Ultrasound Diagnostic Features and Management of Torsion-detorsion

To identify ultrasound predictors of those at risk of testicular loss in patients who underwent immediate scrotal exploration in the setting of torsion-detorsion (TDS) diagnosis.

Retrospectively reviewed patients with concerns for testicular torsion between 2015 and 2023. Patients with history or ultrasound findings described by radiologists suggestive of TDS were analyzed. Patient demographics, duration of pain and surgery, ultrasound and intraoperative findings as well as perioperative outcomes were assessed.

One hundred sixty-nine patients who underwent scrotal exploration for acute testicular pain were identified, 47 met inclusion criteria for TDS. All patients underwent scrotal exploration and bilateral testicular fixation. All testes were salvaged, and no orchiectomies were performed. Average time from onset of pain to urologic evaluation was 18.3 hours. Median TWIST score was 4. The most common ultrasound finding was twisting or swirl in the spermatic cord which was described in 28/47 patients. Asymmetric blood flow, in comparison to the contralateral testicle was reported in 19/47 patients. Hyperemia in 4/47 patients. Ultrasound finding of spermatic cord swirling was the most common correlate with the intraoperative finding of testicular torsion (at least 180 degrees twisting or congestion of the spermatic cord) in 17/26 patients.

Twisting in the spermatic cord was the most common ultrasound description with a positive predictive value (PPV) of 65.4%. Ultrasound findings correlated with intraoperative findings with a PPV of 68.4%. Findings of twisting of the spermatic cord or asymmetric blood flow even in the presence of blood flow are a reasonable indication for scrotal exploration.