GRAY-SCALE, COLOR AND POWER DOPPLER SONOGRAPHIC PREDICTORS OF TESTICULAR VIABILITY IN TESTICULAR TORSION
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Background: Testicular torsion is a true urologic emergency. Color Doppler ultrasonography (CDUS) has become the procedure of choice for evaluation. The testicular salvage rate depends on the duration of ischemia and the degree of torsion. Study objective: To determine whether torsed testis viability can be evaluated by ultrasonography (US) including color and power Doppler studies. Patients and Methods: The study comprised 23 patients (age range 10-39; mean age 14 years) with surgically proved testicular torsion; all underwent scrotal US with color and power Doppler study before surgery. One of these patients showed bilateral testicular involvement with 3 days between the two conditions. Therefore, the total no. of cases= 24. The preoperative sonograms were reviewed to determine testicular size, echogenicity and homogeneity, and vascularity, scrotal skin thickness, testicular focal lesions, and the presence or absence of twist of the spermatic cord (torsion knot) and reactive hydrocele. These findings were correlated with the viability of the testis at surgery. Results: At surgery, 11 cases (45.8%) with testicular torsion had viable testes and the remaining 13 cases (54.2%) had nonviable testes. All 4 cases with average-sized testes on US had viable testes and all 8 cases with small sized-testes had non-viable testes. Testicular viability was found in 63.6% in cases with largesized testes versus 38.5% in cases with nonviable testes (P <0.05). All 5 cases with normal homogeneous testicular echogenicity had viable testes but all 10 cases with heterogenous testicular echogenicity had non-viable testes. Hypoechoic testicular echogenicity was seen in 54.5% of cases with viable testes vs 23% of those with nonviable testes (P< 0.003). All cases with non-viable testes showed twist of the spermatic cord on US (torsion knot) vs 54.5% of cases with viable testes (P < 0.001). All 8 cases with decreased intratesticular flow on US had viable testes at surgery and all 3 cases with peripheral intra-testicular perfusion had nonviable testes. Absent intratesticular blood flow on US was detected in 77% of cases with nonviable testes vs 27.2% in viable testes (P < 0.001). Thus, there was statistically significant difference in testicular viability with respect to the size and echogenicity of the torsed testis, the presence of twist of the spermatic cord (torsion knot) and pattern of intratesticular blood flow. The other parameters showed no statistically significant difference. Conclusion: Preoperative US particularly with power Doppler examination can predict testicular viability in testicular torsion. The best US predictors are testicular echogenicity, intratesticular blood flow and twist of spermatic cord. In the setting of testicular torsion, normal or homogenously hypoechoic testicular echogenicity, decreased intratesticular blood flow and absence of twist of the spermatic cord on US are strong predictors of viability. Immediate surgical detorsion in these patients carries a very high likelihood of salvaging the affected testis. Key words: Testicular torsion, US, CDUS, power Doppler US, viable testis, nonviable testis.