Hendrikx AJ, Dang CL, Vroegindeweij D, Korte JH.
B-mode and colour-flow duplex ultrasonography: a useful adjunct in diagnosing scrotal diseases?
Br J Urol. 1997 Jan;79(1):58-65. doi: 10.1046/j.1464-410x.1997.30213.x.
Abstract/Text
OBJECTIVE: To determine the value of ultrasonography (US) and colour-flow duplex ultrasonography (CFD) as routine investigations in the diagnosis of scrotal pathologies.
PATIENTS AND METHODS: The imaging techniques were applied to 215 consecutive patients with scrotal complaints. The diagnosis of a urologist (D1, made from the patient's history, physical examination and laboratory results) and that of the radiologist (D2, using US and CFD) were compared with the "gold standard' (D3, the operative findings and course of the disease). The sensitivity and specificity of the diagnostic pathways (D1, D2) were determined statistically and compared with D3.
RESULTS: The final diagnoses (D3) were testicular torsion (13 patients), torsion of the appendix testis (5), epididymitis (42), inguinal hernia (7), tumour (11), trauma (9), hydrocele (46), epididymal cyst (37), orchitis (10), varicocele (46) and other diagnoses (8). Using D1, the urologist missed seven diagnoses, of which one was a patient with a testicular torsion combined with an inguinal hernia, and one a patient with a tumour. Using US and CFD (D2), the radiologist missed five diagnoses, including one patient with combined testicular torsion and inguinal hernia.
CONCLUSION: For the diagnosis of scrotal disorders, the basic clinical evaluation usually provides the correct diagnosis. However, US and CFD are useful adjuncts which cause a minimal burden to the patient and that in most cases will lead to the correct diagnosis, especially with important diagnoses like testicular torsion, when US and CFD should be performed immediately. If this does not provide a clear diagnosis, the patient should be explored surgically.
Herbener TE.
Ultrasound in the assessment of the acute scrotum.
J Clin Ultrasound. 1996 Oct;24(8):405-21. doi: 10.1002/(SICI)1097-0096(199610)24:8<405::AID-JCU2>3.0.CO;2-O.
Abstract/Text
Color Doppler imaging (CDI) has become the study of choice in evaluation of the scrotum due to technological advances resulting in superior resolution and sensitive Doppler systems. CDI has become particularly helpful in evaluating the scrotum in the setting of acute disorders, such as torsion of the spermatic cord, epididymal and testicular inflammation, and scrotal trauma. CDI should be the study of choice to evaluate for torsion of the spermatic cord and demonstrates a high degree of accuracy. CDI in such a setting, however, does require operator experience, sensitive Doppler ultrasound equipment, and operator knowledge of the limitations of CDI. With epididymitis or epididymo-orchitis, CDI has proven to be quite helpful in evaluating the scrotal contents for the presence of inflammation and associated complications. In scrotal trauma, CDI's utility remains somewhat controversial, but with further investigation its appropriate application in this situation may become clear.
Thomas WE, Cooper MJ, Crane GA, Lee G, Williamson RC.
Testicular exocrine malfunction after torsion.
Lancet. 1984 Dec 15;2(8416):1357-60. doi: 10.1016/s0140-6736(84)92056-7.
Abstract/Text
The exocrine and endocrine functions of the testis were assessed in 67 patients a median of 4.0 years after unilateral torsion (range 3 months-12 years). Of 54 patients who underwent orchidopexy, some atrophy of the affected testis developed in 46; the degree of atrophy was significantly correlated with the duration of torsion (r = -0.56, p less than 0.001). The remaining 13 patients had undergone orchidectomy after a mean duration of torsion of 71 h. Seminal analysis was abnormal in 44 of 51 patients tested (86%), and the low total motile sperm count correlated with the duration of torsion (r = -0.53, p less than 0.001). Sperm counts were much lower in men with torsion for longer than 8 h than those with a shorter period of torsion (median 7.2 X 10(6) v 83.5 X 10(6); p less than 0.00003). Serum levels of luteinising hormone, prolactin, testosterone, and follicle-stimulating hormone were generally within normal limits. An acute ischaemic episode affecting only one testis causes bilateral loss of exocrine function in most patients, while endocrine function is preserved.
Scott JH 3rd, Harty JI, Howerton LW.
The management of testicular torsion in the acute pediatric scrotum.
J Urol. 1983 Mar;129(3):558-60. doi: 10.1016/s0022-5347(17)52236-3.
Abstract/Text
From July 1976 through June 1981, 51 children with acute scrotal pain and swelling underwent surgical exploration. Testicular torsion (27 cases) and torsion of an appendage (18 cases) were the most common diagnoses. In the group with testicular torsion 5 testes were considered unsalvageable and these were removed. The remaining 22 testes, including those of questionable viability, were left in place. The early salvage rate of 81 per cent decreased to 50 per cent due to testicular atrophy found in the late followup period. The attempt to salvage all testes except those with obvious necrosis resulted in minimal morbidity. This approach is discussed in view of recent reports of long-term damage to the contralateral testis when an ischemic testis is not removed initially.
King LM, Sekaran SK, Sauer D, Schwentker FN.
Untwisting in delayed treatment of torsion of the spermatic cord.
J Urol. 1974 Aug;112(2):217-21. doi: 10.1016/s0022-5347(17)59690-1.
Abstract/Text
