A validation of ultrasound as a diagnostic tool for the detection of testicular torsion

Abstract

Background

Testicular torsion (TT) is a scrotal emergency that needs urgent detection for successful treatment.

Purpose

To investigate the diagnostic value of acute ultrasound and the possibility of more effective detection.

Material and Methods

This retrospective study included patients assessed with ultrasound for suspicion of TT between 2019 and 2023. Registration of parameters included symptoms, durations, ultrasound conclusions, and surgical outcome. Ultrasound assessment included inspection of the spermatic cord and testicular color Doppler signal. Sensitivity and specificity were presented with 95% confidence intervals (CIs) and symptoms with odds ratios (ORs).

Results

A total of 387 patients were included. Surgical exploration (SE) was carried out in 40 patients. TT was surgically confirmed in 23 patients. No missed cases of TT were detected. Spermatic cord rotation ≥180° showed a sensitivity of 100% (95% CI=86–100), specificity of 65% (95% CI=41–83), positive predictive value (PPV) of 79%, and negative predictive value (NPV) of 100%. Absent or reduced testicular color Doppler signal showed a sensitivity of 57% (95% CI=37–74), specificity of 77% (95% CI=53–90), PPV of 76%, and NPV of 57%. Sudden onset of pain (OR=9.44, 95% CI=2.10–42.35), earlier similar episodes (OR=6.71, 95% CI=2.27–19.89), and abdominal pain (OR=14.70, 95% CI=3.25–66.51) showed significant association with TT.

Conclusion

Ultrasound, with focus on the spermatic cord, is reliable as a tool for the detection of TT. SE might be justified when cord rotation is ≥180°. These results can be used to develop and validate ultrasound guidelines for fast detection.