Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children

Gwen M. Grimsby, Bruce J. Schlomer, Vani S. Menon, Lauren Ostrov, Melise Keays, Kunj R. Sheth, Carlos Villanueva, Candace Granberg, Daniel Dajusta, Martinez Hill, Emma Sanchez, Clanton B. Harrison, Micah A. Jacobs, Berk Burgu, Halim Hennes, Linda A. Baker

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Objective: To prospectively correlate pain duration, red scrotal skin, ultrasound appearance of testis, and intraoperative testis color to future testis atrophy after acute testicular torsion. Methods: Patients 2 months-18 years old with unilateral acute scrotum were consecutively enrolled in a National Institutes of Health transcutaneous near-infrared spectroscopy study, with a subgroup analysis of the true torsion group. Presence or absence of red scrotal skin, pain duration, testicular heterogeneity on preoperative ultrasound, and intraoperative testis color based on a novel visual chart 5 minutes after detorsion were recorded. All testes underwent orchiopexy regardless of appearance. Percent volume difference between normal and torsed testicles on follow-up ultrasound was compared between patients with and without risk factors. Results: Thirty of 56 patients who had surgical detorsion underwent scrotal ultrasound at a mean of 117 days after surgery. A color of black or hemorrhagic 5 minutes after detorsion, pain duration >12 hours, and heterogeneous parenchyma on preoperative ultrasound were associated with significant testis volume loss in follow-up compared with normal testis. All patients with a black or hemorrhagic testis had >80% volume loss. Erythematous scrotal skin was not significantly associated with smaller affected testis volume in follow-up. Conclusion: Based on the high atrophy rate, orchiectomy can be considered for testes that are black or hemorrhagic 5 minutes after detorsion. Pain duration >12 hours and parenchymal heterogeneity on preoperative ultrasound were also associated with testis atrophy. Red scrotal skin was not a reliable predictor of atrophy and should not delay exploration.

Original languageEnglish (US)
Pages (from-to)150-155
Number of pages6
JournalUrology
Volume116
DOIs
StatePublished - Jun 2018

ASJC Scopus subject areas

  • Urology

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