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The purpose of this study is to explore the diagnostic efficacy and value of ultrasound detection for testicular torsion in children with scrotal and testicular diseases. A total of 120 children with acute scrotal swelling and pain who were treated in our hospital from August 2017 to August 2022 were selected for preliminary diagnosis through color Doppler ultrasound diagnostic instrument examination. The final diagnosis was made through surgical or conservative treatment. At the same time, 40 children with acute epididymitis during the same period were selected as the control group, and the clinical treatment of patients with testicular diseases was retrospectively analyzed. A total of 120 children were diagnosed with testicular torsion disease, with 57 cases affecting the left testicle and 63 cases affecting the right testicle. Ultrasound examinations revealed no blood flow signal in 78 cases, a significant reduction in blood flow in 38 cases, and no change in 4 cases. Among the pediatric patients who underwent manual reduction, 79 cases had a favorable prognosis. Surgical reduction was performed in 41 cases, with 35 cases successfully treated and 6 cases resulting in testicular removal. Follow-up examinations conducted 6 months to 1 year postoperatively showed testicular atrophy in 4 out of 35 cases with preserved testicles, while the 6 cases that underwent testicular resection had good outcomes. The non-active subgroup had a longer disease course and a greater degree of torsion (P < .05). There was no statistically significant difference in testicular volume and the ratio of healthy testicular volume between the 2 groups (P > .05). The sensitivity of ultrasound diagnosis was 95.24% (73/77), specificity was 78.57% (34/43), and accuracy was 89.29% (107/120). Ultrasound can effectively diagnose testicular torsion and evaluate the success rate of testicular reduction. Early treatment of patients with testicular torsion leads to better efficacy and higher survival rates., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Acute scrotum in a child is common, and the main underlying conditions are torsion of intrascrotal appendages, epididymitis, testicular torsion and idiopathic scrotal edema. The main diagnostic aim is to confirm or rule out testicular torsion, since this may lead to irreversible ischemia within hours. The diagnostics can be difficult, especially in prepubertal boys, but consist of a thorough history and clinical examination, the use of a clinical prediction score, and sometimes ultrasound with doppler. However, none of these tools can with completely accuracy rule out a testicular torsion, and uncertainty should prompt an acute scrotal exploration. The treatment of a testicular torsion is detorsion and bilateral orchidopexy, or unilateral orchidectomy in case of a completely necrotic testicle. Treatment of the other underlying conditions is often only symptomatic, and follow-up is often not required.

Background: This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline., Methods: A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023., Results: Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle., Conclusion: While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle.

Purpose: Ultrasound as a diagnostic tool in suspicion of testicular torsion is still highly debated. In this investigation, we aimed to evaluate whether time spent on scrotal ultrasonography had a negative impact on testicular loss., Methods: Patients' records containing a scrotal ultrasound and/or surgical procedure codes for testicular interventions on suspicion of testicular torsion were examined. Patients aged 0-15 years admitted during 2015-2019 at Copenhagen University Hospital, Rigshospitalet were included., Results: In total, 1566 patients underwent an ultrasound and 142 of these proceeded to surgery while 13 patients proceeded directly to surgery without an ultrasound. The rate of testicular loss with a preceding ultrasound was 23% versus 42% without (p = 0.18). Four cases of testicular torsion were misdiagnosed by ultrasound resulting in a sensitivity of 95.4% and specificity of 95.6%. The mean diagnostic delay from ultrasound examination was 55 ± 39 min, and the mean time from ultrasound to surgery was at 169 ± 76 min versus 171 ± 72 min without ultrasound., Conclusion: In a clinical setting, ultrasound provided a reliable tool for the diagnosis of testicular torsion and did not seem to increase the orchiectomy rate., (© 2024. The Author(s).)

Objective: To evaluate the value of multimodal ultrasonography (US) in a rat experimental torsion model after 6 h of torsion with different degrees., Methods: Twenty-one male rats were divided into three groups. Left testes of the rats were twisted around their vascular pedicle 360 degrees in group 1, 720 degrees in group 2, and 1080 degrees in group 3 and intact right testes of the rats were accepted as control group. Grey-scale US, superb microvascular imaging (SMI), colour Doppler ultrasonography (CDUS), strain elastography (SE), and two-dimensional (2-D) shear wave elastography (SWE) examinations were applied 6 h after torsion procedure and testes were removed for pathological evaluation., Results: Short-axis dimensions and volumes of the torsion side were higher than control testes. Lengths of the testes in the 3rd torsion group were smaller than the testes in groups 1 and 2 (P < 0.002). SMI was better than CDUS in recognizing blood flow in testicular tissue. Strain ratios were higher in group 1 and decreased with the increasing torsion degree. Emean and standard deviation (SD) measurements increased in the torsion side. Pathologically the mean testicular damage scores were statistically significant between torsion and control testes in all groups., Conclusion: Our results showed that short-axis and volume measurements, SMI, 2D-SWE, and SE are effective in the evaluation and diagnosis of testicular torsion (TT)., Advances in Knowledge: Evaluation of affected testis and intact testis with multiparametric US in late presenting TT cases is more reliable than being dependent on a single sonographic modality., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Institute of Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Ultrasound, the imaging method of choice to evaluate abnormalities of the testes and the scrotum, provides accurate anatomic details and allows the assessment of perfusion using color Doppler and power Doppler. Ultrasound represents a rapid and reliable procedure which in most cases leads to a conclusive diagnosis., Differential Diagnosis: The three most common conditions in the clinical picture of acute scrotum are testicular torsion, torsion of the testicular appendages and inflammatory changes of the testis and the epididymis (epididymo-orchitis). Especially in the case of testicular torsion, rapid diagnosis is essential since time is an important factor to initiate organ-preserving therapy., Equipment Technology: High-frequency linear array transducer (at least 10 MHz), which allows detection of slow flow rates, is recommended., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Testicular torsion is a urological emergency caused by the loss of testicular tissue due to ischemic damage. Rapid diagnosis and urgent treatment play a crucial role in the management of testicular torsion. Manual detorsion can be performed at the bedside, thereby reducing the duration of ischemia. Recent studies have reported the use of point-of-care ultrasonography for diagnosing testicular torsion; however, no review article has focused on the ultrasonographic findings pertaining to manual detorsion. This review describes the diagnosis of testicular torsion and the ultrasonographic indications for manual detorsion. Spermatic cord twisting or the whirlpool sign, absence of or decreased blood flow within the affected testis, abnormal testicular axis, abnormal echogenicity, and enlargement of the affected testis and epididymis due to ischemia are the sonographic findings associated with testicular torsion. The following findings are considered indications for manual detorsion: direction of testicular torsion, i.e., inner or outer direction (ultrasonographic accuracy of 70%), and the degree of spermatic cord twist. The following sonographic findings are used to determine whether the treatment was successful: presence of the whirlpool sign and the degree and extent of perfusion of the affected testis. Misdiagnosis of the direction of manual detorsion, a high degree of spermatic cord twisting and insufficient detorsion, testicular compartment syndrome, and testicular necrosis were found to result in treatment failure. The success of manual detorsion is determined based on the symptoms and sonographic findings. Subsequent surgical exploration is recommended in all cases, regardless of the success of manual detorsion., (© 2023. The Author(s), under exclusive licence to The Japan Society of Ultrasonics in Medicine.)

