Materiały źródłowe

• #1 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. […] Testicular torsion is a clinical diagnosis, and patients typically present with severe acute unilateral scrotal pain, nausea, and vomiting. […] If history and physical examination suggest torsion, immediate surgical exploration is indicated and should not be postponed to perform imaging studies. […] Scrotal Doppler ultrasonography is the imaging study of choice to aid in the diagnosis of testicular torsion; however, prompt referral should not be delayed to perform this study. […] Immediate surgery should be performed if testicular torsion is suspected, and should not be delayed by imaging studies if physical examination findings are strongly suggestive.

• #1 Testicular Torsion – Diagnosis and Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/testicular-torsion-diagnosis-and-treatment/

  Testicular torsion occurs when the spermatic cord, which provides blood flow to the testicle, becomes twisted and leading to potential ischemia and venous obstruction. […] Considered a surgical urologic emergency and requires prompt treatment to prevent permanent damage to the testicle, and after eight hours of ischemia it is believed the testis can suffer irreversible damage including infertility in the future, even with one normal testis. […] Common signs and symptoms: Severe pain in the scrotum or testicle. Swelling or redness in the scrotum. A feeling of heaviness or aching in the scrotum. Nausea and vomiting. Lower abdominal pain. […] Ultrasound: Usually history and physical examination is sufficient to make the diagnosis, however if uncertain can urgently obtain doppler ultrasonography to examine the testis up to the spermatic cord at the level of the internal ring. Will show absent or decreased blood flow. If still uncertain after ultrasonography but the diagnosis is strongly suspected, urologic referral and surgical exploration is recommended. […] Urgent surgical intervention to detorse and fixate the testis is warranted in any case of testicular torsion, so urological referral should be made for any suspected case.

• #1 Clinical Diagnosis of Testicular Torsion | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/pocg-testicular-torsion.html

  How accurate are history and physical examination in diagnosing testicular torsion? […] Therefore, prompt and accurate diagnosis is important when patients present with acute scrotal or testicular pain. […] Individual clinical findings that best predict testicular torsion include nausea and vomiting, past trauma, a tender testicle, an abnormal testicular lie (i.e., elevated or transverse), and an absent cremasteric reflex. […] A systematic review and meta-analysis identified 13 studies that evaluated the accuracy of the TWIST score. […] Pooled data from the five prospective studies in children and adolescents showed that the TWIST score is accurate. […] The score performed well: zero of 23 in the low-risk group (0 to 2 points) had testicular torsion compared with seven of 15 in the moderate-risk group (3 to 4 points) and 27 of 30 in the high-risk group (5 to 7 points). […] He has a TWIST score of 4 points and is at moderate risk for testicular torsion, with a 22% probability.

• #1 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  In patients with a history and physical examination suggestive of torsion, imaging studies should not be performed; rather, these individuals should undergo immediate surgical exploration. […] The most commonly used imaging modality is Doppler ultrasonography, which is a highly sensitive (88.9%) and specific (98.8%) preoperative diagnostic tool with a 1% false-negative rate. […] If blood flow is absent on Doppler imaging and consistent with torsion, immediate surgical exploration is indicated. […] Prompt restoration of blood flow to the ischemic testicle is critical in cases of testicular torsion, and prompt referral to a urologist is recommended. […] Reported testicular salvage rates are 90% to 100% if surgical exploration is performed within six hours of symptom onset, decrease to 50% if symptoms are present for more than 12 hours, and are typically less than 10% if symptom duration is 24 hours or more.

• #1 Testicular Torsion Imaging: Practice Essentials, Magnetic Resonance Imaging, Ultrasonography

  https://emedicine.medscape.com/article/381204-overview

  Testicular torsion, also termed torsion of the spermatic cord, is a relatively common and potentially devastating acute condition resulting from obstruction of the arterial blood supply to the testis. […] Accurate diagnosis is imperative because testicular torsion is treated surgically, whereas epididymitis with or without orchitis is treated medically. The optimal timeframe for diagnosis of torsion for salvage of the affected testicle is within 6 hours of the onset of symptoms. […] Diagnostic imaging, particularly Doppler ultrasonography, plays an important role in the assessment of patients with acute scrotal pain. […] Ultrasonography with color and power Doppler imaging has emerged as the primary imaging modality for the diagnosis of testicular torsion. […] In a systematic review and meta-analysis of 26 studies with 2116 patients, ultrasound examination for testicular torsion in adult patients with acute scrotal pain had an overall diagnostic sensitivity of 0.86 and specificity of 0.95.

