Testicular volume and Tanner stage: determinant factors for testicular torsion.

OBJECTIVE: To assess testicular volumes and sexual maturation in patients with testicular torsion. METHODS: A retrospective analysis of consecutively treated patients with testicular torsion between 2016 and 2018. Age, pubic hair staging (Tanner), and by ultrasonography, volume of the unaffected testis (in cubic centimeters) were evaluated either immediately before surgery or at the first postoperative visit. Patients with previous testicular disease, such as cryptorchidism, or with no records of testicular volume were excluded. The analysis included descriptive statistics and Bayesian regression. RESULTS: We treated 149 patients during the study period, and 141 (94.6%, median age 17.3 years) met the inclusion criteria. Median testicular volume was 13.0cm3 (interquartile range of 10.5-15.2), with similar right and left volumes (12.9cm3versus 13.3cm3; p=0.94). Sixty-five (46.1%) patients were Tanner stage IV, 17 (12.1%) stage III, and 59 (41.8%) stage V. CONCLUSION: In this study, we were able to estimate volumes of testicular torsion, which aggregated around late puberty values (13.0cm3 for the whole dataset, 12.2cm3 for patients <25 years), suggesting that testicular hypermobility, due to congenital anatomical abnormalities, remains quiescent until the organ reaches a critical volume, after which torsion becomes possible. These findings provide a tentative explanation for the disease's age distribution.

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

ABSTRACT Purpose To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. Patients and Methods Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. Results 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). Conclusion Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing population-wide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil.

PURPOSE: To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. PATIENTS AND METHODS: Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. RESULTS: 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). CONCLUSION: Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing population-wide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.

Bilateral testicular torsion in an adolescent: a case with challenging diagnosis

ABSTRACT Bilateral testicular torsion is a very uncommon emergency, with a challenging differential diagnosis. We describe the case of a 15-year-old patient with a left testicular torsion of 48 hours of duration and a sudden onset of right scrotum pain during his stay at the emergency area. Bilateral testicular torsion was diagnosed after repeat physical examination and doppler ultrasound, which had been normal for right testis in a first evaluation. Surgical exploration was performed with orchiectomy in left testis and fixation in right testis. In previous literature, there are reported bilateral torsion only in four adolescents and five adults. With this case, we demonstrate that bilateral spermatic cord torsion may be easily overlooked in a patient with acute scrotum and we emphasize the importance of bilateral exploration in testicular torsion.

Bilateral testicular torsion in an adolescent: a case with challenging diagnosis.

Bilateral testicular torsion is a very uncommon emergency, with a challenging differential diagnosis. We describe the case of a 15-year-old patient with a left testicular torsion of 48 hours of duration and a sudden onset of right scrotum pain during his stay at the emergency area. Bilateral testicular torsion was diagnosed after repeat physical examination and doppler ultrasound, which had been normal for right testis in a first evaluation. Surgical exploration was performed with orchiectomy in left testis and fixation in right testis. In previous literature, there are reported bilateral torsion only in four adolescents and five adults. With this case, we demonstrate that bilateral spermatic cord torsion may be easily overlooked in a patient with acute scrotum and we emphasize the importance of bilateral exploration in testicular torsion.

[Testicular torsion: A case report]. / Torsión testicular: reporte de un caso.

BACKGROUND: The acute scrotum is an emergency. Testicular torsion represents approximately 25% of the causes. The annual incidence of testicular torsion is approximately 1/4,000 persons under 25 years, with highest prevalence between 12 and 18 years old. It usually occurs without apparent cause, but it has been associated with anatomical, traumatic, and environmental factors, among others. CLINICAL CASE: A male 15 year-old male, with no history of importance, was seen in the Emergency Department, presenting with a sudden and continuous pain in the left testicle. It was accompanied by a pain that radiated to the abdomen and left inguinal area, with nausea and vomiting of more than 12h onset. Doppler ultrasound showed changes suggestive of testicular torsion. Surgery was performed that showed findings of a necrotic left testicle with rotation of the spermatic cord of 360°. A left orchiectomy was performed. CONCLUSIONS: Testicular torsion should always be considered one of the leading causes of acute scrotal pain. Delays in diagnosis should be avoided as this is directly related to the percentage of testicular salvage or loss.