Purpose: Testicular torsion requires emergency surgery; thus, prompt and correct diagnosis is very important. Ultrasound with color Doppler is usually the first-choice modality for diagnosis; however, skill and experience are required for confident diagnosis. Recently, contrast-enhanced ultrasound for the diagnosis of testicular torsion has been reported, but there have been only a few reports. This study aimed to compare contrast-enhanced ultrasound findings in cases of testicular torsion and non-testicular torsion., Methods: Patients who underwent contrast-enhanced ultrasound for acute scrotum at our institution between April 2010 and January 2023 were divided into testicular torsion (n = 17) and non-testicular torsion (n = 16) groups. The respective contrast-enhanced ultrasound findings were retrospectively examined and compared., Results: In 16 out of 17 cases of testicular torsion, the parenchyma of the affected testis was not enhanced. In the remaining case, reduced contrast enhancement was observed; however, it was still notably less than that observed on the unaffected testis. On the other hand, in all cases of non-testicular torsion (n = 16), the parenchyma of the affected testis was notably enhanced., Conclusion: Contrast-enhanced ultrasound is considered an easy and accurate method for diagnosing testicular torsion., (© 2023. The Author(s), under exclusive licence to The Japan Society of Ultrasonics in Medicine.)

Purpose: Torsion of the appendix testis or epididymis is a cause of acute scrotum in children. Ultrasonography with color Doppler is the first-choice modality for diagnosis. However, this method requires skill and experience to make a diagnosis with confidence. Recently, contrast-enhanced ultrasonography for diagnosis in various fields has been reported. However, to our knowledge, there has been no report of this method being used to diagnose torsion of the appendix testis or epididymis. The purpose of this study was to retrospectively examine contrast-enhanced ultrasonographic findings in torsion of the appendix testis or epididymis., Methods: Patients who underwent contrast-enhanced ultrasonography for torsion of the appendix testis or epididymis at our institution between April 2010 and April 2023 were enrolled in this study (n = 12). Contrast-enhanced ultrasonography findings of the affected appendage and the testis parenchyma were examined retrospectively., Results: The parenchyma of the testes was notably enhanced in all the cases. However, 9 of the 12 cases showed that the appendage with torsion was not enhanced at all. In the remaining three cases, only slight enhancement was seen. Nevertheless, it was notably less than that of the parenchyma of the testis., Conclusion: Our findings indicated that contrast-enhanced ultrasonography may be an easy and reliable method for diagnosing torsion of the appendix testis or epididymis., (© 2023. The Author(s), under exclusive licence to The Japan Society of Ultrasonics in Medicine.)

Objectives: Testicular torsion (TT) is a pediatric surgical emergency that requires prompt treatment. This study investigated the feasibility of point-of-care ultrasound (POCUS) for diagnosing TT in the pediatric emergency department (ED)., Methods: We retrospectively reviewed the medical records of patients, aged 18 years or younger, who visited a university-affiliated hospital pediatric ED with acute scrotal pain without trauma history and underwent diagnostic ultrasounds between January 2010 and October 2022., Results: This study included 731 patients (median age: 9 years), Of these, 315 (43%) were in the POCUS-performed group: 188 in the POCUS-only group, and 127 in the POCUS-and-RADUS group. The other 416 patients (56.9%) were in the RADUS-only group. In total, 45 patients (6.2%) were diagnosed with TT (19 in the POCUS-performed group and 26 in the RADUS-only group). The sensitivity, specificity, and positive and negative predictive values of POCUS for diagnosing TT were 94.7%, 92.9%, 46.2%, and 99.6%, respectively. The median time to perform POCUS was shorter than RADUS (23 versus 61 minutes, P < .001). The POCUS-performed group had a shorter ED length of stay than the RADUS-only group (93 versus 170 minutes, P < .001). Among the patients diagnosed with TT, performing POCUS first did not significantly delay the ED process, including time to operation (250 versus 205 minutes, P = .142)., Conclusions: For patients with acute scrotal pain, evaluation performed by pediatric emergency physicians using POCUS performs well in screening TT, and can decrease length of stay in the ED., (© 2023 American Institute of Ultrasound in Medicine.)

This article discusses the current clinical role and scope of functional radionuclide imaging using testicular perfusion scintigraphy with 99m Tc-pertechnetate in patients presenting with an acute hemiscrotum for an early and reliable diagnosis of testicular torsion. The technique of testicular perfusion scintigraphy is described, and the characteristic findings are detailed with examples. The imaging characteristics of the various phases of testicular torsion and its differentiation from epididymitis and/or epididymo-orchitis and the other related conditions presenting as an acute hemiscrotum are detailed. In some cases, further evaluation by SPECT imaging increases the clarity and accuracy of diagnosis and, on occasion, hybrid SPECT/CT in selected complicated cases improves the diagnostic yield of the perfusion scintigraphy. Ultrasonographic and color Doppler findings are described concurrently with the scintigraphic findings. The several case examples presented demonstrate the additional clinical benefit of complementing functional and structural imaging for improving the sensitivity, specificity and accuracy of testicular imaging in the diagnosis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background/aim: To investigate the effects of acetylsalicylic acid (ASA) and the use of ultrasound elastography on testicular torsion., Materials and Methods: Herein, 6 equal groups of rats were formed (n: 48): control group, sham group, torsion/detorsion (T/D)-1 h group, T/D-1 h + ASA group, T/D-8 h group, and T/D-8 h + ASA group. Testicular torsion was created by rotating the left testis 720° clockwise. At 30 min before torsion, 100 mg/kg of ASA was injected intraperitoneally. Elastography was performed at 8 and 24 h. After orchiectomy, specimens were collected for histopathological evaluation., Results: When comparing the left testicular volume (LV) parameters obtained from the elastography applied at 8 h, significant differences were observed between the following group pairs: the sham and T/D-8 h groups, T/D-1 h and T/D-8 h groups, and T/D-1 h + ASA and T/D-8 h groups (p = 0.004, p = 0.023, and p = 0.026, respectively). The mean LVS (velocity) (stiffness assessment) of the groups was similar at 8 h. When comparing the LV parameters at 24 h, significant differences were found between the T/D-1 h and T/D-8 h groups and between the T/D-8 h and T/D-8 h + ASA groups (p = 0.008 and p = 0.004, respectively). For the LVS mean values at 24 h, significant differences were found between the control and sham groups, sham and T/D-1 h groups, sham and T/D-8 h groups, and sham and T/D-8 h + ASA groups (p = 0.009, p = 0.021, p = 0.027, and p = 0.009, respectively).Histopathological evaluation showed a decrease in the morphological grades and an increase in the mean testicular injury scores in the T/D-1 h + ASA group compared to the T/D-1 h group. The T/D-8 h + ASA group had a higher morphological grade than the T/D-8 h group, whereas their mean testicular injury scores were similar., Conclusion: ASA treatment for testicular torsion was shown to be ineffective. Elastography can be a complementary method to Doppler ultrasonography in the diagnosis of testicular torsion and can guide surgeons in their approach to surgery., Competing Interests: Conflict of interest: The authors have no conflicts of interest to declare., (© TÜBİTAK.)

