Clinical and sonographic features predict testicular torsion in children: a prospective study
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Clinical and sonographic features predict testicular torsion in children: a prospective study. / Boettcher, Michael; Krebs, Thomas; Bergholz, Robert; Wenke, Katharina; Aronson, Daniel; Reinshagen, Konrad.
In: J UROLOGY, Vol. 112, No. 8, 01.12.2013, p. 1201-6.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -