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Anheuser P, Steffens J. [Acute genital diseases]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:557-565. [PMID: 38689028 DOI: 10.1007/s00120-024-02335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
Acute genital diseases can occur at any age and are characterized by complaints of various kinds of the external genitalia. Pain, swelling, and redness of the scrotum, adjacent groin region, and immediate surroundings are the leading symptoms, the severity of which may vary. In addition, peritonitic symptoms such as nausea, vomiting, and circulatory sensations may be present and are comparable to symptoms of an acute abdomen. The term "acute scrotum" encompasses various clinical entities, where scrotal symptoms are predominant and represent a urological emergency situation. Immediate and comprehensive diagnostics are necessary to ensure timely management in case of necessary surgical intervention.
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Affiliation(s)
- Petra Anheuser
- Abteilung für Urologie, AK Wandsbek, Alphonsstraße 14, 22403, Hamburg, Deutschland.
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
| | - Joachim Steffens
- Abteilung für Urologie und Kinderurologie, St. Antonius Hospital Eschweiler, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
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Barkai E, Dekalo S, Yossepowitch O, Ben-Chaim J, Bar-Yosef Y, Beri A, Mano R. Complete Blood Count Markers and C-Reactive Protein as Predictors of Testicular Viability in the Event of Testicular Torsion in Adults. Urol Int 2023; 107:801-806. [PMID: 37423214 PMCID: PMC10614481 DOI: 10.1159/000531145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION The association between blood markers and testicular viability after testicular torsion (TT) is not well known. We evaluated the role of complete blood count markers and C-reactive protein (CRP) in predicting testicular viability after TT. METHODS Fifty men, ≥18 years of age, operated for TT between the years 2015-2020 were enrolled. Blood markers including neutrophil-, lymphocyte-, and platelet count, and CRP were obtained. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were calculated. The study outcome was testicular salvage. RESULTS Median age was 23 years (interquartile range [IQR]: 21, 31). Median duration of torsion was 10 h (IQR: 6, 42). Sonographic texture of the testis was homogenous in 27 (56%) patients and heterogenous in 21 (44%). During scrotal exploration, 36 patients (72%) underwent orchiopexy and 14 (28%) underwent orchiectomy. Patients who underwent orchiopexy were younger (22 years vs. 31 years, p = 0.009), had a shorter duration of torsion (median 8 h vs. 48 h, p < 0.001), and a homogenous texture on scrotal ultrasound (76.5 vs. 7.1%, p < 0.001). Median NLR, PLR, and CRP were higher among patients who underwent orchiectomy; however, these differences did not reach statistical significance. Patients with heterogenous echotexture were significantly more likely to undergo orchiectomy (odds ratio = 42, 95% confidence interval: 7, 831, adjusted p value = 0.009). CONCLUSIONS We found no association between blood-based biomarkers and testicular viability after TT; however, testicular echotexture significantly predicted outcome.
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Affiliation(s)
- Eyal Barkai
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Snir Dekalo
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Jacob Ben-Chaim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Department of Pediatric Urology, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Yuval Bar-Yosef
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Department of Pediatric Urology, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Avi Beri
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Roy Mano
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
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Zvizdic Z, Aganovic A, Milisic E, Jonuzi A, Zvizdic D, Vranic S. The Role of Demographic and Clinical Characteristics in Distinguishing Testicular Torsion from Torsion of the Appendix Testis: A Single-center Retrospective Study. Prague Med Rep 2023; 124:255-264. [PMID: 37736949 DOI: 10.14712/23362936.2023.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
