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Kummari S, Das S, Mahajan S. Role of High-Resolution Ultrasonography With Colour and Duplex Doppler in the Evaluation of Acute Scrotal Diseases. Cureus 2023; 15:e49231. [PMID: 38143647 PMCID: PMC10739279 DOI: 10.7759/cureus.49231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction The term 'acute scrotum' denotes the sudden initiation of pain in the scrotal region. Acute scrotum is a frequent medical condition in children and adults. Ultrasound facilitates precise diagnosis and differentiation of numerous causes of acute scrotum. The objective of our research was to assess the utility of ultrasonography in the identification and prevalence determination of causes of acute scrotum. Materials and methods Patients with acute scrotal pain referred to the Department of Radiodiagnosis at Great Eastern Medical School & Hospital (GEMS), Srikakulam, India, were added in the research. This is a prospective observational study. High-frequency linear transducer (4-15 MHz) was used for imaging. Grey scale, colour and duplex Doppler were performed routinely. The ultimate diagnosis was established by considering the clinical results, follow-up observations, intraoperative observations and, when accessible, histopathological analysis. For the statistical analysis, IBM SPSS Statistics for Windows, version 22 (released 2013; IBM Corp., Armonk, New York, United States). was used. Descriptive analysis was conducted. The Kendall rank correlation coefficient was used to evaluate the non-parametric association between side and torsion. Results A total of 120 patients were included for statistical analysis. Inflammatory pathology was the most common cause of acute scrotum, followed by testicular torsion and torsion of testicular appendage. Testicular torsion and side of pain did not show a significant association. Conclusion High-resolution ultrasonography with colour and duplex Doppler sonography is an excellent imaging modality exhibiting exceptional sensitivity and specificity for the accurate diagnosis of acute scrotal diseases. Inflammatory pathology was the most common cause of acute scrotum, followed by testicular torsion and torsion of the testicular appendage.
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Affiliation(s)
| | - Saraswata Das
- Department of Radiodiagnosis, College of Medicine and JNM Hospital, Kalyani, IND
| | - Suvanya Mahajan
- Department of Radiology, Government Medical College, Jammu, Jammu, IND
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2
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Lukosiute-Urboniene A, Nekrosius D, Dekeryte I, Kilda A, Malcius D. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Emerg Med J 2023; 40:134-139. [PMID: 36526335 DOI: 10.1136/emermed-2021-211946] [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: 08/18/2021] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND We sought to determine which demographic, clinical and ultrasonography characteristics are predictive of testicular torsion (TT) and to determine factors associated with time to treatment. METHODS We retrospectively reviewed all medical records of patients (0-17 years) with acute scrotal syndrome (ASS) who were treated in our hospital in Lithuania between 2011 and 2020. We extracted patients' demographic data, in-hospital time intervals, clinical, US and surgical findings. TT was determined at surgery or clinically after manual detorsion. Test characteristics of demographic, clinical and US findings for the diagnosis of TT versus other causes of ASS were determined. We performed a multivariate analysis to identify independent clinical predictors of torsion, and factors associated with surgical delay. RESULTS A search of medical records yielded 555 cases: 196 (35%) patients with TT and 359 (65%) patients with other ASS causes. Multivariate logistic regression analysis showed that age between 13 and 17 years (OR 8.39; 95% CI 5.12 to 13.76), duration of symptoms <7 hours (OR 3.41; 95% CI 2.03 to 5.72), palpated hard testis (OR 4.65; 95% CI 2.02 to 10.67), scrotal swelling (OR 2.37; 95% CI 1.31 to 4.30), nausea/vomiting (OR 4.37; 95% CI 2.03 to 9.43), abdominal pain (OR 2.38; 95% CI 1.27 to 4.45) were independent clinical predictors of TT. No testicular blood flow in Doppler US had a specificity of 98.2% and a positive predictive value of 94.6%. However, 75 (41.7%) patients with TT had normal testicular blood flow, yielding low sensitivity (58.3%) and negative predictive value of 81.3% for this US finding. In-hospital waiting time for surgery was longer in patients with TT with normal testicular blood flow by USS (195 min) compared with no blood flow (123 min), p<0.01. Higher orchiectomy rates were associated with longer duration of symptoms (p<0.001) and longer waiting time for USS (p=0.029) but not with false-negative US. CONCLUSIONS Pubertal age, symptoms duration of <7 hours, nausea/vomiting, palpated hard testis, abdominal pain and scrotal swelling are predictive factors for TT. Time lost between symptom onset and seeking medical care, and between arrival and US are associated with the need for orchiectomy. Preserved blood flow in USS does not rule out TT and may contribute to delays to surgery.