• #1

  https://link.springer.com/article/10.1007/s00247-018-4093-0

  Testicular sonography has contributed greatly to the preoperative diagnosis of testicular torsion in the pediatric patient and is the mainstay for evaluation of acute scrotal pain. […] Despite its high sensitivity and specificity, both false-negative and false-positive findings occur. […] Our goal is to illustrate key sonographic features in the spectrum of testicular torsion with preserved testicular flow, and to describe how to differentiate testicular torsion from epididymitis in order to avoid the under-diagnosis of testicular torsion. […] Recent investigators have emphasized the concept of intermittent and partial testicular torsion, which can be difficult to diagnose with sonography because these cases have either subtle decreased flow or flow that appears to be symmetrical with the contralateral testis, and symptoms can wax and wane.

• #1 Testicular Torsion Imaging: Practice Essentials, Magnetic Resonance Imaging, Ultrasonography

  https://emedicine.medscape.com/article/381204-overview

  Scintigraphy has a sensitivity of 90% and a specificity of 60% in the diagnosis of testicular torsion. Color Doppler ultrasonography has distinct advantages in diagnosing nonvascular causes of acute scrotum. […] Information about the role of MRI in the diagnosis of torsion is limited, although MRI is likely to be highly sensitive. […] Some studies suggest a high degree of accuracy with MRI, particularly when it is performed with contrast enhancement. […] If the torsion knot or whirlpool patterns are recognized in conjunction with testicular enlargement and absent vascularity, the diagnosis is virtually certain.

• #1 Testicular Torsion Workup: Approach Considerations, Urinalysis, Blood Studies

  https://emedicine.medscape.com/article/2036003-workup

  The sensitivity of color Doppler examination with newer ultrasonography equipment in detecting acute testicular torsion in children is 90-100%, with the specificity of technically adequate studies being essentially 100%. […] The detection of a color or power Doppler signal in a patient presenting with the clinical findings suggestive of testicular torsion does not absolutely exclude torsion. Clinical correlation should be incorporated in the evaluation of acute scrotum because color Doppler ultrasonography is not 100% sensitive. […] Small studies to date suggest that magnetic resonance imaging (MRI), particularly when performed with contrast enhancement, is highly accurate in the diagnosis of testicular torsion, particularly when torsion knot or whirlpool patterns are evident. […] If the diagnosis is equivocal, radionuclide scan of the testicles can be helpful to assess blood flow and to differentiate torsion from other conditions. […] Near-infrared spectroscopy (NIRS) is an emerging tool to assess testicular torsion. It can measure oxygen saturation 3-4 cm deep in the skin, is rapid (taking 20 seconds), and is noninvasive.

• #1 Testicular Torsion – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448199/

  Scrotal complaints are relatively common both in primary care and in the emergency department and comprise at least 0.5 percent of all emergency department visits. Testicular torsion is a true urologic emergency, and early identification is critical to prevent the need for testicular amputation. Ultrasound is the ideal imaging modality to evaluate the scrotal contents. […] Testicular torsion is a time-dependent diagnosis, a true urologic emergency, and early evaluation can assist in urologic intervention to prevent testicular loss. Ultrasound is the ideal imaging modality to evaluate the scrotal contents. […] Testicular viability significantly decreases 6 hours after the onset of symptoms; hence, early diagnosis is key. […] The TWIST scoring system is often used to determine the presence of testicular torsion. It has been validated in several studies in ruling out torsion.

• #1 Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion – Howe – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/16891/html

  Fifteen h of symptoms and 860 degrees of torsion gives testes a 50% salvage rate. […] Interestingly, we also found that about 1 out of every 4 testes undergoes atrophy after orchiopexy. […] It is well documented that there is a 4 to 8 h window of time from the onset of symptoms to surgery that is needed in order to save a torsed testicle. […] Ramachandra et al. demonstrated through multivariate analysis of the factors associated with testicular salvage, that duration of symptoms of less than 6 h was a significant predictor of testicular salvage. […] They concluded that time to presentation is in fact the most important factor in determining salvageability of the testicle in testicular torsion. […] If surgical exploration is delayed, testicular atrophy will occur by 6 to 8 h, with necrosis ensuing within 8 to 10 h of initial presentation.

• #1 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Manual detorsion should be attempted if surgery is not an immediate option or while preparations for surgical exploration are being made, but should not supersede or delay surgical intervention. […] The testes are typically detorsed from the medial to lateral side, turning the physician’s hands as if opening a book. […] Orchiectomy is performed if the affected testicle appears grossly necrotic or nonviable. […] The rate of testicular loss can approach 100% in cases where the diagnosis is missed, emphasizing the necessity of maintaining a high index of suspicion for torsion in males presenting with scrotal pain.

