The impact of ultrasound on testicular loss in cases of testicular torsion in children
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In brief
In brief
This retrospective study of 1566 pediatric patients evaluates whether scrotal ultrasound delays treatment in suspected testicular torsion. Ultrasound demonstrated 95% sensitivity/specificity and did not increase orchiectomy rates compared to direct surgical exploration, supporting its use as a reliable diagnostic tool without compromising outcomes.
- Scrotal ultrasound showed 95.4% sensitivity and 95.6% specificity for diagnosing testicular torsion in pediatric patients aged 0-15 years.
- Pre-operative ultrasound added mean 55-minute diagnostic delay but did not increase time to surgery (169 vs 171 min) or orchiectomy rate (23% vs 42%).
- Ultrasound misdiagnosed 4 of 87 torsion cases, but overall reduced testicular loss rate compared to clinical diagnosis alone in this cohort.
- In high-volume pediatric centers, ultrasound can safely triage suspected torsion without compromising surgical outcomes or increasing organ loss.
Written by the GCMD Library team from the article.
Abstract
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.