Gwen M Grimsby1, Bruce J Schlomer2, Vani S Menon2, Lauren Ostrov3, Melise Keays4, Kunj R Sheth5, Carlos Villanueva6, Candace Granberg7, Daniel Dajusta8, Martinez Hill3, Emma Sanchez3, Clanton B Harrison2, Micah A Jacobs2, Berk Burgu9, Halim Hennes2, Linda A Baker10. 1. Division of Pediatric Urology, Phoenix Children's Hospital, Phoenix, AZ. 2. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Pediatric Urology, Children's Health, Dallas, TX. 3. Division of Pediatric Urology, Children's Health, Dallas, TX. 4. Division of Pediatric Urology, Children's Hospital of East Ontario, Ottawa, Ontario, Canada. 5. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. 6. Division of Pediatric Urology, Children's Hospital & Medical Center, Omaha, NE. 7. Department of Urology, Mayo Clinic, Rochester, MN. 8. Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH. 9. Department of Urology, Ankara Üniversitesi Tıp Fakültesi, Ankara, Turkey. 10. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Division of Pediatric Urology, Children's Health, Dallas, TX. Electronic address: linda.baker@childrens.com.
Abstract
OBJECTIVE: To prospectively correlate pain duration, red scrotal skin, ultrasound appearance of testis, and intraoperative testis color to future testis atrophy after acute testicular torsion. METHODS: Patients 2 months-18 years old with unilateral acute scrotum were consecutively enrolled in a National Institutes of Health transcutaneous near-infrared spectroscopy study, with a subgroup analysis of the true torsion group. Presence or absence of red scrotal skin, pain duration, testicular heterogeneity on preoperative ultrasound, and intraoperative testis color based on a novel visual chart 5 minutes after detorsion were recorded. All testes underwent orchiopexy regardless of appearance. Percent volume difference between normal and torsed testicles on follow-up ultrasound was compared between patients with and without risk factors. RESULTS: Thirty of 56 patients who had surgical detorsion underwent scrotal ultrasound at a mean of 117 days after surgery. A color of black or hemorrhagic 5 minutes after detorsion, pain duration >12 hours, and heterogeneous parenchyma on preoperative ultrasound were associated with significant testis volume loss in follow-up compared with normal testis. All patients with a black or hemorrhagic testis had >80% volume loss. Erythematous scrotal skin was not significantly associated with smaller affected testis volume in follow-up. CONCLUSION: Based on the high atrophy rate, orchiectomy can be considered for testes that are black or hemorrhagic 5 minutes after detorsion. Pain duration >12 hours and parenchymal heterogeneity on preoperative ultrasound were also associated with testis atrophy. Red scrotal skin was not a reliable predictor of atrophy and should not delay exploration.
OBJECTIVE: To prospectively correlate pain duration, red scrotal skin, ultrasound appearance of testis, and intraoperative testis color to future testis atrophy after acute testicular torsion. METHODS:Patients 2 months-18 years old with unilateral acute scrotum were consecutively enrolled in a National Institutes of Health transcutaneous near-infrared spectroscopy study, with a subgroup analysis of the true torsion group. Presence or absence of red scrotal skin, pain duration, testicular heterogeneity on preoperative ultrasound, and intraoperative testis color based on a novel visual chart 5 minutes after detorsion were recorded. All testes underwent orchiopexy regardless of appearance. Percent volume difference between normal and torsed testicles on follow-up ultrasound was compared between patients with and without risk factors. RESULTS: Thirty of 56 patients who had surgical detorsion underwent scrotal ultrasound at a mean of 117 days after surgery. A color of black or hemorrhagic 5 minutes after detorsion, pain duration >12 hours, and heterogeneous parenchyma on preoperative ultrasound were associated with significant testis volume loss in follow-up compared with normal testis. All patients with a black or hemorrhagic testis had >80% volume loss. Erythematous scrotal skin was not significantly associated with smaller affected testis volume in follow-up. CONCLUSION: Based on the high atrophy rate, orchiectomy can be considered for testes that are black or hemorrhagic 5 minutes after detorsion. Pain duration >12 hours and parenchymal heterogeneity on preoperative ultrasound were also associated with testis atrophy. Red scrotal skin was not a reliable predictor of atrophy and should not delay exploration.
Authors: Jonathan D Kaye; Edan Y Shapiro; Selwyn B Levitt; Steven C Friedman; Jordan Gitlin; Jaime Freyle; Lane S Palmer Journal: J Urol Date: 2008-08-21 Impact factor: 7.450
Authors: Kunj R Sheth; Melise Keays; Gwen M Grimsby; Candace F Granberg; Vani S Menon; Daniel G DaJusta; Lauren Ostrov; Martinez Hill; Emma Sanchez; David Kuppermann; Clanton B Harrison; Micah A Jacobs; Rong Huang; Berk Burgu; Halim Hennes; Bruce J Schlomer; Linda A Baker Journal: J Urol Date: 2016-02-02 Impact factor: 7.450
Authors: Mithat Ekşi; Abdullah Hizir Yavuzsan; İsmail Evren; Ali Ayten; Ali Emre Fakir; Fatih Akkaş; Kerem Bursali; Azad Akdağ; Selcuk Sahin; Ali İhsan Taşçi Journal: Pediatr Surg Int Date: 2022-08-02 Impact factor: 2.003
Authors: Paweł Osemlak; Grzegorz Jędrzejewski; Magdalena Woźniak; Paweł Nachulewicz Journal: Medicine (Baltimore) Date: 2021-05-28 Impact factor: 1.889