• #1 Testicular torsion – Wikipedia

  https://en.wikipedia.org/wiki/Testicular_torsion

  The diagnosis should generally be made based on the presenting symptoms. […] An ultrasound can be useful when the diagnosis is unclear. […] However, imaging should not delay surgical intervention as complications develop with prolonged ischemia. […] Immediate surgery is recommended regardless of imaging findings if there is a high degree of suspicion based on history and physical examination. […] Quick recognition of worrisome symptoms is essential to preventing delayed presentation and subsequently losing a testicle. […] Given the treatment implications of testicular torsion, it is important to distinguish testicular torsion from other causes of testicular pain, such as epididymitis, which can present similarly. […] The absence of the cremasteric reflex in an acutely painful testicle is most indicative of testicular torsion.

• #1

  https://link.springer.com/article/10.1007/s00247-018-4093-0

  Swollen epididymis and testis with testicular flow that is only minimally decreased, normal, or increased in boys with incomplete or intermittent testicular torsion can mimic epididymo-orchitis. […] The presence of intratesticular flow does not exclude testicular torsion. […] An integral part of the exam is to look for an abrupt change in configuration of cord at the external inguinal ring or in the scrotal sac. […] An enlarged epididymal-cord complex representing the torsion knot/pseudomass is more frequently identified at the sonographic examination compared to the more classic whirlpool sign of twisted spermatic cord. […] A group discussion among the radiologist, emergency room physician and urologist is recommended for proper management; manual detorsion of the testis might be considered to improve chances of salvage while the patient awaits surgery.

• #1

  https://journals.lww.com/njcp/fulltext/2021/24050/testicular_torsion__losses_from_missed_diagnosis.23.aspx

  Testicular torsion leads to loss of blood supply to the testes due to the twisting of the spermatic cord and its contents, necessitating urgent surgical intervention to salvage the affected testis. […] Testicular loss from missed diagnosis and delayed referral is preventable, especially when patients present early to first contact health care workers. […] This makes having the correct diagnostic knowledge for testicular torsion by these first contact healthcare providers a very essential determinant of its overall outcome. […] Early diagnosis and treatment are necessary to prevent testicular loss, and torsion must be excluded in patients with acute scrotum. […] A good diagnostic knowledge of testicular torsion by the first contact healthcare provider is a very important factor in determining the outcomes of testicular torsion.

• #2 Testicular Torsion – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448199/

  Scrotal complaints are relatively common both in primary care and in the emergency department and comprise at least 0.5 percent of all emergency department visits. Testicular torsion is a true urologic emergency, and early identification is critical to prevent the need for testicular amputation. Ultrasound is the ideal imaging modality to evaluate the scrotal contents. […] Testicular torsion is a time-dependent diagnosis, a true urologic emergency, and early evaluation can assist in urologic intervention to prevent testicular loss. Ultrasound is the ideal imaging modality to evaluate the scrotal contents. […] Testicular viability significantly decreases 6 hours after the onset of symptoms; hence, early diagnosis is key. […] The TWIST scoring system is often used to determine the presence of testicular torsion. It has been validated in several studies in ruling out torsion.

• #2 Testicular torsion; clinical diagnosis or imaging diagnosis?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9160395/

  Testicular torsion is the most common urosurgical emergency in infants, children, and young adolescents, resulting in irreversible ischemic injury within hours; hence demanding urgent surgical attention. […] Though the imaging modalities are helpful in the diagnosis, nothing can supersede the clinical findings and judgment. […] Testicular torsion is a clinical diagnosis, typically presenting with severe acute unilateral scrotal pain, nausea, and vomiting. Physical examination may reveal a high-riding transversely oriented tender testicle, an anterior epididymis with an absent cremasteric reflex. […] Testicular ultrasonography (US) is an initial ideal imaging tool to diagnose. The reduced or absent testicular blood flow has high diagnostic accuracy with a sensitivity of 86%-100% and a specificity of 97.9%-100%.

• #2 Testicular torsion – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/506

  Testicular torsion is a urological emergency. […] A high index of suspicion is important to ensure timely diagnosis and management. […] A history and physical examination consistent with testicular torsion mandates an immediate surgical consult for scrotal exploration, without delay for additional diagnostic tests. […] Key diagnostic factors include testicular pain, intermittent pain, no pain relief upon elevation of scrotum, scrotal swelling or oedema, scrotal erythema, reactive hydrocele, high-riding testicle, horizontal lie, and absent cremasteric reflex. […] 1st investigations to order include Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score and ultrasound with Doppler flow imaging.