Abstract: Testicular torsion is a surgical emergency. It obstructs the blood supply to the testes, leading to testicular ischemia and necrosis. It presents with a sudden onset of severe unilateral testicular pain associated with nausea/vomiting, swollen scrotum, and high-riding testicles with an absent cremasteric reflex and negative Prehn sign. Prompt diagnosis of ischemic testicles using ultrasonography is challenging for emergency physicians. Color Doppler ultrasound may reveal a relative decrease or absence of blood flow in the affected testicle. The most specific ultrasonographic feature was the whirlpool sign of the spermatic cord. Manual detorsion should be performed as soon as possible before surgical intervention. However, manual detorsion may fail because of patient discomfort, incomplete torsion, and rotation of the testicle in a less common direction. We report a case demonstrating ultrasound-guided detorsion in a 14-year-old boy with right testicular torsion. The present case highlights the importance of incorporating ultrasound guidance into manual detorsion, which can improve the success rate of the procedure., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Acute scrotum is a common presentation in the pediatric population and can indicate serious conditions such as testicular torsion, in which quick diagnosis and treatment is crucial for increasing the chances of a favorable outcome. During the COVID-19 pandemic, even patients with serious conditions, had delayed presentations and in-hospital management, resulting in worse outcomes., Objective: The aim of the study was to evaluate the safety of ultrasound in diagnosing pediatric acute scrotum and to identify delays from onset of symptoms until surgical exploration. Additionally, we wanted to gauge the impact of COVID-19 pandemic on delay and outcome., Methods: Medical records of patients aged 1-16 years seen with acute scrotum at the authors' University Hospital from 2017 to 2020 were reviewed, and 438 patients in 467 individual visits were included. Information on demographics, symptoms, ultrasound results, outcome, and time courses were retrieved and analyzed with regards to outcome and the presence COVID-19., Results: We did not find the use of ultrasound to increase the risk of orchiectomy (OR 2.259 (0.387-13.195)), however patients undergoing ultrasound had a significantly longer pre-hospital ischemia time, and therefore an increased orchiectomy rate. Delay between referral and presentation was the greatest predictor of orchiectomy in testicular torsion (OR 1.031 (1.003-1.060)), while in-hospital delay did not increase the risk of orchiectomy (OR 0.998 (0.992-1.004)). Time courses and outcome did not significantly differ before- and during the COVID-19 pandemic., Discussion: The primary contributor to ischemic time in testicular torsion was pre-hospital delay, and neither in-hospital delay nor the delay incurred by use of ultrasound affected the outcome. This might be explained by timely in-hospital management and ultrasound only being used selectively in patients with a lower clinical suspicion of testicular torsion and in those with prolonged symptom duration. During the COVID-19 pandemic, pre- and in-hospital delay as well as outcome did not differ significantly from pre-pandemic measures, which indicates that parents felt safe approaching the healthcare system, and resources were sufficient to handle this patient group in spite of an ongoing pandemic. The current study is limited by its retrospective design, and relatively small group of testicular torsion patients., Conclusion: We found ultrasound to be safe in diagnosing pediatric acute scrotum. Furthermore, it can be inferred that measures aimed at reducing pre-hospital delay could potentially increase the salvage rate in testicular torsion. We did not find COVID-19 to affect either outcome or time to treatment in testicular torsion., Competing Interests: Conflict of interest None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

A survey of 200 emergency scrotal explorations done over four paediatric surgical centres in the UK revealed that the incidence of finding testicular torsion (TT) was 24% and the preoperative utilisation of Doppler ultrasound (DUS) was 10% [1]. We changed our practice to include better preoperative utilisation of a clinical risk score (TWIST) and DUS. This led to a significant increase in the incidence of finding TT from 18% to 53%. Obtaining a DUS did not lead to an increase in our orchidectomy rate. Adopting this change is possible in an NHS setting and it has significant clinical and economic benefits., (Copyright © 2023 Journal of Pediatric Urology Company. All rights reserved.)

Objectives: Acute testicular torsion is a surgical emergency that warrants prompt treatment. The diagnosis is typically confirmed by ultrasonography interpreted by a radiologist (RADUS); however, in this study, we describe the clinical course of 23 patients for whom point-of-care ultrasound (POCUS) was performed by pediatric emergency medicine physicians during the initial assessment for testicular torsion in the pediatric emergency department (PED)., Methods: A retrospective case series analysis of patients aged 0 to 18 years who were diagnosed with acute testicular torsion after undergoing scrotal POCUS through our PED., Results: Between June 2015 and December 2020, 155 boys received an International Classification of Diseases-9 code of Torsion of Testis after presenting to our PED. Seventy-three patients were imaged preoperatively, of which 50 (68.5%) were diagnosed via RADUS alone. Twenty-three patients (31.5%) underwent POCUS (median age 14.1 years [interquartile range {IQR}: 11.4-15.9 years]), of which 14 (60.9%) were imaged by POCUS alone, whereas the remaining 9 patients (39.1%) underwent POCUS before RADUS. Thirteen of the 23 patients (56.5%) who underwent POCUS had intraoperative findings consistent with acute testicular torsion, whereas another 3 patients (13.0%) required manual detorsion in the PED before orchiopexy. Six patients required orchiectomy. All patients for which POCUS findings were suggestive of acute testicular torsion were correctly classified.The median length of stay from time to admission to orchiopexy for those who received RADUS only versus POCUS only was 184 minutes (IQR: 136-255), and 121 minutes (IQR: 80-202), respectively ( P = 0.036). Among the patients who experienced POCUS, the median length of stay for those who underwent RADUS in addition to POCUS compared with those who underwent POCUS alone was 202 minutes (IQR: 136-338.4) ( P = 0.031)., Conclusions: Point-of-care ultrasound performed by pediatric emergency medicine physicians can be used to expedite surgical management and streamline the management of pediatric patients suspected of acute testicular torsion., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Emergency imaging of the scrotum is part of routine medical practice. Indications include epididymitis/epididymo-orchitis, testicular torsion, trauma, tumors and infarction. Prompt diagnosis and management are needed to ensure optimal patient outcome. Ultrasound (US) is the initial, and often the only, imaging modality for testicular pathologies. Usually, B-mode and color Doppler US are adequate. In challenging cases, contrast-enhanced US (CEUS) facilitates final diagnosis or increases the examiner's confidence by confirming findings on non-enhanced US. This paper elaborates on the examination technique of CEUS for testicular pathologies, thereby showing its added value over baseline US techniques in the emergency setting., (© 2023. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Competing Interests: Disclosure: The authors declare no conflict of interest.

