Ultrasound heterogeneity as an indicator of testicular salvage in testicular torsion: A single center experience

doi:10.1016/j.ajur.2021.05.006

Asian Journal of Urology, 2022, 9 (1): 57-62 doi: 10.1016/j.ajur.2021.05.006

Original Articles

Current Issue | Archive | Adv Search

Ultrasound heterogeneity as an indicator of testicular salvage in testicular torsion: A single center experience

Omran Hasan,Mohamed Mubarak(

),S. Mohamed Jawad Alwedaie,Hasan Baksh,Husain Alaradi,Ameer Alarayedh,Ali Alaradi,Abdolsalam Ahmadi,Akbar Jalal

Department of Surgery, Salmaniya Medical Complex Ringgold Standard Institution, Manama, Bahrain

Abstract
Related Citation (15)

Download:

HTML

PDF (688KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective: Testicular torsion is a common urological emergency, mainly in the younger population. Our aim is to evaluate the efficacy and value of testicular echogenicity in predicting testicular viability.
Methods: Patients who were older than 13 years of age and were discharged with the diagnosis of testicular torsion were reviewed. Data obtained included demographic data, history, physical examination results, ultrasound findings including size, color Doppler flow, and echotexture, torsion degrees, and surgical procedure. In addition, the histopathological findings of patients who underwent orchiectomy were reviewed.
Results: A total of 71 cases were diagnosed with testicular torsion between January 2016 to December 2018. The mean age at presentation was 20.4±7.0 years. The average time from the onset of pain until the presentation was 36.0±55.1 h. Out of the 71 ultrasound scans reviewed, 45.1% showed homogenous echotexture and 54.9% showed heterogeneous echotexture of the affected testis. On scrotal exploration, the mean degree of torsion was 475.7±301.8 degrees; 66.2% of the patients had a viable testis; and bilateral orchidopexy was done. The remaining 33.8% had a non-viable testis. Homogenous echotexture was after an average of 13.5 h of scrotal pain, while heterogeneous echotexture presented after 53.7 h of scrotal pain. There was a statistically significant difference between the time of presentation and echotexture changes on scrotal ultrasonography (p<0.01). The relationship between echotexture changes and testicular viability was statistically significant as well (p<0.001).
Conclusion: A long time since the onset of pain coupled with heterogeneous changes in testicular parenchyma is a good indicator of non-viability. However, we still advocate for surgical exploration as the gold standard in diagnosis and management.

Key words： Testis Testicular torsion Orchiopexy Orchiectomy Ultrasound Echotexture

Received: 06 April 2020 Available online: 20 January 2022

Corresponding Authors: Mohamed Mubarak E-mail: mohdkej@yahoo.com

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Omran Hasan
	Mohamed Mubarak
	S. Mohamed Jawad Alwedaie
	Hasan Baksh
	Husain Alaradi
	Ameer Alarayedh
	Ali Alaradi
	Abdolsalam Ahmadi
	Akbar Jalal

TRENDMD:

Cite this article:

Omran Hasan,Mohamed Mubarak,S. Mohamed Jawad Alwedaie, et al. Ultrasound heterogeneity as an indicator of testicular salvage in testicular torsion: A single center experience[J]. Asian Journal of Urology, 2022, 9(1): 57-62.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2021.05.006 OR http://www.ajurology.com/EN/Y2022/V9/I1/57

Demographic data and patient characteristics.

Testes with homogenous echotexture. Figures A-C were viable on exploration; Figure D was non-viable and orchiectomy was done.

Testes with heterogeneous echotexture. All four were non-viable on scrotal exploration.

Comparison of the surgical outcomes depending on ultrasonographic echotexture changes.

