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. |