The acute scrotum (AS) in the pediatric population is a medical emergency. AS is usually caused by testicular torsion (TT) and torsion of the appendix testis (TAT). The current study explored which demographic and clinical characteristics can help distinguish between TT and TAT. We analyzed all children ≤16 years who underwent surgical exploration for AS. The patients were divided into Group 1/TT and Group 2/TAT. Ninety patients were included in the study (24 with TT and 66 with TAT). The peak incidence of TT was significantly higher than in the TAT group (p<0.001). Scrotal pain was more prevalent in the TAT group (p=0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p=0.003 and p<0.001, respectively). The duration of symptoms was significantly longer in the TAT group (p<0.001). The duration of symptoms in the TT cohort significantly impacted the testicular salvage (p=0.008). Color Doppler ultrasound (CDUS) findings of absent/decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p<0.001). The older age, shorter duration of symptoms, systemic signs, and CDUS findings can help distinguish between the two most common acute scrotum causes.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Emir Milisic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Denisa Zvizdic
- Eye Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Comparison of demographic and clinical characteristics in distinguishing testicular torsion from torsion of the appendix testis: A single-center retrospective study. Asian J Urol 2022. [DOI: 10.1016/j.ajur.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pinar U, Duquesne I, Lannes F, Bardet F, Kaulanjan K, Michiels C, Seizilles de Mazancourt E, Dominique I, Vallee M, Felber M, Freton L, Gondran-Tellier B, Matillon X, Khene ZE, Pradere B. The Use of Doppler Ultrasound for Suspected Testicular Torsion: Lessons Learned from a 15-Year Multicentre Retrospective Study of 2922 Patients. Eur Urol Focus 2021; 8:105-111. [PMID: 33663983 DOI: 10.1016/j.euf.2021.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Use of Doppler ultrasonography (DUS) for patients with suspected testicular torsion (TT) is highly controversial and remains debated, as it can delay surgery and its performance may vary. OBJECTIVE To assess the role, impact, safety, and performance of DUS in the management of patients with suspected TT before scrotal exploration. DESIGN, SETTING, AND PARTICIPANTS The TORSAFUF cohort retrospectively included patients older than 12 yr who underwent surgery for suspected TT in 14 academic hospitals between 2005 and 2019. Perioperative data and surgical and DUS reports were collected. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Clinical factors influencing DUS utilisation were analysed using multivariate logistic regression. The orchidectomy rate and delay to surgery were compared by group with and without DUS receipt using one-to-one propensity score (PS) matching to assess imaging safety. For the group with preoperative imaging, DUS performance was evaluated using a contingency table. RESULTS AND LIMITATIONS Overall, 2922 patients were included, of whom 956 (32.7%) underwent DUS before surgery. DUS was more likely to be performed in older patients (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.1-1.2), those who experienced progressive onset of pain (OR 1.5, 95% CI 1.1-2), and patients who presented at the emergency department more than 6 h after their first scrotal symptoms (OR 2.3, 95% CI 1.9-2.8). After PS matching, DUS receipt was not significantly associated with orchidectomy but the delay to surgery was 1 h longer. DUS demonstrated strong sensitivity of 85.2% (95% CI 82.1-88.3%) and specificity of 52.7% (95% CI 48.8-56.6%). The performance was better for younger patients and for those with time since onset of pain of >6 h. CONCLUSIONS In this large retrospective study, DUS before surgery was safe, feasible, and useful in selected cases with suspected TT, but it should not delay or replace surgery in cases with a strong clinical suspicion. PATIENT SUMMARY We analysed the performance and safety of an ultrasound scan of the scrotum before surgery for patients with a suspected twisted testicle (TT). This scan before surgery was not associated with a higher risk of negative outcomes but was only moderate in accurately diagnosing TT. Surgery to correct TT should not be delayed.
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Affiliation(s)
- Ugo Pinar
- Department of Urology, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, AP-HP, Sorbonne Université, Paris, France.