• #2 Testicular Torsion Workup: Approach Considerations, Urinalysis, Blood Studies

  https://emedicine.medscape.com/article/2036003-workup

  If testicular torsion is clinically suggested, perform immediate surgical exploration, regardless of laboratory studies, because a negative finding upon exploration of the scrotum is more acceptable than the loss of a salvageable testis. […] Laboratory tests are unlikely to be of consequence, as no single test has high sensitivity or specificity in diagnosing testicular torsion. However, when there is a strong suspicion of an alternative diagnosis, laboratory tests may be of some use. […] Imaging studies usually are not necessary. Ordering them wastes valuable time when the definitive treatment is emergent urologic consultation for surgical management. However, imaging studies (eg, ultrasonography, nuclear scans) may be useful when a low suspicion of testicular torsion exists. […] The TWIST (Testicular Workup for Ischemia and Suspected Torsion) scoring system was developed for the purpose of determining the risk of testicular torsion on clinical grounds, thus decreasing the indication for ultrasound.

• #2 Testicular Torsion Workup: Approach Considerations, Urinalysis, Blood Studies

  https://emedicine.medscape.com/article/2036003-workup

  TWIST has shown 100% negative predictive value when scored by a urologist, using a cutoff value of 2 to identify low-risk patients, and when scored by trained emergency medical technicians (EMTs) using a cutoff of 0 in children. […] Ultrasound evaluation is indicated for intermediate-risk patients; low-risk patients do not require ultrasound to rule out torsion, and patients at high risk can proceed directly to surgery, with more than 50% avoiding ultrasound. […] Testicular torsion is a clinical diagnosis. If the history and physical examination strongly suggest testicular torsion, the patient should go directly to surgery without delaying to perform imaging studies. […] When a low suspicion of testicular torsion exists, color Doppler and power Doppler ultrasonography can be used to demonstrate arterial blood flow to the testicle while providing information about scrotal anatomy and other testicular disorders.

• #2 Testicular Torsion – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448199/

  Ultrasound is the primary diagnostic modality beyond the physical exam. Ultrasound for testicular torsion is approximately 93% sensitive and 100% specific. […] Ultrasound is not a perfect test for testicular torsion, especially in the very young. For example, 40% of neonatal testicles may have no apparent color flow Doppler. If the clinical concern is high, seek urologic surgery consultation immediately. Any delay in treatment could result in testicular necrosis and loss. The typical window of opportunity for surgical intervention and testicular salvage is 6 hours from the onset of pain. Therefore, early urologic surgery consultation upon presentation may be critical even in the absence of confirmatory testing. […] The outcomes of testicular torsion depend on when the patient presents to the ED and how quickly the diagnosis is made and treatment is undertaken. Delays in diagnosis and treatment always lead to testicular atrophy. About 20% to 40% of cases of testicular torsion result in an orchiectomy. The risk of losing a testis is much higher among African Americans and younger males. For those who present within the first 6 hours of symptoms, the salvage rate is nearly 100%, but this number quickly drops to less than 50% if the delay in seeking help is more than 12 to 24 hours.

• #2 Imaging Testicular Torsion | Applied Radiology

  https://appliedradiology.com/articles/imaging-testicular-torsion

  Testicular torsion, or more accurately, spermatic cord torsion, is an important cause of an acute scrotum. […] Imaging plays a crucial role in the timely and accurate diagnosis of testicular torsion. […] Absent or significantly reduced color Doppler flow in the symptomatic testis compared with the asymptomatic testis is highly predictive of acute testicular torsion. […] The most reliable sign of testicular torsion is the spermatic cord whirlpool sign, a direct indication of torsion. […] The presence of a redundant, wavy piece of cord indicates an anomalous tunica vaginalis attachment (the bell clapper anomaly). […] An altered (horizontal or oblique) lie suggests anomalous tunica vaginalis attachment (the bell clapper anomaly) and also can be associated with intermittent testicular torsion.

• #2 Diagnosis of testicular torsion with preserved blood flow detected by color Doppler ultrasonography | Bulletin of the National Research Centre | Full Text

  https://bnrc.springeropen.com/articles/10.1186/s42269-023-01134-6

  To diagnose testicular torsion promptly and accurately when diagnosis of testicular torsion is difficult by color Doppler ultrasonography owing to testicular blood flow, we assess the helpfulness of physical findings to aid diagnosis of testicular torsion in cases with preserved testicular blood flow. […] Testicular torsion was diagnosed in 34 of the 45 patients, and normal testicular blood flow was detected in six of the 34 patients. […] If testicular blood flow is detected, the presence of abnormal testicular findings and short duration of symptom are highly suspicious for testicular torsion. […] Appropriate diagnosis of testicular torsion is predominantly based on findings of ultrasonography (US). […] Color Doppler ultrasonography (CDUS) is useful to diagnose testicular torsion by the findings of absent or decreased testicular blood flow.

