Management of acute testicular pain in children: changing trends with improvements in scrotal ultrasonography over 18 years

INTRODUCTION@#Doppler scrotal ultrasonography (US) is the modality of choice in diagnosing testicular torsion. We aimed to evaluate the performance of scrotal US in diagnosing testicular torsion over the past 18 years in our institution and determine the factors contributing to the length of wait times for it.@*METHODS@#A retrospective review was conducted of boys who presented with acute scrotal pain from 2014 to 2015. US reports, operative findings, final diagnosis and key time points of the patients' journey (time to emergency department consultation, time to admission, time to US and time to operating theatre [OT]) were collected. US performance results were compared with those observed in a historical cohort from 1998 to 2004. Wait times were compared between operated and non-operated patients.@*RESULTS@#Data from 519 boys with a mean age of 9.15 years was collected. Of these, 438 (84.4%) boys had undergone initial scrotal US; of these scrotal US cases, 28 were surgically explored, with 23 confirmed to have torsion. Another five cases were explored without prior US, and all were confirmed to have torsion. Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (P < 0.0001, r = 0.96) and time to OT (P < 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery.@*CONCLUSION@#There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with acute scrotum should target time to US and time to OT.

Unilateral testicular torsion in a neonate / Torsão testicular unilateral em neonato

A male neonate born at gestational age of 40 weeks was found to have an enlarged and darkened right hemiscrotum after birth. Left testicle was descended and normal. No clinical signs of distress were evident. A color Doppler ultrasound showed an absence of testicular blood flow, consistent with perinatal testicular torsion. The patient underwent a bilateral scrotal exploration through an inguinal incision and a necrotic right testicle was found. A right orchiectomy and left orchiopexy were performed. Perinatal testicular torsion is a rare but severe condition. A high clinical suspicion is required since most of perinatal testicular torsion are intrauterine and can often be asymptomatic, only with localized findings of the affected testis. The management of perinatal testicular torsion is still controversial; however, the most consensual approach is a prompt testicle exploration with orchiectomy of the necrotic testicle and contralateral orchiopexy

Recém-nascido do sexo masculino com idade gestacional de 40 semanas, com edema e escurecimento cutâneo do hemiescroto direito constatados após o nascimento. O testículo esquerdo era palpável na bolsa escrotal e não apresentava alterações. A ecografia escrotal com Doppler revelou ausência de fluxo vascular no testículo direito, achado compatível com torção testicular perinatal. O doente foi submetido a exploração escrotal bilateral através de abordagem por via inguinal, tendo sido confirmada a necrose do testículo direito. Foi realizada orquidectomia direita e orquidopexia esquerda. A torção testicular perinatal corresponde a uma patologia rara, mas com possíveis consequências graves. O seu diagnóstico requer elevada suspeição clínica, uma vez que a maioria dos casos ocorre no período pré-natal, podendo ser assintomáticos após o nascimento e manifestar-se com alterações localizadas ao testículo afetado. A abordagem da torção testicular perinatal é ainda controversa, sendo mais consensual uma exploração escrotal célere com orquidectomia do testículo necrosado e orquidopexia contralateral

Testicular torsion: a modified surgical technique for immediate intravaginal testicular prosthesis implant