Introduction: Doppler scrotal ultrasonography (US) is the modality of choice in diagnosing testicular torsion. We aimed to evaluate the performance of scrotal US in diagnosing testicular torsion over the past 18 years in our institution and determine the factors contributing to the length of wait times for it., Methods: A retrospective review was conducted of boys who presented with acute scrotal pain from 2014 to 2015. US reports, operative findings, final diagnosis and key time points of the patients' journey (time to emergency department consultation, time to admission, time to US and time to operating theatre [OT]) were collected. US performance results were compared with those observed in a historical cohort from 1998 to 2004. Wait times were compared between operated and non-operated patients., Results: Data from 519 boys with a mean age of 9.15 years was collected. Of these, 438 (84.4%) boys had undergone initial scrotal US; of these scrotal US cases, 28 were surgically explored, with 23 confirmed to have torsion. Another five cases were explored without prior US, and all were confirmed to have torsion. Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (P < 0.0001, r = 0.96) and time to OT (P < 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery., Conclusion: There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with acute scrotum should target time to US and time to OT., Competing Interests: None

Background: Previous studies have examined the utility of ultrasonography performed by radiologists for diagnosing paediatric testicular torsion. While point-of-care ultrasound (POCUS) is used in paediatric emergency medicine, its diagnostic accuracy is still unknown., Objectives: The present systematic review and meta-analysis aimed to clarify the accuracy of POCUS in diagnosing testicular torsion in children., Methods: Following the Preferred Reporting Items for Systematic Review and Meta-analysis of Diagnostic Test Accuracy guidelines, a systematic review was performed using the indices of MEDLINE, EMBASE plus EMBASE classics, PubMed and the Cochrane database from inception to November 2020. Any study investigating the diagnostic accuracy of POCUS for paediatric testicular torsion was extracted. The primary outcome was the assessment of the diagnostic accuracy of POCUS for paediatric testicular torsion. The pooled sensitivity and specificity were calculated. Quality analysis was conducted using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2)., Results: Four studies enrolling 784 patients in total were included. The pooled sensitivity, specificity, and positive and negative likelihood ratios of POCUS were 98.4% (95% CI: 88.5% to 99.8%), 97.2% (95% CI: 87.2% to 99.4%), 34.7 (95% CI: 7.4 to 164.4) and 0.017 (95% CI: 0.002 to 0.12), respectively. Risk-of-bias assessment using QUADAS-2 revealed that two of the studies had a high risk of bias in patient selection., Conclusion: The present systematic review and meta-analysis showed that POCUS had high sensitivity and specificity for identifying testicular torsion in paediatric patients although the risk of bias was high in the studies analysed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: We sought to determine which demographic, clinical and ultrasonography characteristics are predictive of testicular torsion (TT) and to determine factors associated with time to treatment., Methods: We retrospectively reviewed all medical records of patients (0-17 years) with acute scrotal syndrome (ASS) who were treated in our hospital in Lithuania between 2011 and 2020. We extracted patients' demographic data, in-hospital time intervals, clinical, US and surgical findings. TT was determined at surgery or clinically after manual detorsion. Test characteristics of demographic, clinical and US findings for the diagnosis of TT versus other causes of ASS were determined. We performed a multivariate analysis to identify independent clinical predictors of torsion, and factors associated with surgical delay., Results: A search of medical records yielded 555 cases: 196 (35%) patients with TT and 359 (65%) patients with other ASS causes. Multivariate logistic regression analysis showed that age between 13 and 17 years (OR 8.39; 95% CI 5.12 to 13.76), duration of symptoms <7 hours (OR 3.41; 95% CI 2.03 to 5.72), palpated hard testis (OR 4.65; 95% CI 2.02 to 10.67), scrotal swelling (OR 2.37; 95% CI 1.31 to 4.30), nausea/vomiting (OR 4.37; 95% CI 2.03 to 9.43), abdominal pain (OR 2.38; 95% CI 1.27 to 4.45) were independent clinical predictors of TT. No testicular blood flow in Doppler US had a specificity of 98.2% and a positive predictive value of 94.6%. However, 75 (41.7%) patients with TT had normal testicular blood flow, yielding low sensitivity (58.3%) and negative predictive value of 81.3% for this US finding. In-hospital waiting time for surgery was longer in patients with TT with normal testicular blood flow by USS (195 min) compared with no blood flow (123 min), p<0.01. Higher orchiectomy rates were associated with longer duration of symptoms (p<0.001) and longer waiting time for USS (p=0.029) but not with false-negative US., Conclusions: Pubertal age, symptoms duration of <7 hours, nausea/vomiting, palpated hard testis, abdominal pain and scrotal swelling are predictive factors for TT. Time lost between symptom onset and seeking medical care, and between arrival and US are associated with the need for orchiectomy. Preserved blood flow in USS does not rule out TT and may contribute to delays to surgery., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: There are two types of testicular torsion: complete and incomplete. The degree and duration of symptoms of this condition are critical for treatment decision-making, as the consequences for untimely diagnosis and management can be serious. The preoperative assessment of the degree of acute testicular torsion using ultrasonography is particularly important for determining the appropriate intervention. The purpose of this study was to compare the effectiveness of high-frequency versus contrast-enhanced ultrasonography in determining the degree of acute testicular torsion., Methods: Fifteen patients with clinically diagnosed acute testicular torsion underwent both high-frequency and contrast-enhanced ultrasonography. We compared the characteristics of the ultrasonographic images of the testicular parenchyma in both the afflicted and contralateral (healthy) testes to determine the reliability of contrast-enhanced ultrasonography in assessing the degree of acute testicular torsion., Results: The high-frequency ultrasound and contrast-enhanced ultrasound diagnosis of 4 complete testicular torsion and 11 incomplete testicular torsion were correct before operation. However, 5 patients with incomplete testicular torsion were misdiagnosed as complete testicular torsion because no blood flow was detected by high frequency ultrasound. Finally, low speed blood flow was detected by contrast-enhanced ultrasound and the diagnosis was corrected. The accuracy of diagnosing incomplete testicular torsion was 100% using contrast-enhanced ultrasonography and 66.7% using high-frequency ultrasonography; the difference between the two methods was statistically significant (χ 2  = 2.50, P ≤ 0.05)., Conclusion: Contrast-enhanced ultrasonography can diagnose testicular torsion with high accuracy and can detect low-velocity blood flow and show microcirculatory blood perfusion in the testicular parenchyma. This can avoid misdiagnosing incomplete testicular torsion as complete, thus averting unnecessary orchiectomy., (© 2022. The Author(s).)