• #2 Testicular torsion; clinical diagnosis or imaging diagnosis?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9160395/

  Scrotal scintigraphy using Technicium 99 pertechnate injected intravenously on an emergency basis is a valid and reliable test to diagnose testicular torsion whenever clinical and sonological findings are inconclusive. […] The surgical exploration of the scrotum is the most definitive and reliable management option, consisting of detorsion of the affected testis and waiting for its pinking up or improved perfusion or orchiectomy for necrosed and gangrenous testis followed by contralateral orchidopexy. […] If history and physical examination suggests torsion, immediate surgical exploration is indicated which should not be postponed to perform imaging studies. […] Clinical findings and clinical judgment from the attending surgeon are sufficient to take a decision for scrotal exploration for salvaging the testis.

• #2 Testicular Torsion Workup: Approach Considerations, Urinalysis, Blood Studies

  https://emedicine.medscape.com/article/2036003-workup

  The sensitivity of color Doppler examination with newer ultrasonography equipment in detecting acute testicular torsion in children is 90-100%, with the specificity of technically adequate studies being essentially 100%. […] The detection of a color or power Doppler signal in a patient presenting with the clinical findings suggestive of testicular torsion does not absolutely exclude torsion. Clinical correlation should be incorporated in the evaluation of acute scrotum because color Doppler ultrasonography is not 100% sensitive. […] Small studies to date suggest that magnetic resonance imaging (MRI), particularly when performed with contrast enhancement, is highly accurate in the diagnosis of testicular torsion, particularly when torsion knot or whirlpool patterns are evident. […] If the diagnosis is equivocal, radionuclide scan of the testicles can be helpful to assess blood flow and to differentiate torsion from other conditions. […] Near-infrared spectroscopy (NIRS) is an emerging tool to assess testicular torsion. It can measure oxygen saturation 3-4 cm deep in the skin, is rapid (taking 20 seconds), and is noninvasive.

• #2 Testicular Torsion: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15382-testicular-torsion

  Testicular torsion requires immediate treatment to prevent permanent damage to your testicle. […] A healthcare provider can diagnose testicular torsion according to your symptoms, medical history, scrotal ultrasound and a physical examination of your testicles. […] Your healthcare provider may order a scrotal ultrasound to determine if blood is flowing within your testicular tissues. […] Testicular torsion requires surgery (orchiopexy). […] If you dont get surgery within six hours, a surgeon will likely need to remove your affected testicle. […] The outlook for testicular torsion is good if you get treatment right away within six hours. […] If you dont get treatment right away within six hours testicular torsion can permanently damage (infarct) your testicle.

• #2 Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion – Howe – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/16891/html

  Salvage rates of over 90% are seen when surgical exploration is performed within 6 h of the onset of symptoms, decreasing to 50% when symptoms last beyond 12 h. […] The chance of testicular salvage is less than 10%, when symptoms have been present for over 24 h. […] A non-parametric Wilcoxon rank/Kruskal-Wallis analysis confirmed that non-salvageable testicles tended to have significantly higher degrees of twisting when compared to their viable counterparts (P=0.002). […] An ROC analysis was performed and a threshold time to intervention of 8.5 h would provide a 73% sensitivity and 80% specificity for the prediction of testicular non-salvage. […] Also, a cut-off value of 495 degrees of torsion would provide a 53% sensitivity and 80% specificity for predicting non-salvage. […] A bivariate fit of probability of non-salvage based on duration of pain and degree of twist were then used, separately to estimate the probability of non-salvage.

• #2 Testicular torsion – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/testicular-torsion/diagnosis-treatment/drc-20378274

  Your doctor will ask you questions to verify whether your signs and symptoms are caused by testicular torsion or something else. Doctors often diagnose testicular torsion with a physical exam of the scrotum, testicles, abdomen and groin. […] Sometimes medical tests are necessary to confirm a diagnosis or to help identify another cause for your symptoms. For example: […] Scrotal ultrasound. This type of ultrasound is used to check blood flow. Decreased blood flow to the testicle is a sign of testicular torsion. But ultrasound doesn’t always detect the reduced blood flow, so the test might not rule out testicular torsion. […] Surgery might be necessary to determine whether your symptoms are caused by testicular torsion or another condition. […] If you’ve had pain for several hours and your physical exam suggests testicular torsion, you might be taken directly to surgery without any additional testing. Delaying surgery might result in loss of the testicle. […] Ultrasound might not detect reduced blood flow to the infant’s scrotum, so surgery might be needed to confirm testicular torsion.

