Management of testicular torsion <360° in children: a single-center, retrospective study

Abstract

Objective: This study aimed to summarize clinical manifestations, and physical examination, laboratory examination, and ultrasound results of children with testicular torsion <360°.

Methods: We performed a retrospective study of children who were diagnosed with testicular torsion <360° between October 2007 and October 2017.

Results: There were 11 (19.2%) patients with testicular torsion of 90°, 33 (58.0%) with 180°, and 13 (22.8%) with 270°. The median age of onset was 5.7 years (range, 1-14 years) and the median duration of symptoms was 4.2 days (range, 0.5-5 days). Ultrasound showed low blood flow in 46 (80.8%) patients. The testis was retained in 41 (72.0%) patients and resected in 16 (28.0%). The testes appeared necrotic at 2 to 3 days after onset for patients with 270° torsion, appeared necrotic at 3 to 4 days after onset for those with 180° torsion, and were not necrotic at 4 to 5 days after onset for those with 90° torsion. The duration of symptoms in children decreased as the torsion angle increased.

Conclusion: Children with testicular torsion <360° are relatively young, while the duration of symptoms is relatively long. A high postoperative testicular survival rate is one of the clinical features in this study.

Keywords: Doppler ultrasound; Testicular torsion; atrophy; children; cremasteric reflex; necrosis.

Figure 1.

(a) Age distribution of children with testicular torsion <360°. (b) A blood flow signal is visible in the affected testis, but is reduced compared with the healthy side. (c) The blood flow signal in the testis is normal, but the testis is in a transverse position.

Figure 2.

(a) Torsion of 90° for 4 days. (b) Torsion of 180° for 4 days. (c) Torsion of 270° for 4 days. (d) Reduction of 90° torsion. (e) Reduction of 180° torsion. (f) Reduction of 270° torsion.

Figure 3.

Association between the torsion angle and duration of symptoms.