The aim of this study was to assess the utility of shear wave elastography in the follow-up of testicular detorsion, evaluate long-term outcomes, and explore its relationship with parameters such as tissue stiffness values, pain duration, and torsion type. Elastography examinations were independently performed by two radiologists to evaluate patients who presented to our hospital for follow-up after being diagnosed with testicular torsion and age-matched controls. Inter-observer variability of the mean testicular tissue elasticity was excellent (Intraclass correlation coefficient: 0.939, p < 0.001). Median time between testicular detorsion and follow-up ultrasound examination was 18 months (range, 11-36 months). Torsion side, torsion degree, and pain duration were recorded, and testicular volumes were calculated. The study population comprised 24 patients (48 testes) with a mean age of 21.1 ± 7.8 years. The mean testicular volume was measured as 12.3 ± 5.4 ml for the testicular salvage group, 13.9 ± 3.8 ml for the contralateral testes, and 13.7 ± 2.7 ml for the control group (p = 0.553). The mean testicular speed mode values were higher in the testicular salvage group (1.34 ± 1.21 m/s) compared with the contralateral testes group (1.00 ± 0.08 m/s), and the control group (1.01 ± 0.06 m/s), however there was no statistically significant difference between the three groups (p = 0.861). While testicular atrophy was detected in three patients, an intraparenchymal wedge-shaped focal hypoechoic area developed after torsion in a further three patients. The elastography examination for focal hypoechoic areas revealed an increase or decrease in tissue stiffness compared to the normal parenchyma. The tissue stiffness values of the testicular salvage group were higher in complete torsion compared to incomplete torsion. The elastography method contributes to other imaging methods in distinguishing focal lesion areas that can be seen after testicular torsion from malignant conditions. Elastography presents as a feasible and practical complementary modality for the follow-up of testicular salvage after torsion., (© 2022 Wiley-VCH GmbH.)

Purpose: To retrospectively compare interpretations of Doppler ultrasound (US) in newborns with confirmed perinatal testicular torsion (PTT) by an experienced faculty (staff) pediatric radiologist (SPR), pediatric radiology fellow (PRF), pediatric urology fellow (PUF) and staff pediatric urologist (SPU)., Methods: US images of 27 consecutive males with PTT between May 2000 and July 2020 were retrieved. The testicles were classified as affected or non-affected by PTT. We performed a blinded comparison of interpretation by four assessors (SPR, PRF, PUF, SPU), with respect to the US features of PTT. Paired inter-rater agreement was calculated using Cohen's Kappa (κ) and overall agreement was assessed using Fleiss' kappa., Results: Overall comparison using Fleiss' kappa found fair agreement for most features except testicular echogenicity and echogenic foci at interface for which there was poor agreement. Paired comparisons revealed better agreement between the SPR and PRF compared to the remaining two pairs, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents., Conclusion: This study highlights the need for focused training program for pediatric urologists to attain similar agreement as the radiologists, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The aim of this study was to evaluate testicular perfusion and vascularization with intraoperative ICG/NIR imaging in a testicular ischemia-reperfusion model and to investigate the effects of ICG on testicular tissue., Materials and Methods: 24 male rats were divided into four groups. In the ICG group, only ICG was given and images of the testicles were recorded with NIR camera. In the torsion group, the testicles were left in torsion for 4 h. ICG/NIR images were obtained after torsion and detorsion. In the reperfusion group, ICG/NIR images of the testicles were obtained at the 4 th hour of reperfusion. After the procedures, testicles were collected and evaluated with histological, immunohistochemical examination and qRT-PCR., Results: There was no histologically negative effect of ICG on testicular tissue. There was no testicular perfusion in the torsion group, but perfusion started after detorsion. At the 4th hour of reperfusion, testicular perfusion continued. TNF-a, IL-6, MCP-1 and caspase-3 immunoreactivity were found to be at low levels in the control and ICG groups, while high in the torsion and reperfusion groups (p < 0.05). In qRT-PCR, TNF-a, IL-6, MCP-1 and caspase-3 expressions were lower in the control and ICG groups, but higher in the torsion and reperfusion groups., Conclusion: There was no histologically negative effect of ICG on testicles. The ICG/NIR imaging technique seems to be a feasible method in testicular torsion and may contribute to the surgeon in the intraoperative management of testicular torsion. In testicles that started to be perfused after detorsion, perfusion still continued at the 4th hour of reperfusion. Our next goal is to test whether testicles showing ICG fluorescence in during reperfusion maintain their viability for long term., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To compare the models developed with a classical statistics method and a machine learning model to predict the possibility of orchiectomy using preoperative parameters in patients who were admitted with testicular torsion., Materials and Methods: Patients who underwent scrotal exploration due to testicular torsion between the years 2000 and 2020 were retrospectively reviewed. Demographic data, features of admission time, and other preoperative clinical findings were recorded. Cox Regression Analysis as a classical statistics method and Random Forest as a Machine Learning algorithm was used to create a prediction model., Results: Among patients, 215 (71.6%) were performed orchidopexy and 85 (28.3%) were performed orchiectomy. The multivariate analysis revealed that monocyte count, symptom duration, and the number of previous Doppler ultrasonography were predictive of orchiectomy. Classical Cox regression analysis had an area under the curve (AUC) 0.937 with a sensitivity and specificity of 88 and 87%. The AUC for the Random Forest model was 0.95 with a sensitivity and specificity of 92 and 89%., Conclusion: The ML model outperformed the conventional statistical regression model in the prediction of orchiectomy. The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Acute scrotum from testicular and epididymal cyst is relatively uncommon, whereas torsion of a cystic paradidymis is exceedingly rare. In this paper, we present the case of a healthy 12-year-old male patient admitted in our emergency room for acute scrotum, in whom diagnosis of torsion of a cystic paradidymis was suggested at color-Doppler US. Surgical exploration after ultrasound examination revealed a cystic paradidymis (Giraldes' organ) (PC) torsion. Immunohistochemical investigations were also performed after cyst excision to confirm the diagnosis. In our experience this is a very rare condition and appears to be only the third case reported in literature and the only one with pre-operative ultrasound (US) images demonstrating the presence of the cyst and its twisted pedicle., (© 2021. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Aims: To develop a decision tree model using US features to differentiate testicular torsion and other conditions of acute scrotum and to investigate predictive parameters of unsalvageable testis in testicular torsion., Materials and Methods: Scrotal US was reviewed in patients aged <30 years who presented with acute scrotum from 2014 to 2020. US findings of whirlpool sign, testicular volume ratio, heterogeneous echotexture, testicular vascularity, epididymis enlargement and/or hyperemia, and avascular nodule were evaluated and compared. A decision tree model was created using the conditional inference tree analysis and the accuracy was calculated. Univariate logistic regression analysis was performed to find out the predictive US features of unsalvageable testes., Results: Total of 381 patients (13.2±7.2 years old; range, 1 day-30 years) were included. Thirty-four patients were diagnosed with testicular torsion, and the others with orchitis or epididymo-orchitis (n=59), epididymitis (n=264), and appendage torsion (n=24). In the conditional inference tree analysis, whirlpool sign, avascular nodule, and increased testicular vascularity were the most significant discriminators (p<0.001), and the whirlpool sign was the first discriminator. The overall accuracy of the conditional inference tree was 91.1% (95% confidence interval [CI], 87.8-93.7%). Heterogeneous echotexture (odds ratio [OR], 74.99; 95% CI, 2.75-2046.26; p=0.01) and symptom-to-operation time >24 h (OR, 49.28; 95% CI, 1.92-1262.03; p=0.02) were significant predictors of unsalvageable testis., Conclusions: Conditional inference tree analysis showed that the whirlpool sign of the spermatic cord, avascular nodule, and altered testicular vascularity were significant discriminators. Heterogeneous echotexture and symptom-to-operation delay were important prognostic factors for unsalvageable testis.

