Department of Urology, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, AP-HP, Sorbonne Université, Paris, France.
Department of Urology, Hôpital Cochin, AP-HP, Université de Paris, Paris France.
Eur Urol Focus. 2022 Jan;8(1):105-111. doi: 10.1016/j.euf.2021.02.011. Epub 2021 Mar 2.
Use of Doppler ultrasonography (DUS) for patients with suspected testicular torsion (TT) is highly controversial and remains debated, as it can delay surgery and its performance may vary.
To assess the role, impact, safety, and performance of DUS in the management of patients with suspected TT before scrotal exploration.
DESIGN, SETTING, AND PARTICIPANTS: The TORSAFUF cohort retrospectively included patients older than 12 yr who underwent surgery for suspected TT in 14 academic hospitals between 2005 and 2019. Perioperative data and surgical and DUS reports were collected.
Clinical factors influencing DUS utilisation were analysed using multivariate logistic regression. The orchidectomy rate and delay to surgery were compared by group with and without DUS receipt using one-to-one propensity score (PS) matching to assess imaging safety. For the group with preoperative imaging, DUS performance was evaluated using a contingency table.
Overall, 2922 patients were included, of whom 956 (32.7%) underwent DUS before surgery. DUS was more likely to be performed in older patients (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.1-1.2), those who experienced progressive onset of pain (OR 1.5, 95% CI 1.1-2), and patients who presented at the emergency department more than 6 h after their first scrotal symptoms (OR 2.3, 95% CI 1.9-2.8). After PS matching, DUS receipt was not significantly associated with orchidectomy but the delay to surgery was 1 h longer. DUS demonstrated strong sensitivity of 85.2% (95% CI 82.1-88.3%) and specificity of 52.7% (95% CI 48.8-56.6%). The performance was better for younger patients and for those with time since onset of pain of >6 h.
In this large retrospective study, DUS before surgery was safe, feasible, and useful in selected cases with suspected TT, but it should not delay or replace surgery in cases with a strong clinical suspicion.
We analysed the performance and safety of an ultrasound scan of the scrotum before surgery for patients with a suspected twisted testicle (TT). This scan before surgery was not associated with a higher risk of negative outcomes but was only moderate in accurately diagnosing TT. Surgery to correct TT should not be delayed.
对于疑似睾丸扭转（TT）的患者，使用多普勒超声（DUS）检查存在争议，仍存在争议，因为它可能会延迟手术，并且其性能可能会有所不同。
评估 DUS 在疑似 TT 患者进行阴囊探查前的管理中的作用、影响、安全性和性能。
设计、地点和参与者：TORSAFUF 队列回顾性纳入了 2005 年至 2019 年间在 14 所学术医院因疑似 TT 接受手术的年龄大于 12 岁的患者。收集围手术期数据和手术及 DUS 报告。
使用多变量逻辑回归分析影响 DUS 使用的临床因素。通过 1：1 倾向评分（PS）匹配比较有和没有 DUS 接受的组之间的睾丸切除术率和手术延迟，以评估影像学安全性。对于术前有影像学检查的组，使用列联表评估 DUS 性能。
共有 2922 例患者入组，其中 956 例（32.7%）在术前进行了 DUS。DUS 更可能在年龄较大的患者（优势比 [OR] 1.1，95%置信区间 [CI] 1.1-1.2）、疼痛逐渐发作的患者（OR 1.5，95% CI 1.1-2）和就诊时间超过首次阴囊症状后 6 小时的患者（OR 2.3，95% CI 1.9-2.8）中进行。在 PS 匹配后，DUS 接受与睾丸切除术率无显著相关性，但手术延迟 1 小时。DUS 显示出 85.2%（95% CI 82.1-88.3%）的高灵敏度和 52.7%（95% CI 48.8-56.6%）的特异性。对于年轻患者和疼痛发作时间>6 小时的患者，其性能更好。
在这项大型回顾性研究中，术前 DUS 是安全、可行的，对于疑似 TT 的患者具有一定的辅助作用，但在具有强烈临床怀疑的情况下，不应延迟或替代手术。
我们分析了术前阴囊超声检查在疑似睾丸扭转（TT）患者中的表现和安全性。术前进行这种扫描不会增加不良结局的风险，但对准确诊断 TT 的准确性仅为中等。纠正 TT 的手术不应延迟。
