Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany.
J Urol. 2013 May;189(5):1853-8. doi: 10.1016/j.juro.2012.11.166. Epub 2012 Dec 3.
Although color coded duplex sonography is useful for visualizing testicular perfusion in patients with clinical suspicion of testicular torsion, fear of overlooking the condition itself remains. Thus, routine scrotal exploration in every patient with acute scrotal pain is common at many centers. We assessed the efficacy of color coded duplex sonography in predicting the need for scrotal exploration in patients with clinical suspicion of testicular torsion.
We prospectively assessed the diagnostic value of color coded duplex sonography in 236 patients (median age 13 years, range 0 to 53) with clinical suspicion of testicular torsion between 1995 and 2012. All patients were evaluated by sonography and subsequently underwent exploration, whereby the surgeon was blinded to the ultrasound results. The sensitivity, specificity, and positive and negative predictive values of color coded duplex sonography for diagnosing testicular torsion were calculated based on preoperative ultrasound findings, and compared to the final diagnosis after surgical exploration.
Testicular torsion was the most common cause of impaired intratesticular blood flow (119 cases, 50.4%), followed by torsion of the testicular appendages (82, 34.8%), epididymo-orchitis (18, 7.6%) and various other conditions (17, 7.2%). The sensitivity, specificity, and positive and negative predictive values of color coded duplex sonography for detecting testicular torsion were 100%, 75.2%, 80.4% and 100%, respectively.
Our data provide evidence that routine surgical exploration is no longer justified in patients with clinical suspicion of testicular torsion if color coded duplex sonography has revealed normal intratesticular perfusion.
尽管彩色编码双功能超声对于可视化临床怀疑睾丸扭转患者的睾丸灌注是有用的，但仍然担心会忽视该病症本身。因此，在许多中心，对于急性阴囊疼痛的每位患者，常规进行阴囊探查是常见的。我们评估了彩色编码双功能超声在预测临床怀疑睾丸扭转患者是否需要阴囊探查中的作用。
我们前瞻性评估了 1995 年至 2012 年间 236 例临床怀疑睾丸扭转患者（中位年龄 13 岁，范围 0 至 53 岁）的彩色编码双功能超声的诊断价值。所有患者均接受了超声评估，随后进行了探查，而外科医生对超声结果是盲法的。根据术前超声结果计算彩色编码双功能超声诊断睾丸扭转的敏感性、特异性、阳性预测值和阴性预测值，并与手术探查后的最终诊断进行比较。
睾丸扭转是导致睾丸内血流受损的最常见原因（119 例，50.4％），其次是睾丸附件扭转（82 例，34.8％）、附睾炎（18 例，7.6％）和各种其他病症（17 例，7.2％）。彩色编码双功能超声检测睾丸扭转的敏感性、特异性、阳性预测值和阴性预测值分别为 100％、75.2％、80.4％和 100％。
我们的数据提供了证据表明，如果彩色编码双功能超声显示正常的睾丸内灌注，则对于临床怀疑睾丸扭转的患者，不再需要常规进行手术探查。