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Affiliation(s)
- Ausra Lukosiute-Urboniene
- Department of Pediatric Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Pediatric Surgery, Lithuanian University of Health Sciences Hospital Kauno klinikos, Kaunas, Lithuania
| | - Deividas Nekrosius
- Department of Pediatric Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Pediatric Surgery, Lithuanian University of Health Sciences Hospital Kauno klinikos, Kaunas, Lithuania
| | - Inga Dekeryte
- Department of Pediatric Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Pediatric Surgery, Lithuanian University of Health Sciences Hospital Kauno klinikos, Kaunas, Lithuania
| | - Arturas Kilda
- Department of Pediatric Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Pediatric Surgery, Lithuanian University of Health Sciences Hospital Kauno klinikos, Kaunas, Lithuania
| | - Dalius Malcius
- Department of Pediatric Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Pediatric Surgery, Lithuanian University of Health Sciences Hospital Kauno klinikos, Kaunas, Lithuania
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3
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Hanumanthappa J, Naushad VA, Mohammed O, Ariboyina AK, Chellapandian SB, Mat Khan SK. Evaluating Acute Testicular Pain Using Point-of-Care Hand-Held Doppler in the Emergency Department: A Prospective Pilot Study. Cureus 2021; 13:e17699. [PMID: 34650873 PMCID: PMC8487873 DOI: 10.7759/cureus.17699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Testicular pain is one of the common conditions in patients visiting the emergency department. The causes of acute testicular pain vary from non-urgent inflammatory conditions like epididymo-orchitis to testicular torsion which is a surgical emergency. Early diagnosis of testicular torsion with early initiation of appropriate surgical intervention helps in salvaging the testes. There is a need for a simple, rapid bedside diagnostic tool for the evaluation and triaging of subjects with acute testicular pain in the emergency department. The aim of this study is to determine whether hand-held Doppler (HHD) examination by the emergency department (ED) physician can safely rule out testicular torsion in a case of acute testicular pain. Materials and Methods A prospective pilot study was conducted in the emergency department of Alkhor Hospital, Hamad Medical Corporation, Qatar. The subjects between 18 to 50 years of age who presented to the ED with testicular pain were included. Subjects with recent trauma to the scrotum, or recent genitourinary surgery and those who had pain for more than 48 hours were excluded. Point-of-care HHD was done by a single ED physician who was blinded for the Doppler study results done by the radiologist. The results of the HHD performed by the ED physician and Doppler study performed by the radiologist were compared and analyzed. Results Forty-five patients were included in the study. The mean age was 28 years and the mean duration of pain was 20 hours. HHD ruled out testicular torsion in 44 subjects with a specificity of 97.8%. In one subject, HHD was reported as torsion testis which was ruled out by the radiologist. The radiologist Doppler ruled out torsion in all 45 subjects. Conclusion The diagnostic performance of HHD by the ED physicians was almost equal to that of radiologists in ruling out testicular torsion. HHD can be used as a first-line triaging tool by the ED physician to rule out torsion of testis in patients presenting with acute testicular pain. We conclude that patients with testicular pain with a negative HHD for torsion testis can be safely discharged from the emergency department.
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Affiliation(s)
| | - Vamanjore A Naushad
- College of Medicine, Qatar University, Doha, QAT.,Internal Medicine, Weill Cornell, Doha, QAT.,General Internal Medicine, Hamad General Hospital /Hamad Medical Corporation, Doha, QAT
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4
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Acute scrotal pain in pediatric patients: diagnosis with an innovative Doppler technique (MicroV). Emerg Radiol 2020; 28:209-214. [PMID: 32591921 DOI: 10.1007/s10140-020-01812-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
Acute scrotal pain is one of the most frequent symptoms in pediatric patients visited in the Emergency Department. Ultrasonography with color and power Doppler represents the first-line method that clinicians use to carry out the differential diagnosis between spermatic cord torsion and inflammation, but sensitivity and specificity are 63-100% and 97-100%, respectively; this variability may be related to operator's experience and testis vascular hemodynamics and also to machine performance and patient age. Recent technological innovations have made possible to create a new Doppler mode called ultrasound microvascular imaging. This technique exploits algorithms capable of separating low frequencies of static tissue artifacts from ones of very weak flows. It is known as MicroV (from Esaote) and Superb microvascular imaging (from Toshiba). It provides both macrocirculation vascular maps, as a typical Doppler feature, and microcirculation vascular maps. Furthermore, the use of background subtraction could improve the visibility of small vascular structures. We report a case of a pediatric patient suffering from acute scrotal pain assessed ultrasonographically with this innovative Doppler technique (MicroV) that may give more confidence in detecting testicular vascular signals if compared with traditional Doppler techniques.
