Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

ABSTRACT Purpose To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. Patients and Methods Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. Results 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). Conclusion Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing population-wide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.

Bilateral testicular torsion in an adolescent: a case with challenging diagnosis

ABSTRACT Bilateral testicular torsion is a very uncommon emergency, with a challenging differential diagnosis. We describe the case of a 15-year-old patient with a left testicular torsion of 48 hours of duration and a sudden onset of right scrotum pain during his stay at the emergency area. Bilateral testicular torsion was diagnosed after repeat physical examination and doppler ultrasound, which had been normal for right testis in a first evaluation. Surgical exploration was performed with orchiectomy in left testis and fixation in right testis. In previous literature, there are reported bilateral torsion only in four adolescents and five adults. With this case, we demonstrate that bilateral spermatic cord torsion may be easily overlooked in a patient with acute scrotum and we emphasize the importance of bilateral exploration in testicular torsion.

value of Tc99m- pertechnitate testicular scintigraphy in diagnosis of acute testicular torsion in pediatric and adult patients

of this study to evaluate the accuracy of Tc99m-Pertechnitate Testicular Scintigraphy [T.S] in evaluating patients with acute scrotal swelling and suspected testicular torsion in pediatric and adult patients by statistical analysis of the results and considering the effect of patients age factor in this regard. Seventy five patients [age range 5 to 38 years] with possible acute testicular torsion from July 2000 to July 2003 were enrolled in this study. T.S was performed for all patients. All of the patients with clinically suspected acute testicular torsion underwent surgery. The surgical findings were reviewed and definite diagnoses were established. None of the other patients had surgery and were followed clinically for at least 3 month after and radionuclide imaging. Seventy Five patients were included in the study, divided into [17 with testicular torsion 58 with non torsion] according to T.S results, with one false positive and no false negative. Overall, T.S has sensitivity of 100% and a specificity of 97% in identifying a testicular torsion. 7 out of 17 patients with testicular torsion had a salvageable testicle at the time of surgery. Tc99m Scintigraphy is a reliable method for diagnosis of testicular torsion sensitivity and specificity are 100% and 98%. There was no significant statistical difference in the sensitivity between pediatric[< 15 years] and adult age groups [> 15 years]

value of Tc99m-pertechnitate testicular scintigraphy in diagnosis of acute testicular torsion in pediatric and adult patients

This study to evaluate the accuracy of Tc99-Pertechnitate Testicular Scintigraphy [T.S] in evaluating patients with acute scrotal swelling and suspected testicular torsion in pediatric and adult patients by statistical analysis of the results was performed for all patients. All of the patients with clinically suspected acute testicular torsion underwent surgery. The surgical finding were reviewed and definite diagnoses were established. None of the other and considering the effect of patients age factor in this regard. Seventy five patients [age range 5 to 38 years] with possible acute testicular torsion from July 2000 to July 2003 were enrolled in this study. T.S patients had surgery and were followed clinically for at least 3 month after and radionuclide imaging. Seventy five patients were included in the study, divided into [17 with testicular torsion 58 with non torsion] according to T.S results with one false positive and no false negative. Overall, T.S has sensitivity of 100% and a specificity of 97% in identifying a testicular torsion 7 out of 17 patients with testicular torsion has a salvageable testicle at the time of surgery. Tc99m scintigraphy is a reliable method for diagnosis of testicular torsion sensitivity and specificity are 100% and 98%. There was no significant statistical difference in the sensitivity between pediatric [<15 years] and adult age groups [>15 years]