Ultrasound technologies in the diagnosis, treatment, and rehabilitation of children with testicular torsion

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Abstract

AIM: This study improves the diagnosis of testicular inversion in children to select different treatment strategies by determining the effectiveness of conservative and surgical testicular detorsion criteria.

MATERIALS AND METHODS: The clinical data from 2010 to 2020 included 110 children with testicular torsion. In 64% of cases, the left testicle predominated. Testicular torsion occurred in 50% of children in the 12- to 14-year-old age group. The time from disease onset to seeking medical help ranged from 1.5 hours to 11 days. It was less than 6 hours in 41.8% of children, from 6 to 12 hours in 13.6% of boys, 12 to 24 hours in 11% of patients, and more than 24 hours in 33.6% of boys and adolescents. The protocol for the diagnosis, treatment and rehabilitation of all children included various techniques for ultrasound examination of the scrotal organs.

RESULTS: The analysis showed the absence of reliable criteria for detecting testicle torsion in the early periods (61%–100%): spiral course of the spermatic vessels (63.9%), change in the position of the testicle (19.8%), increase in the volume of the testicle and appendage (98.3%), a change in testicle shape and the inability to withdraw its poles (47.5%), and a hydrocele (67.2%). The index of false-negative results of the ultrasound scan of the scrotal organs reaches 40%. Conservative navigation detorsion was performed in 39 (35.5%) boys and adolescents during the early disease stages. The ultrasound criteria for the effectiveness of conservative detorsion were established. The main criteria normalized blood flow in the testis (100%). Surgical treatment of testicular inversion was performed in 71 (64.5%) boys and adolescents.

CONCLUSIONS: Compliance with the protocol for diagnosing, treating, and rehabilitating children in different age groups with testicular torsion allowed us to determine adequate emergency treatment strategies and follow-up. An ultrasound differential diagnosis is performed with testicular hydatid torsion and inflammatory diseases of the scrotal organs. The informativeness of the ultrasound methods amounted to 60%.

About the authors

Svetlana Yu. Komarova

Urals State Medical University; Children’s City Clinical Hospital No. 9

Author for correspondence.
Email: urokom@yandex.ru
ORCID iD: 0000-0003-2966-2887
SPIN-code: 9411-6025

Cand. Sci. (Med.)

Russian Federation, 3 Repin str., Ekaterinburg, 620028; Ekaterinburg

Natalya A. Tsap

Urals State Medical University; Children’s City Clinical Hospital No. 9

Email: tsapna-ekat@rambler.ru
ORCID iD: 0000-0001-9050-3629
SPIN-code: 7466-8731

Dr. Sci. (Med.), Professor

Russian Federation, 3 Repin str., Ekaterinburg, 620028; Ekaterinburg

Il’ya A. Karachev

Children’s City Clinical Hospital No. 9

Email: kara4ev83@yandex.ru
SPIN-code: 1059-4501

ultrasound doctor

Russian Federation, 3 Repin str., Ekaterinburg, 620028

References

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2. Fig. 1. The distribution of children with testicular torsion by age

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3. Fig. 2. Boy P., 14 years old. Left testicle torsion. At 12 hours from disease onset. The arrow indicates: an increase in size, rounded shape, and heterogeneous structure due to the alternation of echogenic and hypoechoic areas

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4. Fig. 3. Boy K., nine years old. Right testicle torsion. At 16 hours from the onset of the disease: (a) in B-mode. The arrow indicates: a spiral course of the structures of the spermatic cord; (b) with doppler color flow mapping. The arrow indicates: the spiral course of the vessels of the spermatic cord and enhanced vascular pattern (venous plethora)

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5. Fig. 4. Boy Y., 13 years old. Left testicle torsion. At 19 hours from disease onset. In B-mode: a spiral course of the structures of the spermatic cord. An increase in size, rounded shape and moderately pronounced heterogeneity of the structure (?). With Doppler color flow mapping: the avascular pattern is absent (the arrow)

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