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. 2020 Sep-Oct;14(5):1557988320953003.
doi: 10.1177/1557988320953003.

The Diagnostic Accuracy of Testicular Torsion by Doctors on Duty Using Sonographic Evaluation with Color Doppler

Akinori Nakayama  1 , Hisamitsu Ide  1 , Akiyoshi Osaka  1 , Yasuyuki Inoue  1 , Yukihito Shimomura  1 , Toshiyuki Iwahata  1 , Yoshitomo Kobori  1 , Kazutaka Saito  1 , Shigehiro Soh  1 , Hiroshi Okada  1
Affiliations

The Diagnostic Accuracy of Testicular Torsion by Doctors on Duty Using Sonographic Evaluation with Color Doppler

Akinori Nakayama et al. Am J Mens Health. 2020 Sep-Oct.

Abstract

As testicular torsion is a medical emergency, it requires quick diagnosis and treatment. Color Doppler ultrasound (CDUS) is useful for the diagnosis of testicular torsion. An accurate diagnosis can be difficult when CDUS indicates the preservation of blood flow in the testis. We examined the accuracy of testicular torsion diagnosis in patients with acute scrotum made by doctors on duty using CDUS. The subjects included 26 patients who visited our department between January 2016 and June 2018 presenting with acute scrotal pain. Patients were placed into one of three groups based on testicular blood flow evaluated by CDUS. The first group had no testicular blood flow, the second had diminished blood flow, and the last group had normal or increased blood flow. Patients were also diagnosed through scrotal exploration. Finally, patients were further divided into two groups identified by CDUS frequency utilized during diagnosis (12 MHz groups and ≤8 MHz groups), and the diagnostic accuracy of the two groups was compared. Characterizing torsion by either the absence of or diminished, testicular blood flow in the CDUS evaluation, the sensitivity and specificity of the CDUS performed by doctors on duty accounted for 69.2% and 53.8%, respectively. No improvement in diagnostic accuracy was evident despite the usage of a 12-MHz ultrasonic transducer. In this study, the sensitivity of CDUS performed by doctors on duty was about 70%, suggesting that scrotal exploration should be performed promptly even if testicular blood flow is observed and testicular torsion is suspected from medical history and body findings.

Keywords: color doppler ultrasound; testicular torsion.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Testicular torsion in a 13-year-old boy who presented with right scrotal pain. The right testis is enlarged and appears heterogeneously hypoechoic. Also, a complete absence of detectable flow is observed.
Figure 2.
Figure 2.
Intermittent testicular torsion in a 5-year-old boy who presented with left scrotal pain. (a) After spontaneous detorsion, the left testicular blood flow is increased. (b) Findings at scrotal exploration show traces of twisting.
See this image and copyright information in PMC

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