Transscrotal Near Infrared Spectroscopy as a Diagnostic Test for Testis Torsion in Pediatric Acute Scrotum: A Prospective Comparison to Gold Standard Diagnostic Test Study
Bruce J. SchlomerMélise KeaysGwen M. GrimsbyCandace F. GranbergDaniel DaJustaVani S. MenonLauren OstrovKunj R. ShethMartinez HillEmma SanchezClanton B. HarrisonMicah A. JacobsRong HuangBerk BurguHalim HennesLinda A. Baker
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Abstract:
A rapid test for testicular torsion in children may obviate the delay for testicular ultrasound. In this study we assessed testicular tissue percent oxygen saturation (%StO2) measured by transscrotal near infrared spectroscopy as a diagnostic test for pediatric testicular torsion.This was a prospective comparison to a gold standard diagnostic test study that evaluated near infrared spectroscopy %StO2 readings to diagnose testicular torsion. The gold standard for torsion diagnosis was standard clinical care. From 2013 to 2015 males with acute scrotum for more than 1 month and who were less than 18 years old were recruited. Near infrared spectroscopy %StO2 readings were obtained for affected and unaffected testes. Near infrared spectroscopy Δ%StO2 was calculated as unaffected minus affected reading. The utility of near infrared spectroscopy Δ%StO2 to diagnose testis torsion was described with ROC curves.Of 154 eligible patients 121 had near infrared spectroscopy readings. Median near infrared spectroscopy Δ%StO2 in the 36 patients with torsion was 2.0 (IQR -4.2 to 9.8) vs -1.7 (IQR -8.7 to 2.0) in the 85 without torsion (p=0.004). AUC for near infrared spectroscopy as a diagnostic test was 0.66 (95% CI 0.55-0.78). Near infrared spectroscopy Δ%StO2 of 20 or greater had a positive predictive value of 100% and a sensitivity of 22.2%. Tanner stage 3-5 cases without scrotal edema or with pain for 12 hours or less had an AUC of 0.91 (95% CI 0.86-1.0) and 0.80 (95% CI 0.62-0.99), respectively.In all children near infrared spectroscopy readings had limited utility in diagnosing torsion. However, in Tanner 3-5 cases without scrotal edema or with pain 12 hours or less, near infrared spectroscopy discriminated well between torsion and nontorsion.Keywords:
Gold standard (test)
Acute scrotum
Spermatic Cord Torsion
Palpation
Acute scrotum
Spermatic Cord Torsion
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Testicular scintigraphy has been well validated in the evaluation of patients with suspected testicular torsion and provides an accurate evaluation of testicular perfusion at the lime of imaging. However, the presence of normal or increased perfusion to the testis does not definitively exclude the necessity for surgical intervention. A case of intermittent testicular torsion, with a review of testicular scintigraphy in the evaluation of the acute scrotum arc presented.
Acute scrotum
Spermatic Cord Torsion
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Acute scrotum
Spermatic Cord Torsion
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Acute scrotum
Spermatic Cord Torsion
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Acute scrotum
Spermatic Cord Torsion
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Acute scrotum
Etiology
Spermatic Cord Torsion
Scrotal Pain
Pediatric Surgeon
Surgical emergency
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Acute scrotum
Spermatic Cord Torsion
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Acute scrotum
Spermatic Cord Torsion
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Objective: To decrease the misdiagnosis of testicular torsion and improve the diagnosis and treatment of testicular torsion . Methods: The clinical data of 19 cases of suspected testicular torsion were retrospectively analyzed. Results: Two patients were treated by spontaneous detorsion under anesthesia and 17 treated by surgery in 19 patients aged 10~51years old (mean 21 ),among whom 15 were proved to be testicular torsion and 2, acute epididymitis. Of the 15 cases of testicular torsion, 10 were spermatic cord torsion and 5, testicular torsion. The time from onset of acute scrotum pain to hospital for examination was 2 hours to 10 days. The accurary rate of final diagnosis with color Doppler was 88.1 %. All the 19 cases had acute scrotum pain, with the red and swelled skin of the scrotum, and 18 cases showed Prehn( + ). Conclusion: Patients with acute scrotum pain especially with red and swelled skin of the scrotum should be examined with color Doppler as early as possible. Emergency operation will be important to avoid testiculus necrosis in the suspected testicular torsion.
Acute scrotum
Spermatic Cord Torsion
Scrotal Pain
Epididymitis
Testicular pain
Color doppler
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The leading cause of scrotal pain in the geriatric population is epididymitis. Testicular torsion is rare in adult men. This case report of an 82-year old man with acute scrotum represents the second oldest patient reported in published studies. Due to the long delay between the onset of clinical symptoms and surgical exploration, the testicular infarction with necrosis and orchiectomy ultimately occurred. The diagnosis of testicular torsion in the geriatric population is often delayed and lacks awareness for the diagnosis.
Epididymitis
Acute scrotum
Orchiectomy
Spermatic Cord Torsion
Scrotal Pain
Testicular pain
Orchitis
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