Scrotal Scintigraphy in Testicular Torsion

Testicular torsion: a review

Torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of debate among physicians and surgeons. Testicular torsion is an acute vascular event causing the rotation of the vascular pedicle of the testis, thereby impeding the blood flow to the testis and the scrotal contents. It could be either within or outside the tunica vaginalis. Testicular torsion causes immediate circulatory changes and long-term sequelae such as testicular function and fertility. It is considered a surgical emergency, as a delay causes irreversible testicular damage. The diagnosis and treatment of testicular torsion are discussed in this review, which also illustrates an algorithm and a scoring system for the diagnosis and management of this condition based on current literature.

Clinical and imaging features of testicular torsion: role of ultrasound

The early and accurate diagnosis of testicular torsion remains a clinical challenge. The implications of a missed diagnosis have emphasized the need for a non-invasive test for confirming testicular ischaemia; a problem highlighted by difficulties in establishing the diagnosis clinically. Understandably, the advent of colour Doppler ultrasound (CDUS) (and subsequently 'power' Doppler and microbubble ultrasound contrast), has been greeted with enthusiasm. However, as in other fields of medicine, a policy placing sole reliance on a single technique is likely to be flawed. This review will critically evaluate the role of CDUS and other imaging modalities in the diagnosis of testicular torsion.

The acute pediatric scrotum

The acute pediatric scrotum is a common clinical condition that can present a diagnostic dilemma for even the most experienced physician. The issue of primary importance in each case is to ensure testicular viability through proper evaluation, prompt diagnosis, and surgical intervention if necessary. A review of the various etiologies of acute scrotal disorders in children aids in the formulation of a logical and systematic approach to their accurate diagnosis and management.

The role of nuclear medicine in the evaluation of the male genital tract

Scintigraphic techniques for evaluation of impotence are still evolving. Blood pool studies are most useful in assessing the integrity of arterial inflow, but may also be used to generate indices of venous leak. A non-imaging version of this test may represent a simple and cost-effective alternative. Washout of intracavernosal xenon during erection seems the most useful method of testing venous integrity. Washout using Tc-RBC may emerge as a convenient alternative to the more technically difficult xenon examinations. Development of more effective pharmacologic stimuli may further improve the utility of this quantitative and physiologic examination.