| | - Igor Duquesne
- Department of Urology, Hôpital Cochin, AP-HP, Université de Paris, Paris France
| | - François Lannes
- Department of Urology, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France
| | - Florian Bardet
- Department of Urology, Dijon University Hospital, Dijon, France
| | - Kevin Kaulanjan
- Department of Urology, CHU Pointe à Pitre, Guadeloupe, France
| | - Clément Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | | | - Ines Dominique
- Department of Urology, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Maxime Vallee
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - Margaux Felber
- Department of Urology, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, AP-HP, Sorbonne Université, Paris, France
| | - Lucas Freton
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Bastien Gondran-Tellier
- Department of Urology, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France
| | - Xavier Matillon
- Department of Urology and Transplantation, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Zine-Edine Khene
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Klinke M, Elrod J, Stiel C, Ghadban T, Wenskus J, Herrmann J, Junge CM, Reinshagen K, Boettcher M. The BAL-Score Almost Perfectly Predicts Testicular Torsion in Children: A Two-Center Cohort Study. Front Pediatr 2020; 8:601892. [PMID: 33365292 PMCID: PMC7750324 DOI: 10.3389/fped.2020.601892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/17/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Testicular torsion (TT) is a common emergency that warrants immediate exploration to prevent infertility or testicular loss. To improve diagnostic reliability, various scoring systems have been published. The aim of this study was to evaluate and validate different testicular torsion scores in a large cohort of children with acute scrotum. Methods: Retrospective analysis of all male children that were admitted for acute scrotum at the Pediatric Surgery Department of the Altonaer Kinderkrankenhaus and University medical Center Hamburg-Eppendorf from 01/2013 to 03/2019. Two testicular torsion scores (Boettcher Alert Score, Testicular Workup for Ischemia and Suspected Torsion Score) were applied to all data sets. Furthermore, an artificial intelligence (AI)-based score was developed and compared to the two current scores. Results: In total, 460 boys were included in the study. Of those, 48 (10.4%) had TT. Children with TT suffered most often from short duration of pain, nausea and vomiting, high riding testicle and absent cremasteric reflex. The BALS and the AI-based score had excellent predictive values and all patients with TT would have been detected. Conclusion: The BAL and the AI score show excellent predictive capabilities and may be used to identify all cases of TT in a pediatric population. The scores are easy to apply. As the BALS was slightly better, we advocate to use this score but to validate our findings in prospective multicenter studies.
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Affiliation(s)
- Michaela Klinke
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Stiel
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tarik Ghadban
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Wenskus
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carl-Martin Junge
- Department of Pediatric Radiology, Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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He M, Zhang W, Sun N. Can haematologic parameters be used to predict testicular viability in testicular torsion? Andrologia 2019; 51:e13357. [PMID: 31264256 DOI: 10.1111/and.13357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/18/2019] [Accepted: 05/28/2019] [Indexed: 01/26/2023] Open
Affiliation(s)
- Meng He
- Urology Department, Beijing Children's Hospital Capital Medical University Beijing China
| | - Weiping Zhang
- Urology Department, Beijing Children's Hospital Capital Medical University Beijing China
| | - Ning Sun
- Urology Department, Beijing Children's Hospital Capital Medical University Beijing China
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Abbas TO, Abdelkareem M, Alhadi A, Kini V, Chandra P, Al-Ansari A, Ali M. Suspected testicular torsion in children: diagnostic dilemma and recommendation for a lower threshold for initiation of surgical exploration. Res Rep Urol 2018; 10:241-249. [PMID: 30584529 PMCID: PMC6287511 DOI: 10.2147/rru.s186112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Testicular torsion (TT) represents a clinical challenge that needs emergency surgical assessment. It is common to have negative scrotal exploration due to confounding symptoms and signs which makes it sometimes difficult to differentiate from similar surgical emergencies that do not warrant surgery. At the same time, several occasions of misdiagnoses or late interventions occur with devastating effects. We aim at delineating the significance of the different clinical, laboratory, and radiological variables in the detection of TT. Methods We retrospectively reviewed the charts of 52 patients who were surgically explored with a preoperative working diagnosis of suspected TT in our center over the period from 2011 to 2015. All the patients were examined by pediatric surgeons in the emergency room and had undergone ultrasound imaging of the testes. The ultrasound images were retrospectively reviewed by a pediatric radiologist who was blinded to the intraoperative findings. Univariate and multivariate and logistic regression analyses were performed. Results Of the studied group of patients, the majority (84.6%) had TT upon surgical exploration. The most frequently presented symptom was pain (80.8%), and only a minority (11.5%) presented with vomiting. Radiological findings with the highest sensitivity were heterogeneous echogenicity in favor of TT and enlarged epididymis indicating that TT is unlikely. However, the predictability of TT by any of the assessed clinical and imaging factors was statistically insignificant. Conclusion It is important to gather all relevant data from clinical, laboratory, and imaging sources when assessing pediatric patients with suspected TT given the inaccuracy of each single one of them if used alone. Keeping this in mind, Doppler ultrasound has a significant role to aid in the accuracy of the diagnosis and hence the appropriate decision-making thereafter. However, we found no single clinical or imaging sign that is sensitive enough to prove or rule out TT. Therefore, surgical exploration should take place in a timely manner. Moreover, further research is necessary to construct scoring systems where different predictors collectively have higher reliability.