Aim: The aim of this study is to evaluate sonographic testicular volume of patients who underwent surgical detorsion due to testicular torsion and to reveal the frequency of long-term testicular volume loss and the factors affecting it., Method: The files of patients who underwent surgical detorsion due to unilateral testicular torsion in our hospital between 2011 and 2019 were reviewed retrospectively. Age at the time of detorsion surgery, time from the onset of pain to surgery, degree of torsion, and ultrasonographic testicular volumes before detorsion were noted. Afterward, patients with at least 6 months of follow-up were contacted by phone and testicular volumes were measured by scrotal ultrasonography (US). The sonographic formula Length × Width × Height × 0.72 was used to determine testicular volumes., Results: There were 97 patients who underwent surgical detorsion within the given time frame. However, 43 of these patients accepted to be involved in the study and a follow-up scrotal US was performed. The mean age at the time of detorsion was 13.6 ± 5.6 years, whereas it was 16.7 ± 6.2 years at the time of the follow-up visit. The median time from the onset of pain to surgery was 4 h (range 1-36 h). In the preoperative US, the mean volume of the affected testis was 10.8 ± 5.6 mm 3 , while the mean contralateral testis volume was 10.2 ± 5.4 mm 3 (p = 0.134). The median follow-up time in our study was 24 months (range 6-96 months). In the control US, the mean volume of the affected testis was 9.5 ± 7.1 mm 3 , while the mean volume of the contralateral testis was 14.4 ± 9 mm 3 (p = 0.001). The affected testicular volumes decreased in 23 patients (range 1.1-100%), there was no change in testicular volumes in two patients, and there was an increase in testicular volumes in 18 patients (range 3.8-100%). In the ROC analysis, risk of testicular volume loss can be predicted with 87.5% sensitivity and 83.9% specificity when the time from the onset of pain to surgery exceeds 5.5 h (AUC = 0.904)., Conclusion: Our results indicated that if the time from the onset of pain to surgery exceeds 5.5 h, the testicular volume loss may be expected in the long term. Thus, patients and parents should be informed accordingly., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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.

Introduction: Preoperative test that can predict the salvageability of the torsed testis may add essential information to the surgeon managing testicular torsion (TT), this can assist with patients' and parents' expectations, particularly with nonviable testes. We aimed to examine if parenchymal echotexture changes in preoperative ultrasound can predict irreversible hemorrhagic necrosis., Materials and Methods: Preoperative ultrasound studies of 154 patients with TT were reviewed by 3 raters (2 radiologists and 1 urologist). The raters were asked to categorize the affected testicular parenchymal echotexture into one of the following categories: (1) normal (identical to the contra-lateral testis), (2) homogenous hypoechoic, or (3) focal heterogeneous echotexture. Testis non-viability was defined macroscopically during surgical exploration and correlated with the US results. Sensitivity, specificity, and positive and negative predicting values of the proposed diagnostic test were calculated. Cohen's kappa coefficient was used to determine inter-rater agreement., Results: A total of 54/154 patients had a nonviable testis. Mean of 59.5% cases was classified as category 1, 27.3% cases as category 2, and 13.2% cases as category 3. Testicular necrosis was 12%, 34%, and 92% in each category, respectively. Category 3 classified non-viability with a mean specificity of 99.3% and with a high inter-rater agreement level (Cohen's kappa coefficient of 0.830). Mean positive predictive value of 97% and mean negative predictive value of 74.3%. The mean sensitivity of this test however was low 39.7%., Conclusion: Ultrasound finding of focal parenchymal echotexture heterogeneous changes is highly specific although not sensitive, for nonviable testis. The presence of this finding reassures non-viability in over 99%., (© 2022. American Society of Emergency Radiology.)