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5
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Zitek T, Ahmed O, Lim C, Carodine R, Martin K. Assessing the Utility of Ultrasound and Urinalysis for Patients with Possible Epididymo-Orchitis - A Retrospective Study. Open Access Emerg Med 2020; 12:47-51. [PMID: 32214857 PMCID: PMC7081061 DOI: 10.2147/oaem.s234413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/18/2020] [Indexed: 01/13/2023] Open
Abstract
Purpose Many experts recommend ordering an ultrasound and a urinalysis on all patients with scrotal pain. While the ultrasound may help diagnose a number of potential causes of scrotal pain, the urinalysis primarily has value in assessing for epididymo-orchitis. This study sought to evaluate the utility of these diagnostic tests for patients who presented to the emergency department (ED) with acute scrotal pain and possible epididymo-orchitis. Patients and Methods This was a single-center chart review of patients presenting to the ED with scrotal pain. Trained research assistants reviewed charts to obtain urinalysis and ultrasound results as well as diagnoses and treatments provided. Using the final diagnosis as a gold standard, the sensitivity and specificity of ultrasound and urinalysis were calculated for the diagnosis of epididymo-orchitis. Also, through a prespecified definition of “changed management,” we estimated the percentage of cases in which a urinalysis changed management of patients with acute scrotal pain. Results We identified 663 adult and pediatric patients who presented with scrotal pain during 2016. All patients had an ultrasound performed, and 458 (69.1%) had a urinalysis done. The sensitivity of urinalysis for epididymo-orchitis was 58.2% (95% CI 48.9% to 67.1%), and the specificity was 85.1% (95% CI 80.8% to 88.7%). For ultrasound, the sensitivity was 78.8% (95% CI 71.4% to 85.0%) and the specificity was 98.1% (95% CI 96.4% to 99.1%). In 24 of 458 cases (5.2% [95% CI 3.4% to 7.7%]) where a urinalysis was obtained, its results may have changed management of the patient. Conclusion The diagnosis of patients who present to the ED with scrotal pain is primarily driven by the ultrasound results. While the urinalysis may occasionally provide some benefit in the evaluation of patients with suspected epididymo-orchitis, the reflexive ordering of a urinalysis in patients with scrotal pain may be unnecessary.
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Affiliation(s)
- Tony Zitek
- Department of Emergency Medicine, University Medical Center of Southern Nevada, Las Vegas, NV, USA.,Department of Emergency Medicine, Kendall Regional Medical Center, Miami, FL, USA.,Department of Emergency Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Omar Ahmed
- Department of Emergency Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Chee Lim
- Touro University Nevada College of Osteopathic Medicine, Henderson, NV, USA
| | - Rianda Carodine
- Department of Emergency Medicine, University Medical Center of Southern Nevada, Las Vegas, NV, USA.,University of Nevada, Las Vegas, NV, USA
| | - Kent Martin
- Department of Emergency Medicine, Kendall Regional Medical Center, Miami, FL, USA
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6
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Guo X, Sun L, Lei W, Li S, Guo H. Management of testicular torsion <360° in children: a single-center, retrospective study. J Int Med Res 2020; 48:300060519895861. [PMID: 31891289 PMCID: PMC7645356 DOI: 10.1177/0300060519895861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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.