ABSTRACT Purpose: The aim of this paper is to propose a modified surgical technique for immediate intravaginal prosthesis implantation in patients undergoing orchiectomy due to testicular torsion, and to evaluate the wound healing process and patient's satisfaction. Material and methods: We prospectively analyzed 137 patients with testicular torsion admitted to our facility between April 2018 and May 2020. Twenty-five patients who underwent orchiectomy were included in this study. Fifteen had a testicular prosthesis implanted at the same time as orchiectomy using a modified intravaginal technique (summary figure) and 10 received implants 6 to 12 months after orchiectomy. Wound healing was evaluated at a minimum of four checkpoints (on days 15, 45, 90 and 180 after surgery). At the end of the study, a questionnaire was administered to measure patients' satisfaction rate. Student's t test was used for comparison of quantitative data between negative vs. positive cultures (p <0.05). The chi-square test was used to verify associations between categorical variables and immediate vs. late prosthesis implantation (p <0.05). Results: Patient's ages ranged from 13 to 23 years (mean 16.44 years). Overall time lapse from symptoms to orchiectomy ranged from 10 hours to 25 days (mean 7.92 days). Only one extrusion occurred and it happened in the late implant group. All wounds were healed in 72%, 88%, 95.8% and 100% of the cases on the 15th, 45th, 90th and 180th days after implant, respectively. At the end of the study, all patients stated they would recommend it to a friend or relative. The only patient that had prothesis extrusion asked to have it implanted again. Conclusion: There was no prosthesis extrusion using the modified intravaginal surgical technique for immediate testicular prosthesis implantation, which proved to be an easily performed and safe procedure that can avoid further reconstructive surgery in patients whose testicle was removed due to testicular torsion.

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.

Torsión de cordón espermático: análisis de situación en un período de 4 años en la Clínica Quirúrgica Pediátrica del Centro Hospitalario Pereira Rossell, Montevideo, Uruguay / Torsion of spermatic cord: situation analysis over a period of 4 years in Pediatric Surgical Clinic of the Pereira Rossell Hospital Center, Montevideo, Uruguay / Torção do cordão espermático: análise da situação ao longo de um período de 4 anos em Clinica Cirúrgica Pediátrica do Centro Hospitalar Pereira Rossell, Montevideo, Uruguai

Introducción: El sindrome escrotal agudo es una causa frecuente de consulta en la urgencia pediátrica y el diagnóstico de su etiología puede ser realmente un desafío para el pediatra y el cirujano. Existen múltiples etiologías posibles, siendo la torsión de cordón espermático la más importante, porque el retraso en su diagnóstico y tratamiento conlleva una alta incidencia de necrosis gonadal. Esta patología debe considerarse una emergencia quirúrgica. El objetivo de este artículo es conocer la situación de la torsión de cordón espermático en nuestro medio ya que existe un único estudio sobre esta patología realizado hace más de 30 años. Material y método: Se realizó un estudio observacional descriptivo y retrospectivo. Se identificaron todas las escrototomías realizadas con planteo clínico de síndrome escrotal agudo con la sospecha de una torsión de cordón espermático, en el período comprendido entre el 1.º de enero de 2015 y el 31 de diciembre de 2018. Se analizó la edad de los pacientes, patología diagnosticada en el intraoperatorio, lado afectado, sentido de la rotación y procedimiento realizado. Resultados: En el período comprendido entre el 1.º de enero de 2015 y el 31 de diciembre de 2018 se intervinieron quirúrgicamente 68 pacientes con diagnóstico de sindrome escrotal agudo. Del total, 49 pacientes (72 %) presentaron una torsión de cordón espermático, y a 16 (32,6 %) se les realizó orquiectomía. A todos se les realizó pexia testicular contralateral en el mismo acto quirúrgico. Conclusiones: En el período analizado fueron intervenidos 49 pacientes con torsión de cordón espermático. En 16 casos se realizó orquiectomía. Se identificó una leve predominancia del lado derecho, y el sentido de la rotación fue principalmente interno, si bien existe un importante subregistro de dicho dato en las descripciones operatorias. En el 72 % de los pacientes en quienes se decidió conservar la gónada, el cirujano describe una importante isquemia testicular, por lo que resulta fundamental realizar, para un futuro artículo, el seguimiento de estos pacientes para conocer su evolución.

