The effectiveness of radionuclide scintigraphy in confirming testicular torsion at delayed presentation

Testicular torsion (TT) is a urological emergency that needs early diagnosis and intervention to prevent testicular death and necrosis. This study aimed to determine the efficacy of testicular scintigraphy (TS) in confirming the clinical diagnosis of TT and how this imaging method correlates with the surgical findings.

A retrospective cohort review of clinical data was performed for 68 patients referred for TS from January 2016 to December 2021 to rule out possible TT. The final diagnosis was confirmed at surgery for all those with TS positive for TT.

The median age of the patients was 18.5 years, interquartile range of 15-31 years. Commonly presenting symptoms were pain (99%) and swelling (68%). Only 6% had history of trauma. TT was diagnosed by technetium-99m (^99mTc)-pertechnetate in 35 (51%) patients all of whom underwent surgical exploration. Of this group, 7 (20%) had manual detorsion intraoperatively (intermittent torsion), in 20 (57%) missed (complete) torsion was confirmed and 8 (23%) had a necrotic testis. Of the remaining 33 patients with results negative for torsion, 10 were normal and 23 were diagnosed with either epididymitis 13/23 (57%), orchitis 3/23 (13%) or 7/23 (30%) with epididymo-orchitis. TT was more common in patients under 15 and 15-19 years (P<0.05). The mean presentation time was 5 days with a range of 1-30 days.

The ^99mTc-pertechnetate scan remains an effective investigation in the diagnosis of TT and may serve as a gate-keeper for surgery even in patients who present late for treatment.