood flow velocity.