Introduction: Acute scrotal syndrome is a frequent cause of consultation in the pediatric emergency and the diagnosis of its etiology can really be a challenge for the pediatrician and the surgeon. There are multiple possible etiologies, with torsion of the spermatic cord being the most important due to the high incidence of gonadal necrosis that the delay in diagnosis and treatment entails. This pathology should be considered a surgical emergency. The objective of this article is to know the situation of spermatic cord torsion in our environment since there is only one study done on this pathology more than 30 years ago. Material and method: A descriptive and retrospective observational study was carried out. All scrototomies performed with a clinical approach to acute scrotal syndrome were identified with the suspicion of spermatic cord torsion in the period between January 1, 2015 and December 31, 2018. The patients' age, pathology was analyzed. Diagnosed intraoperatively, affected side, direction of rotation and procedure performed. Results: In the period between January 1, 2015 and December 31, 2018, 68 patients were diagnosed with a diagnosis of acute scrotal syndrome. Of the total, 49 patients (72 %) had spermatic cord torsion, and 16 (32.6 %) had orchiectomy. All of them underwent contralateral testicular pexia in the same surgical act. Conclusions: In the analyzed period, 49 patients with spermatic cord torsion were operated. In 16 cases orchiectomy was performed. A slight predominance of the right side was identified, and the direction of rotation was mainly internal, although there is an important underreporting of this data in the operative descriptions. In 72 % of the patients in whom it was decided to preserve the gonad, the surgeon describes an important testicular ischemia, so it is essential for a future article to monitor these patients to know their evolution.

Introdução: A síndrome escrotal aguda é uma causa freqüente de consulta na emergência pediátrica e o diagnóstico de sua etiologia pode realmente ser um desafio para o pediatra e o cirurgião. Existem múltiplas etiologias possíveis, sendo a torção do cordão espermático a mais importante devido à alta incidência de necrose gonadal que o atraso no diagnóstico e tratamento acarreta. Essa patologia deve ser considerada uma emergência cirúrgica. O objetivo deste artigo é conhecer a situação de torção do cordão espermático em nosso ambiente, uma vez que existe apenas um estudo sobre essa patologia há mais de 30 anos. Material e método: Foi realizado um estudo observacional descritivo e retrospectivo. Todas as escrototomias realizadas com abordagem clínica da síndrome escrotal aguda foram identificadas com suspeita de torção espermática no período de 1 de janeiro de 2015 a 31 de dezembro de 2018. A idade dos pacientes foi analisada. diagnosticado no intraoperatório, lado afetado, direção da rotação e procedimento realizado. Resultados: No período de 1 de janeiro de 2015 a 31 de dezembro de 2018, 68 pacientes foram diagnosticados com diagnóstico de síndrome escrotal aguda. Do total, 49 pacientes (72 %) apresentaram torção espermática e 16 (32,6 %) tiveram orquiectomia. Todos foram submetidos a pexia testicular contralateral no mesmo ato cirúrgico. Conclusões: No período analisado, foram operados 49 pacientes com torção espermática. Em 16 casos, foi realizada orquiectomia. Foi identificada uma ligeira predominância do lado direito, e o sentido de rotação era principalmente interno, embora exista uma importante subnotificação desses dados nas descrições operatórias. Em 72 % dos pacientes nos quais foi decidido preservar a gônada, o cirurgião descreve uma importante isquemia testicular, por isso é essencial que um artigo futuro monitore esses pacientes para conhecer sua evolução.

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.

The amount of spermatic cord rotation magnifies the time-related orchidectomy risk in Intravaginal testicular torsion