Background: Ultrasonography is an effective diagnostic tool for testicular torsion (TT), which is typically characterized by the absence of blood flow in the affected testicle on color Doppler mode. However, there are a few reported cases of TT with symmetrical preserved flow. We report a case of TT with the preserved intratesticular flow on color Doppler ultrasound., Case Report: A 14-year-old boy was admitted due to sudden-onset right scrotal pain. Point-of-care ultrasound (POCUS) revealed that the right testicle was larger than the left. The intratesticular flow in both testicles was preserved. Radiology-performed ultrasound confirmed the preserved intratesticular flow observed on POCUS, but also demonstrated a whirlpool sign of the right spermatic cord. TT was confirmed surgically. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should investigate the presence of intratesticular blood flow and the whirlpool sign of the spermatic cord or other ultrasound features suggestive of TT, even if testicular blood flow is preserved. Suspicion of TT from POCUS findings warrants further evaluation to preserve the patient's fertility., (Copyright © 2021. Published by Elsevier Inc.)

Aim: Torsion of the testicular appendages represents the most common cause of an acute scrotum in prepubertal boys. Its sonographic appearances on gray-scale US and color Doppler US have already been presented in several studies. The aim of this analysis was to expand those already established techniques with strain elastography and thus present typical features of this entity on multiparametric US., Material and Methods: Retrospective analysis of all patients presented to the urological department with an acute scrotum between January 2018 and July 2020 identified eleven patients 6-17 years old (mean, 11.1 years), discharged with the diagnosis torsion of the testicular appendages that were examined with a high-end ultrasound device. Results: On gray-scale US all patients showed a round lesion with heterogenous echotexture adjacent to the upper pole of the testis/epididymis with a diameter of 4 to 11.1 mm (mean, 7.7 mm). Scrotal skin thickening and a concomitant hydrocele were found in 9 (81.8%) and 7 (63.6%) cases, respectively. On color Doppler images, all torsed appendages were avascular and in 9 (81.8%) patients we observed hyperemia of the adjacent epididymis. Strain elastography showed increased tissue stiffness in all documented images., Conclusion: Torsion of the testicular appendages has a set of features on multiparametric US. Awareness of this features can facilitate diagnosis of torsion of the testicular appendages and reduce unnecessary surgicalscrotal exploration or unwarranted antibiotic treatment.

Ultrasonography (US) is the primary imaging modality for the evaluation of pediatric scrotal disease. The ability to obtain exceptional anatomical detail and testicular perfusion information without ionizing radiation makes it the essential tool for evaluating scrotal pain and palpable masses. Challenges arise in both the performance and interpretation of scrotal US in the child. Optimizing imaging parameters and recognizing key differentiating US features help minimize misinterpretations that can lead to poor patient outcomes. Key pearls and pitfalls in pediatric scrotal ultrasound methods and diagnoses are reviewed. Knowledge of what is normal for the various ages of childhood from neonate through adolescence is necessary for accurate US analysis. Imaging evaluation of key causes of the acute painful scrotum including testicular appendage torsion, epididymitis, and testicular torsion are discussed. Sonographic features for the diagnosis of benign and malignant scrotal masses, microlithiasis, and cryptorchidism are reviewed., (Copyright © 2021. Published by Elsevier Inc.)

Color flow and spectral Doppler ultrasound are the backbone of scrotal imaging when evaluating acute scrotal pain. Testicular Torsion is one of the most common causes of acute scrotal pain but can be a challenging diagnosis both clinically and sonographically. This article will review the pertinent Doppler ultrasound findings that can help make the diagnosis of both complete and partial torsion. A review of other causes of testicular ischemia will also be included as these pathologies can mimic Testicular Torsion., (© 2021 American Institute of Ultrasound in Medicine.)

Objectives: To develop a prediction tool based on physical findings and environmental conditions without utilizing color Doppler ultrasonography to guide non-urologists and patients' families in determining the testicular torsion possibility among patients with acute scrotal pain., Methods: Overall, 110 consecutive patients aged ≤30 years with acute scrotal pain at Saitama Medical Center between 2012 and 2014 were retrospectively evaluated. Physical examination results, including scrotal inspection, palpation and gait observation, and environmental conditions at pain onset (time range and ambient temperature) were collected. Multivariate analysis identified significant and independent risk factors for testicular torsion, and a nomogram predicting testicular torsion was constructed. The model underwent prospective validation in an independent set of 123 consecutive patients admitted with acute scrotal pain to our institution between 2015 and 2017., Results: Testicular torsion diagnosis rates were 27% (30/110) and 26% (32/123) in the training and validation cohorts, respectively. Logistic regression analysis showed four risk factors for developing testicular torsion: abnormal testicular position, walking difficulty, midnight to early morning onset and ambient temperature <15°C at pain onset. The constructed nomogram showed that the areas under the receiver operating characteristic curves were 0.92 and 0.84 for the training and validation cohorts, respectively. The calibration plot showed an acceptable fitness between the predicted probability and the observed rate of testicular torsion., Conclusions: A novel nomogram was developed solely based on physical findings and environmental conditions to predict testicular torsion in Japanese patients with acute scrotal pain., (© 2021 The Japanese Urological Association.)

Introduction: The study aimed to analyze testicular torsion (TT) claims settled with compensation to have data available as the basis for making recommendations to decrease clinical risk and prevent claims. TT is a urological emergency with a high rate of orchiectomy, representing one of the main reasons for urological claims., Methods: Data were analyzed from personal majority policy and from the public sector of Catalonia (Spain), as well as data from the main medical civil liability insurance firm at healthcare centers in France in the period from January 1, 2000 to December 31, 2018., Results: Fifty Spanish and 51 French cases were analyzed. Statistical differences were logged in the two settings analyzed in performing ultrasounds, in the area where primary care was provided and with regard to settlement amounts. Diagnosis was late in 76.2% of cases., Discussion: The medical action time from the onset of symptoms and Doppler testicular ultrasound in cases of questionable differential diagnoses is key to prognoses to save the testicles. Properly filling out the emergency report and the rest of medical records are essential for receiving correct medical care and defending possible claims., (© 2022 S. Karger AG, Basel.)

