Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. It accounts for 10% to 15% of acute scrotal disease in children, and results in an orchiectomy rate of 42% in boys undergoing surgery for testicular torsion. Prompt recognition and treatment are necessary for testicular salvage, and torsion must be excluded in all patients who present with acute scrotum. Testicular torsion is a clinical diagnosis, and patients typically present with severe acute unilateral scrotal pain, nausea, and vomiting. Physical examination may reveal a high-riding testicle with an absent cremasteric reflex. If history and physical examination suggest torsion, immediate surgical exploration is indicated and should not be postponed to perform imaging studies. There is typically a four- to eight-hour window before permanent ischemic damage occurs. Delay in treatment may be associated with decreased fertility, or may necessitate orchiectomy.

/pdf/testicular-torsion-diagnosis-evaluation-and-management-iw6d0cko8n.pdf

Testicular torsion: diagnosis, evaluation, and management.

A multitude of new chapters and comprehensive updates put the latest know-how at your fingertips, helping you to optimally manage young patients. A reorganized, streamlined table of contents and refined chapter template for medical emergencies, trauma, surgical emergencies, and behavioral health emergencies approaches pediatric emergencies the way you engage with them in practice. New clinical pathways section provide key steps for managing critical patients New related chapters feature in most chapters enables you to easily cross-reference content across chapters. New colorful design

Textbook of Pediatric Emergency Medicine

Development and initial validation of a scoring system to diagnose testicular torsion in children.

OBJECTIVE. Testicular torsion is a common acute condition in boys requiring prompt accurate management. The objective of this article was to evaluate ultrasound accuracy, findings, and clinical predictors in testicular torsion in boys presenting to the Stollery pediatric emergency department with acute scrotal pain. METHODS. Retrospective review of surgical and emergency department ultrasound records for boys from 1 month to 17 years old presenting with acute scrotal pain from 2008 to 2011 was performed. Clinical symptoms, ultrasound and surgical findings, and diagnoses were recorded. Surgical results and follow-up were used as the reference standard. RESULTS. Of 342 patients who presented to the emergency department with acute scrotum, 35 had testicular torsion. Of 266 ultrasound examinations performed, 29 boys had torsion confirmed by surgery. The false-positive rate for ultrasound was 2.6%, and there were no false-negative findings. Mean times from presentation at the emergency department to ultrasound...

https://www.ajronline.org/doi/pdfplus/10.2214/AJR.12.10036

Retrospective review of diagnosis and treatment in children presenting to the pediatric department with acute scrotum.

Objective

To test the clinical and sonographic predictors of testicular torsion (TT) with the aim of reducing negative exploration rates.




Patients and Methods

We performed a prospective study of all boys treated for ‘acute scrotum’ at our institute between January 2001 and April 2012 and clinical findings were documented.
If available, ultrasonography (US) was added to the diagnostic evaluation.
A prediction of the diagnosis was based on clinical and sonographic features, and was followed by surgical exploration in all patients.




Results

A total of 104 patients were included in the 16-month period of the study.
No single finding excluded TT. The clinical features (pain 55%.
Ultrasound predictors alone were not able to identify all boys with TT.




Conclusions

It is safe to refrain from routine surgical exploration in every child with acute scrotum if the clinical score is applied, which results in a marked reduction of negative explorations.
A reliable diagnosis could not be obtained based on US alone. As scrotal US is unpleasant for the child, we propose to refrain from this if the clinical score is positive. Patients with a negative clinical score are suitable candidates for US to establish and secure diagnosis.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/bju.12229

Clinical and sonographic features predict testicular torsion in children: a prospective study

Purpose:This study aimed to compare clinical manifestations, physical examination findings, laboratory, and radiographic dates in pediatric patients with different pathological diagnoses of acute scrotum as well as to accurately establish the true incidence of various pathological diagnoses of acute

Acute scrotum in children: an 18-year retrospective study.

In this paper, we evaluated the historical features and physical examination findings, as well as laboratory tests and ultrasound examinations, in children with testicular torsion (TT), in order to improve diagnosis and treatment in this population. A retrospective review of patients with diagnosis of TT between January 1990 and January 2010 was performed. We included 118 cases in the study, accounting for 9.01% of all cases of acute scrotum. Mean patient age was 9.3 ± 5.6 years. The left side was predominantly affected. The median duration of symptoms up to surgical exploration was 64 h. Absence of cremasteric reflex presented in 94.9% patients. All boys had an ultrasound of the scrotum; decreased or absent blood flow was observed in all orchidectomy patients. Heterogeneous echogenicity presented in all cases of orchidectomy. At surgery, viable testes were present in 46 boys (39%) and preserved; in 72 boys with nonviable testes, they were removed. The median duration of symptoms at presentation was 12 h when the testes were successfully conserved and 90 h when they were removed. Testicular salvage depends critically on early surgical intervention. Ultrasound is a useful tool for the clinical assessment of patients with TT, however, sonographic interpretation must be in conjunction with the clinical manifestations. We advocate immediate surgical exploration with suspected TT. Long-term hormonal levels are within the normal range regardless of the fate of the testis. Further follow-up is needed to confirm fertility after TT.

/pdf/testicular-torsion-in-children-a-20-year-retrospective-study-11yj9u8vad.pdf

Bin Song

Papers

Acute scrotum in children: an 18-year retrospective study.

Testicular Torsion in Children: A 20-Year Retrospective Study in a Single Institution