Abstract Purpose To investigate the roles of age, testicular rotation and time in the surgical outcome of intravaginal testicular torsion (iTT). Patients and Methods We retrieved the records of all iTT patients treated in our unit from January 2012 to January 2014. Explanatory variables were: age (years); presentation delay (PrD, time between symptoms and hospitalization); surgical delay (SurgD, time between hospitalization and surgery) and testicular rotation (rotation), with surgical outcome (orchidopexy, orchidectomy) as response variable. Differences in PrD, SurgD, age and rotation by surgical outcome were evaluated non-parametrically. Step-down logistic regression included age, PrD, SurgD and rotation as predictors. Statistical significance and confidence intervals (CI) were set at p<0.05 and 0.95. Odds ratios (OR) were computed from the model's coefficients. Results Complete variable information was available for 117 patients, and most (61, 52.1%) underwent orchidectomy. Ages were similar between orchidectomy and orchidopexy patients (median 15.8 vs. 16.0 years, p=0.78). In contrast, PrD (85.0 vs. 8.4 hours, p<0.001), SurgD (3.0 vs. 16.0 hours, p<0.001) were different between orchidectomy and orchidopexy patients. SurgD was similar with PrD<24 hours (4.0 vs. 2.8, p=0.1). Orchidectomy patients had greater rotation (3.0π vs. 2.0π radians, p<0.001). Logistic regression revealed that PrD (OR 0.94; 0.92–0.97; p<0.001) and rotation (OR 0.43; 0.27–0.70; p<0.001) were inversely associated with orchidopexy. Conclusion Testicular rotation exerts a multiplicative effect on PrD, so time should not be regarded as the sole predictor of surgical outcome in iTT.

Torção testicular: suspeita clínica e abordagem / Testicular torsion: clinical suspicion and approach

A torção testicular é uma emergência urológica frequente e seu reconhecimento e conduta precoces são necessários visto que a janela terapêutica é estreita e são graves os prejuízos quando retardada a correção, que geralmente é cirúrgica.

Testicular torsion is a frequent urological emergency and its early recognition and management are imperative, since the therapeutic window is narrow and there are serious losses when the correction is delayed, which is usually surgical.

Torção de testículo - artigo de revisão / Testicular torsion - review article

A torção testicular é uma emergência urológica bastante frequente que necessita de rápida intervenção para evitar a perda do órgão acometido. Diagnóstico precoce e tratamento cirúrgico imediato habitualmente preservam a função testicular.

Testicular torsion is a very common urological emergency that require rapid intervention to prevent loss of the affected organ. Early diagnosis and immediate surgical treatment usually preserve the testicular function.

Decompressive fasciotomy in testicular torsion of the spermatic cord in rats

PURPOSE: To evaluate the effect of decompression fasciotomy on testes undergoing torsion of the spermatic cord. METHODS: Spermatic cord torsion was induced in 40 Wistar testes for six and 12 hours. At the time of distortion, decompression fasciotomy was performed on half of the animals. After 42 days, the testicles were examined both macroscopically and microscopically. A non-parametric Mann- Whitney U- test was used for statistical analysis. The results were considered significant at p≤0.05. RESULTS: Testicular weight; volume and degree of histological alterations were evaluated. When the groups without and with fasciotomy were compared, a 12-hour torsion subgroup in the fasciotomy group was noted to present larger volume, heavier weight and superior histological classification when compared with the 12-hour subgroup in the without fasciotomy group. No differences between the two groups after six hours of torsion were found. No significant changes were noticed in the contralateral testis. CONCLUSIONS: Testicular fasciotomy (decompression) benefited the macroscopic and histological aspects of the testicles undergoing cord torsion for a 12-hour period. These results demonstrate the role played by compartment syndrome in the pathophysiology of spermatic cord torsion and the need for decompression.

Long-term effects of the testicular torsion on the spermatogenesis of the contralateral testis and the preventive value of the twisted testis orchiepididymectomy / Efeitos tardios da torção testicular sobre a espermatogênese do testículo contralateral e o valor preventivo da orquiepididimectomia do testículo torcido