Background: Use of Doppler ultrasonography (DUS) for patients with suspected testicular torsion (TT) is highly controversial and remains debated, as it can delay surgery and its performance may vary., Objective: To assess the role, impact, safety, and performance of DUS in the management of patients with suspected TT before scrotal exploration., Design, Setting, and Participants: The TORSAFUF cohort retrospectively included patients older than 12 yr who underwent surgery for suspected TT in 14 academic hospitals between 2005 and 2019. Perioperative data and surgical and DUS reports were collected., Outcome Measurements and Statistical Analysis: Clinical factors influencing DUS utilisation were analysed using multivariate logistic regression. The orchidectomy rate and delay to surgery were compared by group with and without DUS receipt using one-to-one propensity score (PS) matching to assess imaging safety. For the group with preoperative imaging, DUS performance was evaluated using a contingency table., Results and Limitations: Overall, 2922 patients were included, of whom 956 (32.7%) underwent DUS before surgery. DUS was more likely to be performed in older patients (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.1-1.2), those who experienced progressive onset of pain (OR 1.5, 95% CI 1.1-2), and patients who presented at the emergency department more than 6 h after their first scrotal symptoms (OR 2.3, 95% CI 1.9-2.8). After PS matching, DUS receipt was not significantly associated with orchidectomy but the delay to surgery was 1 h longer. DUS demonstrated strong sensitivity of 85.2% (95% CI 82.1-88.3%) and specificity of 52.7% (95% CI 48.8-56.6%). The performance was better for younger patients and for those with time since onset of pain of >6 h., Conclusions: In this large retrospective study, DUS before surgery was safe, feasible, and useful in selected cases with suspected TT, but it should not delay or replace surgery in cases with a strong clinical suspicion., Patient Summary: We analysed the performance and safety of an ultrasound scan of the scrotum before surgery for patients with a suspected twisted testicle (TT). This scan before surgery was not associated with a higher risk of negative outcomes but was only moderate in accurately diagnosing TT. Surgery to correct TT should not be delayed., (Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Doppler ultrasound can diagnose testicular torsion with high sensitivity and specificity but may delay surgical treatment. This study aims to assess whether the use of doppler ultrasound, in cases with intermediate clinical suspicion of testicular torsion, can improve diagnostic accuracy compared to clinical assessment alone., Methods: We implemented a new clinical algorithm where patients with intermediate suspicion of testicular torsion undergo doppler ultrasound within 60 min. This study compared the patients that presented within one year prior to the implementation (group 1) to the patients who presented within one year after the implementation (group 2). The primary outcome measure was failure to confirm testicular torsion upon surgical exploration (negative surgical exploration). Missed testicular torsion was one of the secondary endpoints., Results: 590 consecutive patients were included. 322 (55%) in group 1 and 268 (45%) in group 2. There were 9 (2.8%) testicular torsions in group 1 vs 9 (3.4%) in group 2 ( p  = 0.69) and 2 (0.6%) missed testicular torsions in group 1 vs 0 in group 2 ( p  = 0.50). Doppler ultrasound was performed in 65 patients (24.2%) in group 2 vs 0 in group 1 ( p  < 0.01). Negative surgical exploration was performed in 27 (8.4%) patients in group 1 vs 8 (3.0%) in group 2 ( p  < 0.01)., Conclusion: Doppler ultrasound assessment of patients at intermediate clinical risk of testicular torsion significantly reduced the frequency of negative surgical explorations without increased rate of missed testicular torsions.

Introduction and Aim: Speedy diagnosis are mandatory in testicular torsion, nevertheless some cases of irreversible ischemia still occur. In this study we analysed the results of patients undergoing surgical exploration for acute scrotum., Materials and Methods: A multicentric retrospective clinical evaluation was carried out on patients who underwent urgent scrotal exploration at 12 different departments in North-Eastern Italy. Data included complete anagraphic information, clinical presentation, numeric pain rating scale, previous testicular surgery, Doppler serial ultrasonography (US) evaluation and concordance with surgical findings, testicular mobility, surgical treatment, staged or concurrent treatment of the contralateral gonad. Statistical analysis was conducted both for descriptive and inferential statistics with SPSS v26., Results: Three hundred and sixty-eight cases were collected between January 2010 and June 2019. The time between symptom onset and ER access time was within 6 h in majority of patients. However, 17.4% of subject presented after more than 12 h. In patients undergoing US, this showed signs of ischemia in 237 patients (77.2%) and normal vascularisation in 70 (22.8%) of whom 26 had signs of testicular torsion at surgical exploration. Overall, the US data were concordant with the surgical findings in 254 cases (82.7%). A significant association was found between time-to-evaluation and time-to-treatment and the need for orchiectomy ( p  < 0.01)., Conclusion: Testicular torsion management is still challenging in terms of time-saving decision making. Scrotal US is helpful, but even in the contemporary its sensitivity is low era in a non-neglectable number of cases, therefore surgical exploration is warranted in acute scrotum when torsion cannot be ruled out, even when US shows vascularisation.

Purpose: Manual detorsion can be performed for testicular torsion before scrotal exploration. Using sonographic findings, this study investigated the need for additional treatments after manual detorsion for testicular torsion., Methods: This study evaluated 13 retrospective cases of testicular torsion subjected to manual detorsion. Manual detorsion was classified as failure or success based on residual spermatic cord twist. The following sonographic findings of the affected testis were compared using the Fisher exact test: whirlpool sign, horizontal or altered lie, and hypoperfusion., Results: Manual detorsion failed in five patients. There was a significant difference in the incidence of the whirlpool sign between the two groups (present/absent sign in the failure vs. success groups: 4/1 vs. 0/8, p = 0.007). Horizontal or altered lie and hypoperfusion in the affected testis were not significantly different between groups (5/0 vs. 3/4, p = 0.07, one case excluded, and 5/0 vs. 4/4, p = 0.10, respectively)., Conclusions: Ultrasound findings after manual detorsion, particularly, the whirlpool sign, were useful for planning subsequent treatment such as additional manual detorsion or surgical intervention. The testicular axis and the perfusion of the twisted testis may not recover to normal after successful manual detorsion, but if they recover, this procedure could be judged a success., (© 2021 Wiley Periodicals LLC.)

Aim: Testicular torsion is a surgical emergency and delayed operative management can negatively impact fertility. The aims of this study were to establish patterns of ultrasound use, correlate ultrasound and intraoperative findings and determine the impact of ultrasound on admission-to-operation time in patients undergoing scrotal exploration for suspected torsion., Method: All adult patients who underwent acute scrotal exploration for suspected torsion between 2007 and 2017 at Auckland City Hospital were included (n=316). Clinical notes were reviewed for demographic and clinical data. Admission-to-operation time was compared between patients who had a formal ultrasound and those who did not., Results: Ultrasound was performed in 153/316 (48.4%) patients. Ultrasound sensitivity and specificity for torsion was 97.8% and 52.9% respectively. Median admission-to-operation time was 106 minutes for patients who did not have an ultrasound and 225 minutes for those who did (excluding those with missed torsion on ultrasound) (p=<0.0001). Non-viable testicle was identified intraoperatively in 11/163 patients (6.7%) who did not have an ultrasound, and in 42/122 (34.4%) of those who did (excluding those with missed torsion on ultrasound) (p=<0.0001)., Conclusion: Ultrasound is a sensitive test for testicular torsion but associated with an average two-hour delay to theatre and a higher rate of intraoperative finding of non-viable testicle in this centre., Competing Interests: Nil.