Ugo Pinar1, Igor Duquesne2, François Lannes3, Florian Bardet4, Kevin Kaulanjan5, Clément Michiels6, Emilien Seizilles de Mazancourt7, Ines Dominique8, Maxime Vallee9, Margaux Felber10, Lucas Freton11, Bastien Gondran-Tellier3, Xavier Matillon7, Zine-Edine Khene11, Benjamin Pradere12. 1. Department of Urology, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, AP-HP, Sorbonne Université, Paris, France. Electronic address: ugo.pinar@aphp.fr. 2. Department of Urology, Hôpital Cochin, AP-HP, Université de Paris, Paris France. 3. Department of Urology, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France. 4. Department of Urology, Dijon University Hospital, Dijon, France. 5. Department of Urology, CHU Pointe à Pitre, Guadeloupe, France. 6. Department of Urology, Bordeaux University Hospital, Bordeaux, France. 7. Department of Urology and Transplantation, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. 8. Department of Urology, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France. 9. Department of Urology, Poitiers University Hospital, Poitiers, France. 10. Department of Urology, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, AP-HP, Sorbonne Université, Paris, France. 11. Department of Urology, University Hospital of Rennes, Rennes, France. 12. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: 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. OBJECTIVE: 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. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: 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. RESULTS AND LIMITATIONS: 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. CONCLUSIONS: 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. PATIENT SUMMARY: 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.
BACKGROUND: 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. OBJECTIVE: 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. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: 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. RESULTS AND LIMITATIONS: 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. CONCLUSIONS: 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. PATIENT SUMMARY: 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.