Scrotal emergencies.

This review describes the clinical, grey-scale and colour Doppler US findings of different conditions that may be the cause of an acute scrotum. The US appearances of testicular torsion, torsion of the appendix testis, epididymoorchitis, incarcerated hernia and idiopathic scrotal oedema are described. Some of the major studies regarding the sensitivity and specificity of US in the diagnosis of these diseases are reviewed. Grey-scale and colour Doppler US demonstrate high accuracy in the aetiological diagnosis of an acute scrotum and can differentiate between diseases that require immediate surgical intervention and those that can be treated conservatively.

Torsión testicular bilateral y sincrónica en un recién nacido. Caso clínico / Bilateral and synchronous testicular torsion in a newborn. Case report

La torsión testicular perinatal, definida como aquella ocurrida entre el período prenatal y el período postnatal hasta el mes de nacimiento, es una entidad rara que, en general, afecta uno de los testículos. Como la mayoría de los casos ocurre durante el período prenatal, la tasa de pérdida testicular es muy alta.La torsión testicular bilateral, ya sea sincrónica o asincrónica, es mucho más rara. La existencia de torsión testicular unilateral debe alertar al equipo médico neonatal sobre la posibilidad cierta de torsión contralateral.Presentamos un recién nacido con torsión testicular bilateral (compromiso de pared escrotal bilateral, con testículos duros,adheridos a cubiertas escrotales, sin hidrocele ni signos inflamatorios agudos, ecografía y eco-doppler característicos, y necrosis isquémica con pérdida de ambos testículos durante la exploración quirúrgica). Proponemos pautas de manejo de la torsión testicular.(AU)

Painless inter epididymal testicular torsion of the spermatic cord.

Inter epididymal testicular torsion of the spermatic cord is extremely rare and usually diagnosed at surgery. We present an unusual case of spermatic cord torsion in a 14-year-old male patient. It is important to highlight that the torsion occurred only on the distal half of the epididymis leaving the head untwisted and edematous. In addition, the fact that this condition was painless made this case extremely rare and motivated our presentation.

Utilidad ultrasonido en la evaluación de la patología escrotal benigna / Sonographic findings in benign scrotal diseases

La utilización de la ecografía tanto en escala de grises como Doppler color resulta una práctica de mucha utilidad en la caracterización de diversas entidades a nivel del escroto y su contenido. Para su realización se utilizaron transductores lineales con frecuencia entre 7,5-10 MHz en cortes transversales y sagitales de testículo y epidídimo, incluyendo imágenes comparativas del tamaño y ecogenicidad de ambos testículos. Este ensayo iconográfico intenta revisar el aporte del ultrasonido en la patología escrotal benigna más frecuente (AU)

Escroto agudo en pediatría: evaluación con US y doppler color / US and color doppler US findings in the acute scrotum in children

La tumefacción dolorosa aguda del escroto presenta dificultad diagnóstica. Es necesario diferenciar las patologías quirúrgicas de urgencia, como la torsión testicular, de aquellas que requieren tratamiento médico evitando exploraciones quirúrgicas innecesarias. Se usó prospectivamente ecografía Doppler color para evaluar 36 pacientes con escroto agudo. Usamos el simple criterio de presencia, ausencia o aumento del flujo intra y peritesticular. Los resultados fueron correlacionados con el diagnóstico final establecido por cirugía o el seguimiento clínico. El US Doppler color demostró ausencia de flujo en seis de los siete pacientes con torsión testicular aguda (especificidad: 85,7 por ciento) y aumento del mismo en diez epididimitis y 13 orquiepididimitis (T: 23) (especificidad: 100 por ciento). El US Doppler color es un método seguro, no invasivo, que permite rápidamente evaluar la perfusión del testículo en el escroto agudo. La habilidad para detectar el flujo testicular varía con el equipamiento y la experiencia del operador (AU)