[1]	Mansbach JM, Forbes P, Peters C. Testicular torsion and risk factors for orchiectomy. Arch Pediatr Adolesc Med 2005; 159:1167e71.
[2]	Chiu B, Chen CS, Keller JJ, Lin CC, Lin HC. Seasonality of testicular torsion: A 10-year nationwide population based study. J Urol 2012; 187:1781e5.
[3]	Chen JS, Lin YM, Yang WH. Diurnal temperature change is associated with testicular torsion: A nationwide, population based study in Taiwan. J Urol 2013; 190:228e32.
[4]	Arce JD, Cortes M, Vargas JC. Sonographic diagnosis of acute spermatic cord torsion. Rotation of the cord: A key to the diagnosis. Pediatr Radiol 2002; 32:485e91.
[5]	Cubillos J, Palmer JS, Friedman SC, Freyle J, Lowe FC, Palmer LS. Familial testicular torsion. J Urol 2011; 185(Suppl 6):2469e73.
[6]	Sharp VJ, Kieran K, Arlen AM. Testicular torsion: Diagnosis, evaluation, and management. Am Fam Physician 2013; 88:835e40.
[7]	Radmayr C, Bogaert G, Dogan HS, Nijman JM, Rawashdeh YFH, Silay MS, et al. EAU paediatric urology guidelines. [Accessed 10 January 2020]. https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Paediatric-Urology-2021.pdf.
[8]	Middleton WD, Middleton MA, Dierks M, Keetch D, Dierks S. Sonographic prediction of viability in testicular torsion: Preliminary observations. J Ultrasound Med 1997; 16:23e7. quiz 29-30. doi: 10.1016/0301-5629(90)90083-O
[9]	Kaye JD, Shapiro EY, Levitt SB, Friedman SC, Gitlin J, Freyle J, et al. Parenchymal echo texture predicts testicular salvage after torsion: Potential impact on the need for emergent exploration. J Urol 2008; 180(Suppl 4):1733e6.
[10]	Cost NG, Bush NC, Barber TD, Huang R, Baker LA. Pediatric testicular torsion: Demographics of national orchiopexy versus orchiectomy rates. J Urol 2011; 185:2459e63.
[11]	Waldert M, Klatte T, Schmidbauer J, Remzi M, Lackner J, Marberger M. Color Doppler sonography reliably identifies testicular torsion in boys. Urology 2010; 75:1170e4.
[12]	Al-Hunayan AA, Hanafy AM, Kehinde EO, Al-Awadi KA, Ali YM, Al-Twheed AR, et al. Testicular torsion: A perspective from the Middle East. Med Princ Pract 2004; 13:255e9.
[13]	Lee SM, Huh JS, Baek M, Yoo KH, Min GE, Lee HL, et al. A nationwide epidemiological study of testicular torsion in Korea. J Kor Med Sci 2014; 29:1684e7.
[14]	Huang WY, Chen YF, Chang HC, Yang TK, Hsieh JT, Huang KH. The incidence rate and characteristics in patients with testicular torsion: A nationwide, population-based study. Acta Paediatr 2013; 102:e363-7. https://doi.org/10.1111/apa.12275.
[15]	Zhao LC, Lautz TB, Meeks JJ, Maizels M. Pediatric testicular torsion epidemiology using a national database: Incidence, risk of orchiectomy and possible measures toward improving the quality of care. J Urol 2011; 186:2009e13.
[16]	Dunne P O’Loughlin B. Testicular torsion: Time is the enemy. Aust N Z J Surg 2000; 70:441e2.
[17]	Filho ACD, Alves JR, Filho HB, de Oliveira PG. The amount of spermatic cord rotation magnifies the time related orchidectomy risk in intravaginal testicular torsion. Int Braz J Urol 2016; 42:1210e9.
[18]	Howe AS, Vasudevan V, Kongnyuy M, Rychik K, Thomas LA, Matuskova M, et al. Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion. Transl Androl Urol 2017; 6:1159e66.
[19]	Ghorayeb S, Hartman C, Samson P, Yamashita Y, Palmer S. Ultrasonic evaluation of heterogeneity levels in normal and torsed testes. In: Paper presented at the proceedings of the 2nd international conference on biomedical engineering and systems, Barcelona, Spain; 2015. No. 297. http://www.avestia.com/EECSS2015_Proceedings/files/papers/ICBES297.pdf.
[20]	Chen M, Esler R. Accuracy and delay of using ultrasound in testicular torsion. J Urol Surg 2019; 6:273e7.
[21]	Johnston JW, Larsen P, El-Haddawi FH, Fancourt MW, Farrant GJ, Gilkison WT, et al. Time delays in presentation and treatment of acute scrotal pain in a provincial hospital. ANZ J Surg 2015; 85:330e3.
[22]	Alyami FA, Modahi NH, Alharbi AM, Alkhelaif AA, Alhazmi H, Trbay MS, et al. Parents’ awareness and knowledge of testicular torsion: A cross-sectional study. Urol Ann 2019; 11:58e61.
[23]	Friedman AA, Ahmed H, Gitlin JS, Palmer LS. Standardized education and parental awareness are lacking for testicular torsion. J Pediatr Urol 2016; 12:166. e1e8. https://doi.org/10.1111/apa.12275.
[24]	Ubee SS, Hopkinson V, Srirangam SJ. Parental perception of acute scrotal pain in children. Ann R Coll Surg Engl 2014; 96:618e20.
[25]	Bayo SO, Fredrick OO, Obafemi SJ. Awareness and sources of information relating to testicular self-examination and torsion among male undergraduates in a Nigerian university. Int J Med Med Sci 2014; 1:143e50.