The Role of Gray-Scale Ultrasound in the Diagnosis of Postnatal Testicular Torsion in Children
https://doi.org/10.52560/2713-0118-2021-5-54-68
Abstract
Testicular torsion is a severe variant of postnatal gonad pathology in children. The speed of development of irreversible ischemic disorders determines not only the medical, but also the social significance of the problem and determines the need for accurate and rapid diagnosis and prompt provision of adequate care to the patient. The only objective method for diagnosing testicular torsion in children is ultrasound. At the same time, the characteristics of the child’s body: the small size of the object of study, low rates of intratesticular blood flow and restless behavior during the study sharply reduce the diagnostic value of the Doppler study or make it technically impossible. Thus, seroshkal ultrasound is the first stage of diagnosis of this complex emergency pathology, based on the results of which it is possible to diagnose testicular torsion with great accuracy. The publication summarizes our own experience of 110 echographic observations of postnatal testicular torsion in children older than 2 months, all cases were verified intraoperatively. A quantitative method for estimating the deformity of a twisted testicle is proposed and its statistical reliability is proved. The options presented for gray-scale changes in the structure of damaged gonads and determined their prognostic significance. The publication contains a review of the literature and is extensively illustrated.
About the Authors
E. B. Olkhova
Moscow State University of Medicine and Dentistry named after A. I. Evdokimov, Department of Radiology, Ministry of Healthcare of Russia; Moscow Clinical Municipal Children Hospital St. Vladimir of the Department of Healthcare of Moscow
Russian Federation
Russian Federation
Olkhova Elena Borisovna, M. D. Med., Professor, Professor of Department of Radiology; the Head of Department of the Ultrasound Diagnostic
9а, ul. Vucheticha, Moscow, 127206, Russia
Phone number: +7 (495) 611-01-77
M. V. Topolnik
Moscow Clinical Municipal Children Hospital St. Vladimir of the Department of Healthcare of Moscow
Russian Federation
Russian Federation
Topolnik Margarita Vladimirovna, Radiologist of Department of Ultrasound Diagnostic
1/3, ul. Rubtsovsko-Dvortsovaya, Moscow, 107014, Russia
Phone number: +7 (499) 268-83-87
A. Yu. Rudin
Moscow Clinical Municipal Children Hospital St. Vladimir of the Department of Healthcare of Moscow
Russian Federation
Russian Federation
Rudin Andrey Yurievich, urologist of Department of Ultrasound Diagnostic
1/3, ul. Rubtsovsko-Dvortsovaya, Moscow, 107014, Russia
Phone number: +7 (499) 268-54-75
V. I. Runenko
Moscow Clinical Municipal Children Hospital St. Vladimir of the Department of Healthcare of Moscow
Russian Federation
Russian Federation
Runenko Vladimir Igorevich, the Head of Department of the Urology
1/3, ul. Rubtsovsko-Dvortsovaya, Moscow, 107014, Russia
Phone number: +7 (499) 268-54-75
I. V. Melnik
Clinical hospital «Lapino» LLC HAVEN Company group Mother and Child
Russian Federation
Russian Federation
Melnik Inna Vyacheslavovna, ultrasound specialist, the Head of Ultrasound Departament 2
111, 1 Uspenskoe highway, Lapino, Moscow region, Odintsovskii district, 143081, Russia
Phone number: + 7 (495) 526-60-60
References
1. Abbas T. O., Abdelkareem M., Alhadi A. et al. Suspected testicular torsion in children: diagnostic dilemma and recommendation for a lower threshold for initiation of surgical exploration. Res. Rep. Urol. 2018. V. 5. No. 10. P. 241–249.
2. Afsarlar C. E., Elizondo R., Yilmaz E. et al. Ultrasonographic findings in the epididymis of pediatric patients with testicular torsion. J. Pediatr. Urol. 2017. V. 13. No. 4. P. 393. e1 – 393. e6.
3. Afsarlar C. E., Cakmakci E., Demir E. et al. Novel prognostic grayscale ultrasonographic findings in the testis from a comprehensive analysis of pediatric patients with testicular torsion. J. Pediatr. Urol. 2019. V. 15. No. 5. P. 480.
4. Arap M. A., Vicentini F. C., Cocuzza M. et al. Late hormonal levels, semen parameters, and presence of antisperm antibodies in patients treated for testicular torsion. J. Androl. 2007. V. 28. No. 4. P. 528–532.
5. Bass J. B., Couperus K. S. , Pfaff J. L. et al. A Pair of Testicular Torsion Medicolegal Cases with Caveats: The Ball’s in Your Court. Clin. Pract. Cases Emerg. Med. 2018. V. 18. T. 2. No. 4. P. 283–285.
6. Castaıeda-Sınchez, Tully B., Shipman M. et al. Testicular torsion: A retrospective investigation of predictors of surgical outcomes and of remaining controversies. J. Pediatr. Urol. 2017. V. 13. No. 5. P. 516.
7. Chmelnik M., Schenk J.-P., Hinz U. et al. Testicular torsion: sonomorphological appearance as a predictor for testicular viability and outcome in neonates and children // Pediatr. Surg. Int. 2010. V. 26. No. 3. P. 281–286.
