Sonographic prediction of viability in testicular torsion: preliminary observations

This study was performed to determine if sonography can assist in predicting testicular viability in the setting of testicular torsion. Sixteen patients with sonographically diagnosed and surgically proved testicular torsion were studied. The preoperative sonograms were reviewed retrospectively to determine testicular echogenicity and homogeneity, testicular size and vascularity, scrotal skin thickness and vascularity, and the presence or absence of a hydrocele. These findings were correlated with the viability of the testis at surgery. All nine patients with normal homogeneous testicular echogenicity had viable testes at surgery. All seven patients with hypoechoic or inhomogeneous testes had nonviable testes at surgery and pathologic evidence of necrosis. The other findings were less helpful in predicting viability. In the setting of testicular torsion, normal testicular echogenicity is a strong predictor of viability. Immediate surgical detorsion in these patients carries a very high likelihood of salvaging the affected testis.