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 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 ultrasonography (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. 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. 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 large-sized testes versus 38.5% in cases with nonviable testes (P >0.05). All 5 cases
with isoechoic 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). 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. |