PURPOSE: To determine whether the testicular torsion causes long-term effects on the spermatogenesis of the contralateral testis, and whether the orchiepididymectomy of the twisted testis could prevent them, using specific spermatogenesis parameters to elucidate the conflicting results in the literature. METHODS: Seventy-four pubertal male Wistar rats were randomly selected. The experimental group consisted of 40 rats, divided into four subgroups, submitted to 1.080 degrees counterclockwise left testicular torsion and its scrotal fixation at the beginning of the experiment, and left orchiepididymectomy at one, five, ten and 90 days, respectively. The control group consisted of 24 rats, divided into four sham operation control subgroups. An additional control subgroup consisted of the ten remaining rats, submitted only to the left orchiepididymectomy at the beginning. At 90 days, the contralateral testes of the experimental and control subgroups were collected for the evaluation of their spermatogenesis parameters: testicular weight, seminiferous tubular diameter, Johnsen score and differential counting of the germ cells. RESULTS: No statistically significant differences were observed among the experimental and control subgroups for all of the spermatogenesis parameters of the contralateral testes. CONCLUSIONS: Testicular torsion does not cause long-term effects on the spermatogenesis of the contralateral testis in pubertal rats, and the orchiepididymectomy of the twisted testis is not necessary for preventive purposes for the contralateral spermatogenesis.

OBJETIVO: Determinar se a torção testicular causa efeitos tardios sobre a espermatogênese do testículo contralateral e se a orquiepididimectomia do testículo torcido poderia preveni-los, usando parâmetros específicos da espermatogênese para elucidar os resultados conflitantes na literatura. MÉTODOS: Foram selecionados aleatoriamente 74 ratos machos púberes da linhagem Wistar. O grupo experimental foi composto por 40 ratos divididos em quatro subgrupos, submetidos à torção anti-horária de 1,080 graus do testículo esquerdo e sua fixação escrotal no início do experimento e à orquiepidimectomia esquerda com um, cinco, dez e 90 dias, respectivamente. O grupo controle foi composto por 24 ratos divididos em quatro subgrupos de cirurgias simuladas. Um subgrupo controle adicional foi constituído pelos dez ratos restantes submetidos unicamente à orquiepididimectomia esquerda no início do experimento. Aos 90 dias, os testículos contralaterais dos subgrupos experimentais e controles foram coletados para avaliação dos parâmetros de suas espermatogêneses: peso testicular, diâmetro do túbulo seminífero, graduação de Johnsen e contagem diferencial das células germinativas. RESULTADOS: Não houve diferença estatisticamente significativa entre todos os subgrupos experimentais e controles para todos os parâmetros analisados da espermatogênese dos testículos contralaterais. CONCLUSÕES: A torção testicular não causa efeitos tardios sobre a espermatogênese do testículo contralateral em ratos púberes e a orquiepididimectomia do testículo torcido não é necessária para fins preventivos da espermatogênese contralateral.

Testicular torsion and weather conditions: analysis of 21,289 cases in Brazil

PURPOSE: The hypothesis of association between testicular torsion and hyperactive cremasteric reflex, worsened by cold weather, has not been proved. Thirteen studies in the literature evaluated this issue, with inconclusive results. The aim of the present study was to evaluate the seasonality of testicular torsion in a large subset of patients surgically treated in Brazil, and additionally to estimate the incidence of testicular torsion. MATERIALS AND METHODS: Brazilian Public Health System Database was assessed from 1992-2010 to evaluate hospital admissions associated with treatment of testicular torsion. Average monthly temperature between 1992-2010 was calculated for each region. RESULTS: We identified 21,289 hospital admissions for treatment of testicular torsion. There was a higher number of testicular torsions during colder months (p = 0.002). To estimate the incidence of testicular torsion, we have related our findings to data from the last Brazilian census (2010). In 2010, testicular torsion occurred in 1.4:100,000 men in Brazil. CONCLUSIONS:Testicular torsion occurred at an annual incidence of approximately 1.4:100,000 men in Brazil in 2010. Seasonal variations do occur, with a significant increase of events during winter. Our findings support the theory of etiological role of cold weather to the occurrence of testicular torsion. Strategies to prevent these events can be based on these findings.

