Testicular Torsion in Children. Diagnostic and Prognostic Potential of Ultrasonography

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Abstract
Introduction: Testicular torsion is the most urgent case in pediatric andrology that requires emergency care due to the high sensitivity of testicular tissue to hypoxia.Objective: To determine statistically significant parameters indicating diagnostic significance of some ultrasonographic testicular torsion symptoms in children.Materials and methods: Ultrasonography was performed in 202 children with testicular torsion (main group) and 449 patients (control group) aged from 2 months to 17 years 11 months and 28 days. During statistical processing we determined the mean values, their standard deviation, sampling errors, significance of differences in the mean values, correlation coefficient and did ROC analysis. For an objective ultrasonographic assessment of testicular shape, we implemented the coefficient of rounding – ko = (testicular length – testicular thickness) / testicular length – and the parameter Δko calculated as the difference between ko for the affected side and the contralateral one.Results and discussion: Testicular torsion was more common in children above 12 years of age (84.7%). The ko was 0.160 ± 0.007 in the group of children with testicular torsion and 0.037±0.003 in the control group (t = 16.92, p >> .001). The ROC analysis proved the Δko to be highly informative: AUC was 0.886. The Δko was 0.130 ± 0.008 for patients with favorable treatment outcomes and 0.19 ± 0.01 (p < 0.001) for those with unfavorable outcomes. In most cases (71), the whirlpool sign was visualized with preserved blood flow. In such a case, the probability of the favorable treatment outcome was 74.6%. The whirlpool sign visualization was significantly less common (31 cases) without Doppler ultrasonography; favorable treatment outcomes were achieved in 54.8%. Of 22 patients with the undetected whirlpool sign, favorable treatment outcomes were possible only in 40.9%.Conclusions: The coefficient of rounding ko can be used as an auxiliary criterion for the early diagnosis of testicular torsion. With Δko = 0.08, the sensitivity of the parameter in respect of testicular torsion is 79.2%, and specificity is 85.7%. With Δko = 0.16, the specificity of the parameter is almost 100% with a 45.0% decrease of the sensitivity. Whirlpool sign detection using color Doppler ultrasonography is a positive prognostic factor.

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