8. Feng Sh., Yang H., Lou Yi. et al. Clinical Characteristics of Testicular Torsion and Identification of Predictors of Testicular Salvage in Children: A Retrospective Study in a Single Institution. Urol. Int. 2020. V. 104. No. 11–12. P. 878–883.
9. Goetz J., Roewe R., Doolittle J. et al. A comparison of clinical outcomes of acute testicular torsion between prepubertal and postpubertal males. J. Pediatr. Urol. 2019. V. 15. No. 6. P. 610–616.
10. Grimsby G. M., Schlomer B. J., Menon V. S. et al. Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children // Urology. 2018. V. 116. P. 150–155.
11. Gopal M., O’Connor E., Donald L. Mc. et al. Affiliations expand Emergency scrotal exploration in children: Is it time for a change in mindset in the UK? // J. Pediatr. Urol. 2020. V. 1. S. 1477–5131. No. 20. P. 30658–30659.
12. Kaye J. D., Shapiro E. Y., Levitt S. B. et al. Parenchymal echo texture predicts testicular salvage after torsion: potential impact on the need for emergent exploration // J. Urol. 2008. V. 180. No. 4. Suppl. P. 1733–1736.
13. Li X., Gao Y., Yin Zh., Yang J. Clinical features of testicular torsion and its misdiagnosis: analysis of 274 cases // Nan. Fang. Yi Ke Da Xue Xue Bao. 2019. V. 30 (39). No. 4. P. 490–494.
14. Lian B. S. Y., Ong C. C. P., Chiang L. W. et al. Factors Predicting Testicular Atrophy after Testicular Salvage following Torsion // Eur. J. Pediatr. Surg. 2016. V. 26. No. 1. P. 17–21.
15. Mellick L. B., Sinex J. E., Gibson R. W., Mears K. A Systematic Review of Testicle Survival Time After a Torsion Event // Pediatr. Emerg. Care. 2019. V. 35. No. 12. P. 821–825.
16. Nason G. J., Tareen F., McLoughlin D. et al. Scrotal exploration for acute scrotal pain: a 10-year experience in two tertiary referral paediatric units // Scand. J. Urol. 2013. V. 47. No. 5. P. 418–422.
17. Pogorelic Z., Neumann Ch., Jukic M. An unusual presentation of testicular torsion in children: a single - centre retrospective study // Can. J. Urol. 2019. V. 26. No. 6. P. 10026–10032.
18. Pogoreliı Z., Mustapiı K., Jukiı M. et al. Management of acute scrotum in children: a 25-year single center experience on 558 pediatric patients // Can. J. Urol. 2016. V. 23. No. 6. P. 8594–8601.
19. Prando D. Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs. Abdom. Imaging. 2009. V. 34. No. 5. P. 648–661.
20. Ramachandra P., Palazzi K. L., Holmes N. M., Marietti S. Factors influencing rate of testicular salvage in acute testicular torsion at a tertiary pediatric center. West. J. Emerg. Med. 2015. V. 16. No. 1. P. 190–194.
21. Romao R. L. P., Anderson K. H., Lellan D. M., Anderson P. Point-of-care influences orchiectomy rates in pediatric patients with testicular torsion. J. Pediatr. Urol. 2019. V. 15 No. 4. P. 367. e1 – 367. e7.
22. Samson P., Hartman Ch., Palmerola R. et al. Ultrasonographic Assessment of Testicular Viability Using Heterogeneity Levels in Torsed Testicles. J. Urol. 2017. V. 197. No. 3. Pt. 2. P. 925–930.
23. Sharp V. J., Kieran K., Arlen A. M. Testicular torsion: diagnosis, evaluation, and management. Am. Fam. Physician. 2013. V. 15 (88) No. 12. P. 835–840.
24. Tanaka K., Ogasawara Y., Nikai K. et al. Acute scrotum and testicular torsion in children: a retrospective study in a single institution. J. Pediatr. Urol. 2020. V. 16. No. 1. P. 55–60.
25. Tian X.-M., Tan X.-H. et al. Risk Factors for Testicular Atrophy in Children With Testicular Torsion Following Emergent Orchiopexy. Front. Pediatr. 2020. V. 11. No. 8. P. 584796.
26. Wang D., Deng J., Song D. et al. The misdiagnosis of testicular torsion (a report of 113 cases). Zhonghua Nan Ke Xue. 2004. V. 10. No. 11. P. 864–866.
27. Yu K.-J., Wang T.-M., Chen H.-W., Wang H.-H. The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis. Chang. Gung. Med. J. 2012. V. 35. No. 1. P. 38–45.
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For citations:
Olkhova E.B., Topolnik M.V., Rudin A.Yu., Runenko V.I., Melnik I.V. The Role of Gray-Scale Ultrasound in the Diagnosis of Postnatal Testicular Torsion in Children. Radiology - Practice. 2021;(5):54-68. (In Russ.) https://doi.org/10.52560/2713-0118-2021-5-54-68
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