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Affiliation(s)
- Tariq O Abbas
- Department of Pediatric Surgery, Hamad General Hospital, Doha, Qatar, .,College of Medicine, Qatar University, Doha, Qatar, .,Weill Cornell Medical College-Qatar, Doha, Qatar,
| | | | | | | | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Mansour Ali
- Department of Pediatric Surgery, Hamad General Hospital, Doha, Qatar,
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Direction of Rotation in Testicular Torsion and Identification of Predictors of Testicular Salvage. Urology 2018; 114:163-166. [PMID: 29203186 DOI: 10.1016/j.urology.2017.11.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/15/2017] [Accepted: 11/21/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To identify the rate at which testicular torsion occurs in a lateral direction and identify any predictors of direction of testicular rotation and orchiectomy. MATERIALS AND METHODS We performed a retrospective review of 104 cases of emergent scrotal exploration performed for testicular torsion by 3 pediatric urologists from 2003 to 2017. Patients with neonatal torsion, negative scrotal exploration, or exploration for presumed intermittent testicular torsion were excluded. Univariable logistic regression was performed to assess if any factors predicted direction of testicular rotation. Univariable and multivariable logistic regression was used to identify predictors of testicular salvage. RESULTS Of 104 cases of acute testicular torsion, information regarding the direction of testicular rotation was available in 81 patients. Lateral testicular rotation occurred in 38 cases (46%). No factors were found to be predictive of direction of torsion. Orchiectomy for testicular nonviability was performed in 50 of 104 cases (48%). On univariable analysis, younger age (p = .002), absence of gastrointestinal symptoms (P = .02), time to exploration (P < .001), testicular size differential on ultrasound (p = .002), absence of hydrocele (P = .01), abnormal ultrasound echotexture (P < .001), and degree of torsion (P = .04) were associated with orchiectomy. With the exception of absence of gastrointestinal symptoms, all predictors of orchiectomy remained statistically significant on multivariable analysis. CONCLUSION Testicular rotation occurs in a lateral direction in 46% of cases. Lateral manual detorsion should be performed only with awareness of the potential for increasing the degree of testicular rotation. New independent predictors of testicular salvage were identified.
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Afsarlar CE, Elizondo R, Yilmaz E, Cakmakci E, Ballow DJ, Demir E, Guney G, Koh CJ. Ultrasonographic findings in the epididymis of pediatric patients with testicular torsion. J Pediatr Urol 2017; 13:393.e1-393.e6. [PMID: 28713006 DOI: 10.1016/j.jpurol.2017.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although grayscale ultrasound and color Doppler ultrasound characteristics of the torsed testis are well established in the literature, less is known about its anatomic partner: the epididymis. OBJECTIVE The purpose of this study was to describe the ultrasound characteristics of the epididymis in pediatric patients with testicular torsion, and to describe their potential role as prognostic criteria for testicular salvage outcomes. STUDY DESIGN During a retrospective review of 217 pediatric patients with acute testicular torsion during 2009-2016, morphological features of the epididymis from scrotal ultrasounds (size, parenchymal characteristics, and vascular flow of both epididymis heads), as well as patient demographics, time duration, surgical outcomes, histopathology results, and follow-up periods were analyzed. RESULTS Mean epididymis size and twisting degree were significantly higher in the torsed testes than in the contralateral epididymis (P < 0.001) (Summary table). Cystic structures in the epididymis were identified: a higher number of cysts was associated with testicular non-viability (P = 0.025) and higher twisting degree (P = 0.017). Histopathologic examination showed that these spaces were infiltrated connective tissue most likely formed by venous congestion and vessel rupture. DISCUSSION Scrotal ultrasound can provide information on testicular morphology and viability, as well as morphological changes in the epididymis over time in pediatric patients with testicular torsion. These findings may provide potential prognostic information regarding testicular viability, as a higher number of cystic spaces in the epididymis was associated with a higher rate of testicular non-viability and a higher twisting degree. In addition, the epididymis size (volume) can change during the time course of the ischemic state. CONCLUSIONS This was the first study to describe and analyze epididymis ultrasound findings in pediatric patients with testicular torsion and to correlate them with testicular salvage outcomes. Further prospective studies are needed to determine the role of epididymis ultrasound findings as a potential pre-operative prognostic tool.