Extravaginal testicular torsion: a clinical entity with unspecified surgical anatomy

PURPOSE: To review and evaluate the anatomical definitions of perinatal extravaginal torsion (EVT) of the testis. MATERIALS AND METHODS: An extensive review of the literature was made to reveal the prevalent anatomical background predisposing to EVT. Gross appearance of twisted testes obtained during surgery for 14 cases of EVT was used to test the validity of the above theories. RESULTS: The most commonly accepted suggestions describe an EVT within dartos muscle that includes all layers of spermatic cord or an EVT outside parietal layer of tunica vaginalis within internal spermatic fascia. However, both of them were found inadequately documented, while a large volume of controversial data has been accumulated, that raises doubts regarding the validity of such definitions. The gross appearance of twisted testes failed to confirm both an EVT including all layers of the spermatic cord and also an EVT outside tunica vaginalis as possible mechanisms of torsion. CONCLUSION: The anatomical basis of EVT remains unclear and further investigation is required.

Torsión testicular bilateral y sincrónica en un recién nacido. Caso clínico / Bilateral and synchronous testicular torsion in a newborn. Case report

La torsión testicular perinatal, definida como aquella ocurrida entre el período prenatal y el período postnatal hasta el mes de nacimiento, es una entidad rara que, en general, afecta uno de los testículos. Como la mayoría de los casos ocurre durante el período prenatal, la tasa de pérdida testicular es muy alta.La torsión testicular bilateral, ya sea sincrónica o asincrónica, es mucho más rara. La existencia de torsión testicular unilateral debe alertar al equipo médico neonatal sobre la posibilidad cierta de torsión contralateral.Presentamos un recién nacido con torsión testicular bilateral (compromiso de pared escrotal bilateral, con testículos duros,adheridos a cubiertas escrotales, sin hidrocele ni signos inflamatorios agudos, ecografía y eco-doppler característicos, y necrosis isquémica con pérdida de ambos testículos durante la exploración quirúrgica). Proponemos pautas de manejo de la torsión testicular.

Painless inter epididymal testicular torsion of the spermatic cord

Inter epididymal testicular torsion of the spermatic cord is extremely rare and usually diagnosed at surgery. We present an unusual case of spermatic cord torsion in a 14-year-old male patient. It is important to highlight that the torsion occurred only on the distal half of the epididymis leaving the head untwisted and edematous. In addition, the fact that this condition was painless made this case extremely rare and motivated our presentation.

Testicular Torsion : a Fifteen Year Review in a Nigerian Teaching Hospital

Aim and Objectives: To determine the prevalent age; presentation; duration of symptoms before intervention; and outcome of management of testicular torsion (TT) in our community. Design: A fifteen-year retrospective study. Setting: University Teaching Hospital. Materials and Method: Records of patients managed for TT; January 1992- Decem- ber 2006; were reviewed. Records of 91 out of 106 patients managed during the period were available for review. The age of patient; presentation; duration of symptoms; predisposing factors; interval between presentation and operation; and outcome of management were extracted and analyzed. Results: Ninety-one patients; mean age 20.1yrs (range 8-34) were reviewed. The average duration of symptoms at presentation was 26.7hrs (range 1.5- 168). The patients were mostly 74(81.3) students. All of them presented with scrotal pain; and 66(72.5) had scrotal swelling (Left: Right=1.8:1). Torsion was partial (180-270o) in 14(15.4); and complete (360o-1440o) in 77(84.6). Intra-scrotal anatomic abnormalities were observed in 77(84.6) patients. Testes were viable in 59(64.8) patients offered bilateral orchidopexy and gangrenous in 32(35.2) that had orchi- dectomy with contralateral orchidopexy. The average duration of hospital stay was 2.8days. Most of the patients 76(83.5) were lost to follow up within 3 weeks postoperative. Conclusion: TT occurs in patients aged 8-34yrs in our immediate community. Presentation is late and most patients 77(84.6) have predisposing congenital abnormalities. There is a need for increase awareness by the general public and the health personnel's of the danger posed by delay in treating TT. Where doubts exist; early scrotal exploration should be the investigation and intervention of choice to prevent irreversible damage to the germ cells

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]