Mao Chang-Kun, Cao Yong-Sheng, Liu Xiang, Peng Bo, Chu Han, Deng Qi-Fei, Yu Xin, Tao Cheng-Pin, Zhang Tao, Yang Chao, Peng Shan
Department of Urology, Anhui Provincial Children's Hospital, Hefei, China.
Front Pediatr. 2023 Jun 15;11:1176345. doi: 10.3389/fped.2023.1176345. eCollection 2023.
To explore the clinical characteristics of testicular torsion in children with non-scrotal initial symptoms who were misdiagnosed.
A retrospective analysis of 73 cases children with testicular torsion and non-scrotal symptoms who were admitted to our department from October 2013 to December 2021 was performed. Patients were divided into misdiagnosis (27 cases) and clear diagnosis at first visit (46 cases) groups. Clinical data, including age at surgery, clinical presentation, physical examination, number of visits (≥2 times), affected side, time from initial symptoms to surgery, and surgical outcomes, were collected. The TWIST (Testicular Workup for Ischemia and Suspected Torsion) score was calculated and analyzed.
Statistically significant differences between the misdiagnosis and clear diagnosis groups were seen in the time from initial symptoms to surgery, the number of visits, the degree of testicular torsion, and the rate of orchiectomy (< 0.05). There were no statistically significant differences (> 0.05) in age, affected side, TWIST score, guardian, direction of testicular torsion, intra-vaginal or extra-vaginal torsion, and Arda classification. Postoperative follow-up was 6-40 months. Of the 36 patients who required an orchiopexy, 1 had testicular atrophy at six months and 2 were lost to follow-up. The contralateral testis of the 37 children who underwent orchiectomies developed normally without torsion.
The clinical manifestations of testicular torsion in children are diverse and can easily lead to misdiagnosis. Guardians should be aware of this pathology and seek timely medical attention. When the initial diagnosis and treatment of testicular torsion is difficult, the TWIST score during the physical examination may be useful, especially for patients with intermediate-to-high risk scores. Color Doppler ultrasound can assist in making the diagnosis, but when testicular torsion is highly suspected, routine ultrasound is not necessary as it may lead to delayed surgical treatment.
探讨以非阴囊初始症状起病且被误诊的小儿睾丸扭转的临床特征。
对2013年10月至2021年12月期间收治的73例有睾丸扭转且有非阴囊症状的患儿进行回顾性分析。将患者分为误诊组（27例）和初诊即明确诊断组（46例）。收集临床资料，包括手术年龄、临床表现、体格检查、就诊次数（≥2次）、患侧、从初始症状到手术的时间以及手术结果。计算并分析TWIST（睾丸缺血及疑似扭转检查）评分。
误诊组和明确诊断组在从初始症状到手术的时间、就诊次数、睾丸扭转程度及睾丸切除率方面存在统计学显著差异（<0.05）。在年龄、患侧、TWIST评分、监护人、睾丸扭转方向、鞘内或鞘外扭转以及阿尔达分类方面无统计学显著差异（>0.05）。术后随访6至40个月。在36例需要进行睾丸固定术的患者中，1例在6个月时出现睾丸萎缩，2例失访。接受睾丸切除术的37例患儿的对侧睾丸发育正常，未发生扭转。
小儿睾丸扭转的临床表现多样，容易导致误诊。监护人应了解这种疾病并及时就医。当睾丸扭转的初始诊断和治疗困难时，体格检查时的TWIST评分可能有用，特别是对于中高风险评分的患者。彩色多普勒超声有助于诊断，但当高度怀疑睾丸扭转时，常规超声检查可能导致手术治疗延迟，因此不必要进行。