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Affiliation(s)
- C E Afsarlar
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatric Surgery, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - R Elizondo
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - E Yilmaz
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatric Surgery, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - E Cakmakci
- Department of Radiology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - D J Ballow
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - E Demir
- Department of Biostatistics, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - G Guney
- Department of Pathology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - C J Koh
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Rouzrokh M, Mirshemirani A, Khaleghnejad-Tabari A. Outcomes of Second Look Exploration in Testicular Torsion of Children. IRANIAN JOURNAL OF PEDIATRICS 2015; 25:e528. [PMID: 26396707 PMCID: PMC4575805 DOI: 10.5812/ijp.528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/25/2014] [Indexed: 11/29/2022]
Abstract
Background: Testicular torsion (TT), or twisting of the testicle resulting in a strangulation of the blood supply, occurs in men whose tissue surrounding the testicle is not well attached to the scrotum. It is important to emphasize that testicular torsion is a medical emergency. Objectives: The aim of this study is to evaluate the second look exploration and outcomes in TT. Patients and Methods: Seventy boys out of 124 patients underwent early exploration and 48 hours later second look exploration due to TT. All patients were checked with preoperative color-doppler ultrasonography (CDU) and intraoperative bleeding test. Data included age at admission, side of pathology, relation of TT with season of year, duration of preoperative history, degree of testicular torsion, CDU findings, and degree of bleeding; results of second look exploration, follow-up, and outcomes were analyzed. Results: Totally 70 patients were included in this study within five years, of which mean age was 28.6 ± 32.9 months (range 1 to 144), 48% of our patients had nausea and vomiting. Preoperative CDU showed absent/weak flow in 50 (71%) cases. Winter showed most frequently (44%) referred cases of testicular torsion. Orchidopexy was performed in 44 (63%) and orchidectomy in 26 (37%) cases after second look exploration. Mean follow-up duration was 3.1 ± 1.4 years. 4 (9%) cases in orchidopexy group developed testicular atrophy during follow-up, all four cases had a history of longer than 12 hours and grade II testicular bleeding test intra-operatively. Other orchidopexy patients salvaged. 26 patients, who were in grade III, underwent orchidectomy in second look exploration. Conclusions: TT requires emergency attention. The ischemia time of the testis is traditionally after 6 hours, and imaging or other diagnostic modality should not be a cause of delay. Early surgical exploration is modality of choice, and second look exploration after 48 hours can be more effective and salvageable in these patients.
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Affiliation(s)
- Mohsen Rouzrokh
- Pediatric Surgery Research Center, Shahid Beheshti University of Medial Sciences, Tehran, IR Iran
| | - Alireza Mirshemirani
- Pediatric Surgery Research Center, Shahid Beheshti University of Medial Sciences, Tehran, IR Iran
- Corresponding author: Alireza Mirshemirani, Pediatric Surgery Research Center, Shahid Beheshti University of Medial Sciences, Tehran, IR Iran. Tel/Fax: +98-2122924488, E-mail:
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Saroha M, Batra P, Dewan P, Faridi M. Genital injuries in neonates following breech presentation. J Neonatal Perinatal Med 2015; 8:421-5. [PMID: 26757006 DOI: 10.3233/npm-15915025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Breech presentation is seen in 3-4% of babies born. Delivering a breech baby through vaginal route is difficult and carries a much higher complication rate than cesarean sections. Breech born babies carry an overall increased risk of maternal morbidity, neonatal mortality, birth asphyxia and birth injuries. Various types of birth injuries to the babies have been reported following breech delivery, but genital injuries are less commonly reported and thus, less anticipated. We report series of five babies with spectrum of genital injuries following breech delivery. These injuries led to significant short and long term morbidity in these babies. Keeping high index of suspicion, an early cesarean section can be an aide in preventing these complications. Once the baby is born, careful examination and early intervention should be done to prevent long term complications.