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Affiliation(s)
- Xiang Guo
- Urology Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Lan Sun
- Department of Dermatology, the First Hospital of Wuhan, Wuhan, China
| | - Wei Lei
- Urology Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Shuang Li
- Urology Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Hui Guo
- Urology Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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7
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Tokuda B, Kiba M, Yamada K, Nagano H, Miura H, Goto M, Yamada K. The split sign: The MRI equivalent of the bell clapper deformity. Br J Radiol 2019; 92:20180312. [PMID: 30604623 DOI: 10.1259/bjr.20180312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
METHODS: The cases of eight patients who underwent MRI and surgery for acute scrotum between January 2010 and January 2017 were evaluated. We recorded whether hyperintense fluid on T2 weighted images existed between the posterior aspect of the epididymis and the scrotal wall ("split sign") and investigated if it correlated with BCD in surgical findings. RESULTS: In one patient without hydrocele, readers were unable to evaluate the anatomy of the tunica vaginalis. Among seven patients with hydrocele, five had the split sign and all were surgically confirmed as BCD. In two patients with hydrocele but no split sign, one had normal scrotal anatomy and the other had a BCD with a necrotic testis adherent to the scrotal wall. CONCLUSION: The split sign on MRI corresponded well to the lack of fixation of the epididymis to the scrotal wall and detected BCD with high sensitivity (5/6). ADVANCES IN KNOWLEDGE: A hyperintense area on T2 weighted image between the posterior aspect of the epididymis and scrotal wall ("split sign") is a useful MRI finding for diagnosing BCD.
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Affiliation(s)
- Bunta Tokuda
- 1 Department of Radiology, Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Maki Kiba
- 1 Department of Radiology, Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Kaori Yamada
- 1 Department of Radiology, Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Hitomi Nagano
- 1 Department of Radiology, Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Hiroshi Miura
- 1 Department of Radiology, Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Mariko Goto
- 1 Department of Radiology, Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Kei Yamada
- 1 Department of Radiology, Kyoto Prefectural University of Medicine , Kyoto , Japan
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8
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Gkolezakis V, Petrolekas A, Koutsouri A, Ouranos V, Arapantoni P, Sidiropoulos P. [Segmental testicular infarction]. Urologe A 2018; 57:947-950. [PMID: 30014277 DOI: 10.1007/s00120-018-0721-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Segmental testicular infarction is a rare cause of acute scrotum and only a few cases have been reported. Torsion of the testis, testicular tumor and infection are important differential diagnoses. The present case report describes a 61-year-old man with left-sided testicular pain increasing over 24 h. The diagnosis of segmental testicular infarction was considered after color Doppler ultrasound of the left scrotum and it was confirmed by surgical exploration and pathological examination. Although it is uncommon, segmental testicular infarction should be taken into consideration when acute scrotal pain is encountered, especially for younger patients, since a testis-sparing treatment strategy can be performed.
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Affiliation(s)
- V Gkolezakis
- Urologische Klinik und Poliklinik, Errikos Ntynan Hospital Center, Leoforos Mesogeion 107, 11526, Athen, Griechenland.
| | - A Petrolekas
- Urologische Klinik und Poliklinik, Errikos Ntynan Hospital Center, Leoforos Mesogeion 107, 11526, Athen, Griechenland
| | - A Koutsouri
- Klinik und Poliklinik für Innere Medizin, Errikos Ntynan Hospital Center, Athen, Griechenland
| | - V Ouranos
- Klinik und Poliklinik für Radiologie, Errikos Ntynan Hospital Center, Athen, Griechenland
| | - P Arapantoni
- Pathologisches Institut, Errikos Ntynan Hospital Center, Athen, Griechenland
| | - P Sidiropoulos
- Urologische Klinik und Poliklinik, Errikos Ntynan Hospital Center, Leoforos Mesogeion 107, 11526, Athen, Griechenland
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9
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McDowall J, Adam A, Gerber L, Enyuma COA, Aigbodion SJ, Buchanan S, Laher AE. The ultrasonographic "whirlpool sign" in testicular torsion: valuable tool or waste of valuable time? A systematic review and meta-analysis. Emerg Radiol 2018; 25:281-292. [PMID: 29335899 DOI: 10.1007/s10140-018-1579-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/03/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE A positive whirlpool sign (WS) is defined as the presence of a spiral-like pattern when the spermatic cord is assessed during ultrasonography (US), using standard, high-resolution ultrasonography (HRUS) and/or color Doppler sonography (CDS), in the presence of testicular torsion. The objective of this review was to assess the validity and accuracy of this sign by performing a comprehensive systematic literature review and meta-analysis. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a comprehensive literature search was performed (August, 2017), using the following databases: BMJ Best Practice, Cochrane Library, Embase, PubMed, Scopus, and Web of Science. Selected studies were further assessed for relevance and quality using the Oxford 2010 Critical Appraisal Skills Program (CASP). RESULTS Of the studies assessed, a total of 723 participants were included, with a mean of 72.3 (SD 71.9) participants. Of the participants, 226 (31.3%) were diagnosed with testicular torsion (TT). Meta-analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity of the WS of 0.73 (95% CI, 0.65-0.79) and 0.99 (95% CI, 0.92-0.99), respectively. Removal of all neonates increased the pooled sensitivity to 0.92 (95% CI, 0.70-0.98) while the pooled specificity remained almost unchanged at 0.99 (95% CI, 0.95-1.00). The estimated summary effect of all studies with sufficient data was 4.34 (95% CI, 1.01-7.67; n = 394; p = 0.001). A large degree of heterogeneity was suggested by an I2 statistic of 88.27% (95% CI, 68.60-98.68%). Removal of neonatal subjects increased the estimated summary effect to 5.32 (95% CI, 1.59-9.05; n = 375; p = 0.001). CONCLUSION The WS, when correctly diagnosed, may be viewed as a very definitive sign for TT in the pediatric and adult populations. However, its role in neonates is limited.
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Affiliation(s)
- Jared McDowall
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Ahmed Adam
- Division of Urology, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louis Gerber
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Callistus O A Enyuma
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa.,Department of Paediatrics, Faculty of Medicine, University of Calabar, Calabar, Nigeria
| | - Sunday J Aigbodion
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Sean Buchanan
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa.,Africa Institute of Emergency Medicine, Johannesburg, South Africa
| | - Abdullah E Laher
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa
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10
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Kashanian JA, Mazur DJ, Hehemann MC, Morrison CD, Oberlin DT, Raup VT, Choi AW, Trinh B, Said MA, Keeter MK, Brannigan RE. Scrotal Ultrasound for Pain: Low Frequency of Absolute Surgical Indications. Urology 2017; 108:17-21. [PMID: 28705576 DOI: 10.1016/j.urology.2017.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/10/2017] [Accepted: 03/18/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the results of scrotal ultrasounds (US) conducted for scrotal or testicular pain and review the pathologic findings of orchiectomies done for lesions that were suspicious for malignancy on US. MATERIALS AND METHODS We retrospectively reviewed the indications and findings of all scrotal US completed at our institution from 2002 to 2014. If a patient underwent an orchiectomy for an intratesticular lesion that was concerning for malignancy on US, the pathology report was also reviewed. RESULTS There were 18,593 scrotal US performed, with 7,668 (41.2%) conducted for scrotal pain. Of the US performed for pain, 80.4% revealed benign or normal findings, and only 2.2% demonstrated a finding that is an absolute indication for surgery (intratesticular lesion suspicious for malignancy 0.8%, abscess 0.7%, torsion 0.6%, infiltrative process such as lymphoma 0.1%). For those patients undergoing an orchiectomy, 75% had malignancy on pathologic analysis. CONCLUSION The majority of the 7668 US performed to evaluate scrotal or testicular pain reveal normal or benign findings. A low percentage demonstrates a finding that necessitates urgent or emergent surgery.
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Affiliation(s)
- James A Kashanian
- Department of Urology, Weill Cornell Medicine, Weill Cornell Medical College, New York, NY
| | - Daniel J Mazur
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Marah C Hehemann
- Department of Urology, Loyola University Health System, Maywood, IL
| | - Christopher D Morrison
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniel T Oberlin
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Valary T Raup
- Department of Surgery, Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew W Choi
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brian Trinh
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mohammed A Said
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Mary Kate Keeter
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Robert E Brannigan
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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11
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Weatherspoon K, Polansky S, Catanzano T. Ultrasound Emergencies of the Male Pelvis. Semin Ultrasound CT MR 2017; 38:327-344. [PMID: 28865524 DOI: 10.1053/j.sult.2017.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Male pelvic emergencies are uncommon, and symptoms typically include scrotal pain, scrotal enlargement, or a palpable scrotal mass or all of these. Ultrasound is often the first-line modality for evaluation of male pelvic emergencies, which may be stratified into vascular, infectious, or traumatic causes. Entities such as testicular torsion, Fournier gangrene, and testicular dislocation are surgical emergencies and should not be missed or misdiagnosed, as this may cause a significant delay in urgently necessary treatment. Radiologists need to be familiar with the role of imaging as well as the key characteristic imaging findings of these injuries to direct the appropriate management.
