[Should scrotal ultrasound be discouraged in cases of suspected spermatic cord torsion?].
OBJECTIVE
To assess the value of scrotal ultrasound to guide the diagnosis of torsion of the spermatic cord.


METHODS
Retrospective study from January 1995 to June 2001. One hundred and sixty eight patients were admitted to the emergency department with an empirical diagnosis of torsion of the spermatic cord. Scrotal ultrasound was performed when there was a doubt about the diagnosis or in the presence of atypical clinical features. All patients underwent surgical exploration of the scrotum. Two groups were distinguished: torsion and no torsion. We evaluated the contribution of ultrasound signs.


RESULTS
Scrotal ultrasound was performed in 66 cases (39%) and suggested the diagnosis of torsion in 30 cases and showed no signs of torsion in 36 cases. Seven of these 36 cases actually presented torsions confirmed by surgical exploration (false-negative), corresponding to a sensitivity of 79% and a specificity of 88%. The interval between arrival of the patient in the emergency department and scrotal exploration was 2.6-fold longer when scrotal ultrasound was performed (p < 0.001). Surgical exploration identified 99 torsions (59%). Orchidectomy had to be performed in 15 cases (15% of torsions). However, the need for orchidectomy was not significantly different according to whether or not scrotal ultrasound was performed (p = 0.08).


CONCLUSIONS
As scrotal ultrasound gave false-negative results in 10% of cases and delayed surgery, we do not recommend this examination as an emergency investigation. Systematic surgical exploration of the scrotum in all cases of painful testis must be performed urgently without preoperative morphological assessment.
Zini
Laurent
L
Clinique d'Urologie, Hôpital Huriez, 59037 Lille. laurentzini@wanadoo.fr
Mouton
Damien
D
Leroy
Xavier
X
Valtille
Pierre
P
Villers
Arnauld
A
Lemaitre
Laurent
L
Biserte
Jacques
J
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012611:Scrotum / Q000000981:diagnostic imaging; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging* / Q000601:surgery; D014463:Ultrasonography