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Melcer Y, Mendlovic S, Klin B, Keidar R, Lysyy O, Herman A, Maymon R. Fetal diagnosis of testicular torsion: what shall we tell the parents? Prenat Diagn 2014; 35:167-73. [DOI: 10.1002/pd.4512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 09/22/2014] [Accepted: 09/26/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Y. Melcer
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - S. Mendlovic
- Department of pathology, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - B. Klin
- Department of Pediatric Surgery, Assaf Harofeh Medical; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - R. Keidar
- Department of Neonatology, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - O. Lysyy
- Department of Diagnostic Imaging, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - A. Herman
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - R. Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center; Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
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14
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Differentiation of Epididymitis and Appendix Testis Torsion by Clinical and Ultrasound Signs in Children. Urology 2013; 82:899-904. [DOI: 10.1016/j.urology.2013.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 03/26/2013] [Accepted: 04/01/2013] [Indexed: 11/30/2022]
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15
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Boettcher M, Krebs T, Bergholz R, Wenke K, Aronson D, Reinshagen K. Clinical and sonographic features predict testicular torsion in children: a prospective study. BJU Int 2013; 112:1201-6. [DOI: 10.1111/bju.12229] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Boettcher
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
| | - Thomas Krebs
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
| | - Robert Bergholz
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
| | - Katharina Wenke
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
| | - Daniel Aronson
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
| | - Konrad Reinshagen
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
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16
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17
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Abstract
The current opinion on spermatic cord torsion is discussed in this review, with special attention to natural history, value of diagnostic tools, evidence for surgical management, outcome and management of atypical forms of torsion.
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Affiliation(s)
- Marcel Drlík
- Department of Urology, General Teaching Hospital and 1st Medical School of Charles University, Ke Karlovu 6, 128 08 Praha 2, Czech Republic.
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18
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Retrospective Review of Diagnosis and Treatment in Children Presenting to the Pediatric Department With Acute Scrotum. AJR Am J Roentgenol 2013; 200:W444-9. [DOI: 10.2214/ajr.12.10036] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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19
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Günther P, Rübben I. The acute scrotum in childhood and adolescence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:449-57; quiz 458. [PMID: 22787516 DOI: 10.3238/arztebl.2012.0449] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 03/28/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The acute scrotum in childhood or adolescence is a medical emergency. Inadequate evaluation and delays in diagnosis and treatment can result in irreversible harm, up to and including loss of a testis. Various diseases can produce this clinical picture. The testis is ischemic in only about 20% of cases. METHODS This review is based on a selective literature search, the existing clinical guideline, and the authors' experience. RESULTS The clinical approach to the acute scrotum must begin with a standardized, rapidly performed diagnostic evaluation. Dopper ultrasonography currently plays a central role. Its main use is to demonstrate the central arterial blood supply and venous drainage of the testis. The resistance index of the testicular vessels should also be determined. CONCLUSION Physical examination and properly performed Doppler ultrasonography enable adequate evaluation of the acute scrotum in childhood and adolescence. In the rare cases of diagnostic uncertainty, immediate surgical exposure of the testis remains the treatment of choice.
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Affiliation(s)
- Patrick Günther
- Sektion Kinderchirurgie, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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20
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Sonography of the Pediatric Scrotum: Emphasis on the Ts—Torsion, Trauma, and Tumors. AJR Am J Roentgenol 2012; 198:996-1003. [DOI: 10.2214/ajr.11.8034] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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21
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Sonographic Patterns of Testicular Torsion. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2011. [DOI: 10.1177/8756479311419503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to determine the sonographic patterns of the testes in patients with testicular torsion. Clinical data of 46 patients with testicular torsion confirmed by surgical exploration or manual detorsion were reviewed, and sonographic patterns of testicular torsion were categorized according to the sonographic characteristics of the testes, and their relation to the pathologic changes were analyzed. The sonographic appearances of testicular torsion were categorized into six patterns, reflecting pathologic changes of testicular torsion. Sonography of testicular torsion has different patterns, and recognition of these patterns may help the examiner establish a diagnosis and subsequently manage the patient.
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