• #2

  https://link.springer.com/article/10.1007/s00247-018-4093-0

  Swollen epididymis and testis with testicular flow that is only minimally decreased, normal, or increased in boys with incomplete or intermittent testicular torsion can mimic epididymo-orchitis. […] The presence of intratesticular flow does not exclude testicular torsion. […] An integral part of the exam is to look for an abrupt change in configuration of cord at the external inguinal ring or in the scrotal sac. […] An enlarged epididymal-cord complex representing the torsion knot/pseudomass is more frequently identified at the sonographic examination compared to the more classic whirlpool sign of twisted spermatic cord. […] A group discussion among the radiologist, emergency room physician and urologist is recommended for proper management; manual detorsion of the testis might be considered to improve chances of salvage while the patient awaits surgery.

• #2 Testicular Torsion in the Emergency Room: A Review of Detection and Ma | OAEM

  https://www.dovepress.com/testicular-torsion-in-the-emergency-room-a-review-of-detection-and-man-peer-reviewed-fulltext-article-OAEM

  Testicular torsion is a challenging and time-sensitive diagnosis that is encountered frequently in daily practice, especially in the emergency room. A thorough history, the presence of a painful and swollen testis and testicular ultrasonography plays a vital role in the prompt diagnosis of testicular torsion. […] Prompt diagnosis is essential to prevent complications of testicular torsion which include testicular infarction, necrosis, and sub/infertility. […] The early recognition of testicular torsion has been associated with an increase in the rates of testicular salvage and the prevention of complications such as testicular infarction and infertility. […] Since it is not always possible to rule-out testicular torsion on history and examination alone, radiological imaging or immediate exploration is often required.

• #2 Testicular Torsion | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/testicular-torsion/

  Color Doppler complete absence of intratesticular blood flow vis a vis normal blood flow on the unaffected side is diagnostic of torsion although commonly not observed note presence/absence of central perfusion as often peripheral perfusion may be preserved. […] Remember, presence of arterial perfusion does not exclude partial torsion. […] Important clinical mimics of testicular torsion to be aware of include torsion of the appendix testis and epididymo-orchitis because they present similarly with acute scrotal pain but can be reliably and confidently diagnosed on imaging. […] It is important to distinguish appendix torsion from frank testicular torsion because the treatment for appendix torsion is generally symptomatic while torsion of the testis is a true surgical emergency.

• #2

  https://journals.lww.com/njcp/fulltext/2021/24050/testicular_torsion__losses_from_missed_diagnosis.23.aspx

  The inclusion of torsion education as a mandatory content of continuing medical education programme of doctors, nurses and allied health care providers as recommended by Ugwumba and colleagues can address this diagnostic knowledge gap. […] It is believed that efforts toward enlightening first-line health care professionals will help to reduce the testicular loss associated with delays in diagnosis, and treatment or referral of testicular torsion. […] This case series highlights the importance of training the first contact health care provider on recognition and prompt intervention or referral of patients with testicular torsion. […] The learning point is every case of testicular pain in children or young adults should be treated as testicular torsion until proven otherwise and this should be emphasized in the continuing medical education programmes of doctors and allied health professionals.

• #3 Testicular Torsion: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15382-testicular-torsion

  Testicular torsion requires immediate treatment to prevent permanent damage to your testicle. […] A healthcare provider can diagnose testicular torsion according to your symptoms, medical history, scrotal ultrasound and a physical examination of your testicles. […] Your healthcare provider may order a scrotal ultrasound to determine if blood is flowing within your testicular tissues. […] Testicular torsion requires surgery (orchiopexy). […] If you dont get surgery within six hours, a surgeon will likely need to remove your affected testicle. […] The outlook for testicular torsion is good if you get treatment right away within six hours. […] If you dont get treatment right away within six hours testicular torsion can permanently damage (infarct) your testicle.

• #3 Clinical Diagnosis of Testicular Torsion | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/pocg-testicular-torsion.html

  How accurate are history and physical examination in diagnosing testicular torsion? […] Therefore, prompt and accurate diagnosis is important when patients present with acute scrotal or testicular pain. […] Individual clinical findings that best predict testicular torsion include nausea and vomiting, past trauma, a tender testicle, an abnormal testicular lie (i.e., elevated or transverse), and an absent cremasteric reflex. […] A systematic review and meta-analysis identified 13 studies that evaluated the accuracy of the TWIST score. […] Pooled data from the five prospective studies in children and adolescents showed that the TWIST score is accurate. […] The score performed well: zero of 23 in the low-risk group (0 to 2 points) had testicular torsion compared with seven of 15 in the moderate-risk group (3 to 4 points) and 27 of 30 in the high-risk group (5 to 7 points). […] He has a TWIST score of 4 points and is at moderate risk for testicular torsion, with a 22% probability.