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Affiliation(s)
- Kimberly Weatherspoon
- Department of Radiology, Radiology resident Baystate Medical Center, University of Massachusetts, Springfield, MA.
| | - Stanley Polansky
- Department of Radiology, Assistant Professor Baystate Medical Center, University of Massachusetts, Springfield, MA
| | - Tara Catanzano
- Department of Radiology, Program Director Radiology Residency Program, Baystate Medical Center, University of Massachusetts, Springfield, MA
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12
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13
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Lorenzo L, Rogel R, Sanchez-Gonzalez JV, Perez-Ardavin J, Moreno E, Lujan S, Broseta E, Boronat F. Evaluation of Adult Acute Scrotum in the Emergency Room: Clinical Characteristics, Diagnosis, Management, and Costs. Urology 2016; 94:36-41. [PMID: 27210570 DOI: 10.1016/j.urology.2016.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 04/18/2016] [Accepted: 05/05/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the clinic characteristics, diagnosis, management, and costs of the adult acute scrotum in the emergency room (ER). Acute scrotum is a syndrome characterized by intense, acute scrotal pain that may be accompanied by other symptoms. It is usual in children and commonly found as well in adults, with different causal pathologies between these groups. METHODS Between November 2013 and September 2014, 669 cases of adult acute scrotum who presented to our ER were prospectively analyzed. Patients under 15 years of age were excluded. Patient age, reason for consultation, investigations performed, final diagnosis, management, and costs were evaluated. For the statistical analysis, the Mann-Whitney, Kruskal-Wallis U, and chi-square tests were used. RESULTS A total of 669 cases of acute scrotum were analyzed. The mean age at presentation was 40.2 ± 17.3 years. The most presented diagnoses were orchiepididymitis (28.7%), epididymitis (28.4%), symptoms of uncertain etiology (25.1%), and orchitis (10.3%). Diagnostic tests were carried out in 57.8% of cases. Most cases were treated as outpatients (94.2%), with 5.83% admitted and 1% undergoing surgical treatment. Overall, 13.3% of patients represented to the ER. Abnormal results in blood and urine tests were more common among older patients and infectious pathologies. The average cost generated by an acute scrotum ER consult was 195.03€. CONCLUSION Infectious pathologies are the most common causes of acute scrotum at ER. Abnormal blood and urine tests are unusual and are more common in older patients and infectious pathologies.
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Affiliation(s)
- Laura Lorenzo
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Ramon Rogel
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain.
| | | | - Javier Perez-Ardavin
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Elena Moreno
- Department of Biological Statistics, Instituto de Investigaciones Sanitarias La Fe, Valencia, Spain
| | - Saturnino Lujan
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Enrique Broseta
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Francisco Boronat
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain
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Güneş M, Umul M, Çelik AO, Armağan HH, Değirmenci B. A novel approach for manual de-torsion of an atypical (outward) testicular torsion with bedside Doppler ultrasonography guidance. Can Urol Assoc J 2015; 9:E676-8. [PMID: 26425241 DOI: 10.5489/cuaj.2849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 17-year-old boy presented with right testicular torsion to the lateral side. Torsion was diagnosed by physical examination; the colour Doppler ultrasonography (CDU) confirmed right testicular torsion with minimal peripheral hydrocele. Transverse and longitudinal examination of the spermatic cord with ultrasound and CDU revealed a counter-clockwise testicular torsion. Manual de-torsion was performed in a clockwise direction (720o) and testicular blood flow and the neutral position of the spermatic cord were confirmed by CDU. We did not encounter a residual twist of the spermatic cord upon surgical exploration. In our experience, ultrasound and CDU may predict the direction of testicular torsion and may allow appropriate management of cases prior to surgery.
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Affiliation(s)
- Mustafa Güneş
- Department of Urology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Mehmet Umul
- Department of Urology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Ahmet Orhan Çelik
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Hamit Hakan Armağan
- Department of Emergency Medicine, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Bumin Değirmenci
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
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