Modifications of echogenicity of the testis during acute ...€¦ · Dishomogeneous torsion testis...
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371 Archivio Italiano di Urologia e Andrologia 2014; 86, 4 ORIGINAL PAPER Modifications of echogenicity of the testis during acute torsion may be a predictive factor of organ damage? Giuseppe Benedetto, Filippo Nigro, Emiliano Bratti, Andrea Tasca Department of Urology, San Bortolo Hospital, Vicenza, Italy In the setting of symptoms of testicular torsion the absence of diastolic flow or color flow on Doppler ultrasound has traditionally prompted emergent scrotal exploration. This practice emanates from the difficulty on ultrasound of distin- guishing salvageable testes from those that are not sal- vageable. We evaluated the changes of echogenicity in the course of testicular torsion of the testis to identify charac- teristics predictive of irreversible organ damage. KEY WORDS: Testicular torsion; Echogenicity of testicular torsion. Submitted 3 October 2014; Accepted 31 October 2014 Summary No conflict of interest declared. flow in the testis wrong. Six boys underwent orchiecto- my for testicular necrosis and histological examination documented hemorrhagic necrosis of the testis consis- tent with testicular torsion. The ultrasound pattern of these patients documented in all the presence of a dishomogeneous and heterogeneous echotexture of the testis. In the other eight patients an hypoechoic and isoechoic homogeneous testicular framework was documented, compatible with the integrity of the testis as assessed at scrotal exploration The average time between the onset of symptoms and the scrotal exploration was 9 hours (range 6-18) in patients in whom the testis was preserved, and 15 hours (range 9-21) in patients undergoing then to orchiectomy. There were no intra- and postoperative complications in patients undergoing orchiectomy DISCUSSION In our series the heterogeneously hypoechoic testicular parenchyma showed an irreversible organ damage that required removal of the organ. DOI: 10.4081/aiua.2014.4.371 Presented at 19 th National Congress SIEUN, Fermo 2014 INTRODUCTION AND AIMS During the acute torsion of the testis, in addition to clin- ical signs and symptoms, the scrotal Doppler ultrasound can be of support in evaluating the absence of testicular flow. We evaluated the changes of echogenicity in the course of testicular torsion of the testis to identify char- acteristics predictive of irreversible organ damage. MATERIAL AND METHODS We retrospectively analyzed, the scrotal ultrasound of patients undergoing scrotal exploration for testicular torsion in the last year in our department, evaluating the sono- graphic features and comparing them to the outcome of the scrotal exploration, and in case of orchiectomy to outcome for histology. Was also evaluated the average time between the onset of symptoms and evaluation in the emergency room and the scrotal exploration. RESULTS During the past year, 14 children were eval- uated at our department for acute torsion of the testis and underwent scrotal exploration. All underwent preoperative scrotal Doppler ultrasound that documented the absence of Figure. Dishomogeneous torsion testis alteration.
Transcript of Modifications of echogenicity of the testis during acute ...€¦ · Dishomogeneous torsion testis...
371Archivio Italiano di Urologia e Andrologia 2014; 86, 4
ORIGINAL PAPER
Modifications of echogenicity of the testis during acutetorsion may be a predictive factor of organ damage?
Giuseppe Benedetto, Filippo Nigro, Emiliano Bratti, Andrea Tasca
Department of Urology, San Bortolo Hospital, Vicenza, Italy
In the setting of symptoms of testiculartorsion the absence of diastolic flow or
color flow on Doppler ultrasound has traditionallyprompted emergent scrotal exploration. This practiceemanates from the difficulty on ultrasound of distin-guishing salvageable testes from those that are not sal-vageable. We evaluated the changes of echogenicity in thecourse of testicular torsion of the testis to identify charac-teristics predictive of irreversible organ damage.
KEY WORDS: Testicular torsion; Echogenicity of testicular torsion.
Submitted 3 October 2014; Accepted 31 October 2014
Summary
No conflict of interest declared.
flow in the testis wrong. Six boys underwent orchiecto-my for testicular necrosis and histological examinationdocumented hemorrhagic necrosis of the testis consis-tent with testicular torsion. The ultrasound pattern of these patients documented inall the presence of a dishomogeneous and heterogeneousechotexture of the testis. In the other eight patients an hypoechoic and isoechoichomogeneous testicular framework was documented,compatible with the integrity of the testis as assessed atscrotal exploration The average time between the onset of symptoms andthe scrotal exploration was 9 hours (range 6-18) inpatients in whom the testis was preserved, and 15 hours(range 9-21) in patients undergoing then to orchiectomy.There were no intra- and postoperative complications inpatients undergoing orchiectomy
DISCUSSIONIn our series the heterogeneously hypoechoic testicularparenchyma showed an irreversible organ damage thatrequired removal of the organ.
DOI: 10.4081/aiua.2014.4.371
Presented at 19th National Congress SIEUN, Fermo 2014
INTRODUCTION AND AIMSDuring the acute torsion of the testis, in addition to clin-ical signs and symptoms, the scrotal Doppler ultrasoundcan be of support in evaluating the absence of testicularflow. We evaluated the changes of echogenicity in thecourse of testicular torsion of the testis to identify char-acteristics predictive of irreversible organ damage.
MATERIAL AND METHODSWe retrospectively analyzed, the scrotalultrasound of patients undergoing scrotalexploration for testicular torsion in the lastyear in our department, evaluating the sono-graphic features and comparing them to theoutcome of the scrotal exploration, and incase of orchiectomy to outcome for histology. Was also evaluated the average time betweenthe onset of symptoms and evaluation in theemergency room and the scrotal exploration.
RESULTSDuring the past year, 14 children were eval-uated at our department for acute torsion ofthe testis and underwent scrotal exploration.All underwent preoperative scrotal Dopplerultrasound that documented the absence of
Figure. Dishomogeneous torsion testis alteration.
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Archivio Italiano di Urologia e Andrologia 2014; 86, 4
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Therefore, taking into account echotexture and obvioussigns of torsion scrotal exploration cannot be emergent.On the other hand, an homogeneous echotexture her-alds testicular viability and the need to scrotal explo-ration in emergency.
CONCLUSIONWe evaluated the changes of echogenicity in the courseof testicular torsion of the testis to identify characteristicspredictive of irreversible organ damage.
However the smallness of our sample requires confirma-tion by in-depth studies of larger series.
REFERENCES1. Kaye JD, Shapiro EY, Levitt SB, et al. Parenchymal echo texturepredicts testicular salvage after torsion: potential impact on the needfor emergent exploration.J Urol. 2008; 180(4 Suppl):1733-6.
2. Nistal M, Paniagua R, Gonzalez-Peramato P, Reyes-Múgica M.Testicular torsion, testicular appendix torsion and other forms of tes-ticular infarction. Pediatr Dev Pathol. 2014.
CorrespondenceGiuseppe Benedetto, [email protected] Nigro, [email protected] Bratti, [email protected] Tasca, [email protected] Urologia, Ospedale San Bortolo, Via Rodolfi, 37 - Vicenza, Italy
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