• #3 Testicular torsion; clinical diagnosis or imaging diagnosis?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9160395/

  Scrotal scintigraphy using Technicium 99 pertechnate injected intravenously on an emergency basis is a valid and reliable test to diagnose testicular torsion whenever clinical and sonological findings are inconclusive. […] The surgical exploration of the scrotum is the most definitive and reliable management option, consisting of detorsion of the affected testis and waiting for its pinking up or improved perfusion or orchiectomy for necrosed and gangrenous testis followed by contralateral orchidopexy. […] If history and physical examination suggests torsion, immediate surgical exploration is indicated which should not be postponed to perform imaging studies. […] Clinical findings and clinical judgment from the attending surgeon are sufficient to take a decision for scrotal exploration for salvaging the testis.

• #3 Testicular Torsion in the Emergency Room: A Review of Detection and Ma | OAEM

  https://www.dovepress.com/testicular-torsion-in-the-emergency-room-a-review-of-detection-and-man-peer-reviewed-fulltext-article-OAEM

  Utilizing clinical scores when assessing patients with an acute scrotum can provide guidance in identifying patients who may require scrotal ultrasonography, urological consultation or urgent scrotal exploration. […] The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score focuses on five criteria from the history and clinical examination to estimate the likelihood of testicular torsion. […] Although surgical exploration is invasive, it remains the gold standard in the diagnosis of testicular torsion. […] Since testicular salvage is time dependent and clinical examination as well as the various imaging modalities described above are unable to exclude the diagnosis of testicular torsion in all cases, early surgical exploration must be given consideration when the index of suspicion for testicular torsion is high. […] Testicular torsion is a time-sensitive diagnosis that requires prompt surgical intervention to avoid testicular ischemia, infertility, and unwanted litigation.

• #3 Testicular Torsion Imaging: Practice Essentials, Magnetic Resonance Imaging, Ultrasonography

  https://emedicine.medscape.com/article/381204-overview

  Testicular torsion, also termed torsion of the spermatic cord, is a relatively common and potentially devastating acute condition resulting from obstruction of the arterial blood supply to the testis. […] Accurate diagnosis is imperative because testicular torsion is treated surgically, whereas epididymitis with or without orchitis is treated medically. The optimal timeframe for diagnosis of torsion for salvage of the affected testicle is within 6 hours of the onset of symptoms. […] Diagnostic imaging, particularly Doppler ultrasonography, plays an important role in the assessment of patients with acute scrotal pain. […] Ultrasonography with color and power Doppler imaging has emerged as the primary imaging modality for the diagnosis of testicular torsion. […] In a systematic review and meta-analysis of 26 studies with 2116 patients, ultrasound examination for testicular torsion in adult patients with acute scrotal pain had an overall diagnostic sensitivity of 0.86 and specificity of 0.95.

• #3

  https://link.springer.com/article/10.1007/s00247-018-4093-0

  The whirlpool sign is defined as an abrupt change in the course of the spermatic cord with a spiral twist at the external inguinal ring or in the scrotal sac. […] The classic whirlpool sign is observed less frequently compared to a tortuous redundant cord but is considered to be of great diagnostic significance. […] Redundant spermatic cord can be described as the presence of excess and tortuous spermatic cord in the scrotal sac and is a very helpful sign of anomalous attachment of the tunica vaginalis. […] The presence of radiating, dilated anechoic tubules, which represent congested vessels, helps in recognizing cord structure in the torsion knot or pseudomass. […] The decision about color Doppler flow is subjective but is best accomplished by looking at both testes simultaneously in the transverse plane, in real time.

• #3 Testicular Torsion | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/testicular-torsion/

  Color Doppler complete absence of intratesticular blood flow vis a vis normal blood flow on the unaffected side is diagnostic of torsion although commonly not observed note presence/absence of central perfusion as often peripheral perfusion may be preserved. […] Remember, presence of arterial perfusion does not exclude partial torsion. […] Important clinical mimics of testicular torsion to be aware of include torsion of the appendix testis and epididymo-orchitis because they present similarly with acute scrotal pain but can be reliably and confidently diagnosed on imaging. […] It is important to distinguish appendix torsion from frank testicular torsion because the treatment for appendix torsion is generally symptomatic while torsion of the testis is a true surgical emergency.

• #3 Testicular torsion – Wikipedia

  https://en.wikipedia.org/wiki/Testicular_torsion

  A Doppler ultrasound scan of the scrotum can identify the absence of blood flow in the twisted testicle and is nearly 90% accurate in diagnosis. […] Radionuclide scanning (scintigraphy) of the scrotum is the most accurate imaging technique, but it is not routinely available, particularly with the urgency that might be required.

