An analysis of clinical outcomes using color doppler testicular ultrasound for testicular torsion.
OBJECTIVE
To delineate the clinical outcomes of color Doppler ultrasound (US) in the equivocal torsion patient.


METHODS
From 1992 to 1997, 130 patients (<23 years old) from 2 institutions underwent US imaging using a 7.5-mHz linear transducer to evaluate an acute scrotum equivocal, or of low suspicion, for torsion. The US reports and hospital charts of these patients were retrospectively reviewed.


RESULTS
After clinical and radiologic evaluation, torsion was excluded in 110 patients without surgical exploration. In 3 patients, intermittent testicular torsion was diagnosed and in 17 patients, emergent exploration was performed for US diagnosis of testicular torsion. Twenty-five patients (22.7%) were subsequently lost to follow-up. Follow-up of 85 patients with US negative for torsion (mean length of follow-up = 466.9 days) revealed no testicular atrophy in 83. Two patients underwent delayed orchiectomy/contralateral orchiopexy for missed testicular torsion. Of 17 patients with US positive for torsion, 9 underwent orchiectomy for a necrotic torsed testis, 7 viable torsed testes were found, and 1 torsed appendix testis was found. Therefore, color Doppler US for the equivocal acute scrotum yielded a 1% false-positive rate, sensitivity of 88.9%, and specificity of 98.8%.


CONCLUSIONS
When faced with ruling out testicular torsion, it is necessary to integrate the multiple pieces of patient data, knowing that each piece of data may have inaccuracies. With this in mind, this analysis of outcomes verifies that color Doppler US is an excellent adjunctive study in the clinically real situation in which the clinical evaluation is equivocal or low suspicion.
Baker
L A
LA
Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD 21287-2101, USA.
Sigman
D
D
Mathews
R I
RI
Benson
J
J
Docimo
S G
SG
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D009336:Necrosis; D009919:Orchiectomy; D011237:Predictive Value of Tests; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging* / Q000601:surgery; D013737:Testis / Q000098:blood supply*; D018615:Ultrasonography, Doppler, Color