Clinical and sonographic features predict testicular torsion in children: a prospective study

TY - JOUR

T1 - Clinical and sonographic features predict testicular torsion in children: a prospective study

AU - Boettcher, Michael

AU - Krebs, Thomas

AU - Bergholz, Robert

AU - Wenke, Katharina

AU - Aronson, Daniel

AU - Reinshagen, Konrad

N1 - © 2013 The Authors. BJU International © 2013 BJU International.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - OBJECTIVE: To test the clinical and sonographic predictors of testicular torsion (TT) with the aim of reducing negative exploration rates.PATIENTS AND METHODS: We performed a prospective study of all boys treated for 'acute scrotum' at our institute between January 2001 and April 2012 and clinical findings were documented. If available, ultrasonography (US) was added to the diagnostic evaluation. A prediction of the diagnosis was based on clinical and sonographic features, and was followed by surgical exploration in all patients.RESULTS: A total of 104 patients were included in the 16-month period of the study. No single finding excluded TT. The clinical features (pain <24 h, nausea/vomiting, abnormal cremasteric reflex, high position of the testis) appeared predictive (100% sensitivity) and the clinical scoring system was proven to be reliable, reducing the negative exploration rate by >55%. Ultrasound predictors alone were not able to identify all boys with TT.CONCLUSIONS: It is safe to refrain from routine surgical exploration in every child with acute scrotum if the clinical score is applied, which results in a marked reduction of negative explorations. A reliable diagnosis could not be obtained based on US alone. As scrotal US is unpleasant for the child, we propose to refrain from this if the clinical score is positive. Patients with a negative clinical score are suitable candidates for US to establish and secure diagnosis.

AB - OBJECTIVE: To test the clinical and sonographic predictors of testicular torsion (TT) with the aim of reducing negative exploration rates.PATIENTS AND METHODS: We performed a prospective study of all boys treated for 'acute scrotum' at our institute between January 2001 and April 2012 and clinical findings were documented. If available, ultrasonography (US) was added to the diagnostic evaluation. A prediction of the diagnosis was based on clinical and sonographic features, and was followed by surgical exploration in all patients.RESULTS: A total of 104 patients were included in the 16-month period of the study. No single finding excluded TT. The clinical features (pain <24 h, nausea/vomiting, abnormal cremasteric reflex, high position of the testis) appeared predictive (100% sensitivity) and the clinical scoring system was proven to be reliable, reducing the negative exploration rate by >55%. Ultrasound predictors alone were not able to identify all boys with TT.CONCLUSIONS: It is safe to refrain from routine surgical exploration in every child with acute scrotum if the clinical score is applied, which results in a marked reduction of negative explorations. A reliable diagnosis could not be obtained based on US alone. As scrotal US is unpleasant for the child, we propose to refrain from this if the clinical score is positive. Patients with a negative clinical score are suitable candidates for US to establish and secure diagnosis.

KW - Child

KW - Child, Preschool

KW - Early Diagnosis

KW - Germany

KW - Humans

KW - Incidence

KW - Magnetic Resonance Imaging

KW - Male

KW - Nausea

KW - Pain

KW - Physical Examination

KW - Prospective Studies

KW - Radionuclide Imaging

KW - Scrotum

KW - Sensitivity and Specificity

KW - Spermatic Cord Torsion

KW - Unnecessary Procedures

KW - Vomiting

U2 - 10.1111/bju.12229

DO - 10.1111/bju.12229

M3 - SCORING: Journal article

C2 - 23826981

VL - 112

SP - 1201

EP - 1206

JO - J UROLOGY

JF - J UROLOGY

SN - 0022-5347

IS - 8

ER -