• #3 Testicular Torsion in the Emergency Room: A Review of Detection and Ma | OAEM

  https://www.dovepress.com/testicular-torsion-in-the-emergency-room-a-review-of-detection-and-man-peer-reviewed-fulltext-article-OAEM

  Testicular torsion is a challenging and time-sensitive diagnosis that is encountered frequently in daily practice, especially in the emergency room. A thorough history, the presence of a painful and swollen testis and testicular ultrasonography plays a vital role in the prompt diagnosis of testicular torsion. […] Prompt diagnosis is essential to prevent complications of testicular torsion which include testicular infarction, necrosis, and sub/infertility. […] The early recognition of testicular torsion has been associated with an increase in the rates of testicular salvage and the prevention of complications such as testicular infarction and infertility. […] Since it is not always possible to rule-out testicular torsion on history and examination alone, radiological imaging or immediate exploration is often required.

• #3 Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion – Howe – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/16891/html

  Fifteen h of symptoms and 860 degrees of torsion gives testes a 50% salvage rate. […] Interestingly, we also found that about 1 out of every 4 testes undergoes atrophy after orchiopexy. […] It is well documented that there is a 4 to 8 h window of time from the onset of symptoms to surgery that is needed in order to save a torsed testicle. […] Ramachandra et al. demonstrated through multivariate analysis of the factors associated with testicular salvage, that duration of symptoms of less than 6 h was a significant predictor of testicular salvage. […] They concluded that time to presentation is in fact the most important factor in determining salvageability of the testicle in testicular torsion. […] If surgical exploration is delayed, testicular atrophy will occur by 6 to 8 h, with necrosis ensuing within 8 to 10 h of initial presentation.

• #3 Testicular Torsion Workup: Approach Considerations, Urinalysis, Blood Studies

  https://emedicine.medscape.com/article/2036003-workup

  If testicular torsion is clinically suggested, perform immediate surgical exploration, regardless of laboratory studies, because a negative finding upon exploration of the scrotum is more acceptable than the loss of a salvageable testis. […] Laboratory tests are unlikely to be of consequence, as no single test has high sensitivity or specificity in diagnosing testicular torsion. However, when there is a strong suspicion of an alternative diagnosis, laboratory tests may be of some use. […] Imaging studies usually are not necessary. Ordering them wastes valuable time when the definitive treatment is emergent urologic consultation for surgical management. However, imaging studies (eg, ultrasonography, nuclear scans) may be useful when a low suspicion of testicular torsion exists. […] The TWIST (Testicular Workup for Ischemia and Suspected Torsion) scoring system was developed for the purpose of determining the risk of testicular torsion on clinical grounds, thus decreasing the indication for ultrasound.

• #3 Testicular torsion – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/testicular-torsion/

  Testicular torsion is typically a clinical diagnosis. Do not delay definitive treatment for diagnostic workup if clinical suspicion is high. […] Imaging is not routinely indicated if there is high clinical suspicion but should be considered in patients with atypical clinical features. […] Either formal ultrasound or POCUS can be used to diagnose torsion, depending on operator skill and availability. […] Surgical intervention is recommended for suspected testicular torsion, regardless of radiological findings.

• #3 Diagnosis of testicular torsion with preserved blood flow detected by color Doppler ultrasonography | Bulletin of the National Research Centre | Full Text

  https://bnrc.springeropen.com/articles/10.1186/s42269-023-01134-6

  To diagnose testicular torsion promptly and accurately when diagnosis of testicular torsion is difficult by color Doppler ultrasonography owing to testicular blood flow, we assess the helpfulness of physical findings to aid diagnosis of testicular torsion in cases with preserved testicular blood flow. […] Testicular torsion was diagnosed in 34 of the 45 patients, and normal testicular blood flow was detected in six of the 34 patients. […] If testicular blood flow is detected, the presence of abnormal testicular findings and short duration of symptom are highly suspicious for testicular torsion. […] Appropriate diagnosis of testicular torsion is predominantly based on findings of ultrasonography (US). […] Color Doppler ultrasonography (CDUS) is useful to diagnose testicular torsion by the findings of absent or decreased testicular blood flow.

• #3 Testicular torsion; clinical diagnosis or imaging diagnosis?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9160395/

  Testicular torsion is the most common urosurgical emergency in infants, children, and young adolescents, resulting in irreversible ischemic injury within hours; hence demanding urgent surgical attention. […] Though the imaging modalities are helpful in the diagnosis, nothing can supersede the clinical findings and judgment. […] Testicular torsion is a clinical diagnosis, typically presenting with severe acute unilateral scrotal pain, nausea, and vomiting. Physical examination may reveal a high-riding transversely oriented tender testicle, an anterior epididymis with an absent cremasteric reflex. […] Testicular ultrasonography (US) is an initial ideal imaging tool to diagnose. The reduced or absent testicular blood flow has high diagnostic accuracy with a sensitivity of 86%-100% and a specificity of 97.9%-100%.

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