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The role of ultrasound imaging in adult patients with testicular torsion: a systematic review and meta-analysis

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Abstract

Purpose

Our aim was to determine the accuracy of ultrasound (US) examination-based testicular torsion diagnosis in adult patients with acute scrotal pain.

Methods

A comprehensive electronic search was performed using internet retrieval systems up to 5 August 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The quality of eligible studies was assessed using Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2). The diagnostic value of ultrasound in patients with testicular torsion was evaluated using pooled estimates of sensitivity, specificity, likelihood ratio, and diagnostic odds ratio, as well as the summary receiver operating characteristics curve.

Results

Twenty-six studies with 2116 patients were included in the study. Overall diagnostic sensitivity was 0.86 [95% confidence interval (CI) 0.79–0.91] and specificity was 0.95 (95% CI: 0.92–0.97). Subgroup analysis of prospective studies showed pooled sensitivity of ultrasound for testicular torsion was 0.94 (95% CI 0.83–0.98), and pooled specificity was 0.98 (95% CI 0.94–1.00). Recent studies after 2010 showed diagnostic sensitivity of 0.95 (95% CI 0.84–0.99) and specificity of 0.98 (95% CI 0.93–0.99).

Conclusions

This meta-analysis demonstrated that ultrasound represents an effective imaging modality for diagnosing testicular torsion in adult patients with acute scrotal pain.

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References

  1. McAndrew HF, Pemberton R, Kikiros CS, et al. The incidence and investigation of acute scrotal problems in children. Pediatr Surg Int. 2002;18:435–7.

    Article  CAS  PubMed  Google Scholar 

  2. Sharp VJ, Kieran K, Arlen AM. Testicular torsion: diagnosis, evaluation, and management. Am Fam Phys. 2013;88:835–40.

    Google Scholar 

  3. Lorenzo L, Rogel R, Sanchez-Gonzalez JV, et al. Evaluation of adult acute scrotum in the emergency room: clinical characteristics, diagnosis, management, and costs. Urology. 2016;94:36–41.

    Article  PubMed  Google Scholar 

  4. Frohlich LC, Paydar-Darian N, Cilento BG, et al. Prospective validation of a clinical score for males presenting with an acute scrotum. ARPN J Eng Appl Sci. 2017;12:3218–21.

    Google Scholar 

  5. Sierzenski PR, Baty G. Testicular ultrasound. Clin Emerg Radiol. 2008;22:330–6.

    Article  Google Scholar 

  6. Yin S, Trainor JL. Diagnosis and management of testicular torsion, torsion of the appendix testis, and epididymitis. Clin Pediatr Emerg Med. 2009;10:38–44.

    Article  Google Scholar 

  7. Baker LA, Sigman D, Mathews RI, et al. An analysis of clinical outcomes using color doppler testicular ultrasound for testicular torsion. Pediatrics. 2000;105:604–7.

    Article  CAS  PubMed  Google Scholar 

  8. Samson P, Hartman C, Palmerola R, et al. Ultrasonographic assessment of testicular viability using heterogeneity levels in torsed testicles. J Urol. 2017;197:925–30.

    Article  PubMed  Google Scholar 

  9. Nason GJ, Tareen F, McLoughlin D, et al. Scrotal exploration for acute scrotal pain: a 10-year experience in two tertiary referral paediatric units. Scand J Urol. 2013;47:418–22.

    Article  PubMed  Google Scholar 

  10. Waldert M, Klatte T, Schmidbauer J, et al. Color Doppler Sonography Reliably Identifies Testicular Torsion in Boys. Urology. 2010;75:1170–4.

    Article  PubMed  Google Scholar 

  11. McDowall J, Adam A, Gerber L, et al. The ultrasonographic “whirlpool sign” in testicular torsion: valuable tool or waste of valuable time? A systematic review and meta-analysis. Emerg Radiol. 2018;25:281–92.

    Article  PubMed  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Whiting PF, Rutjes AWS, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529–36.

    Article  PubMed  Google Scholar 

  14. Krieger JN, Wang K, Mack L. Preliminary evaluation of color Doppler imaging for investigation of intrascrotal pathology. J Urol. 1990;144:904–7.

    Article  CAS  PubMed  Google Scholar 

  15. Middleton WD, Siegel BA, Melson GL, et al. Acute scrotal disorders: prospective comparison of color Doppler US and testicular scintigraphy. Radiology. 1990;177:177–81.

    Article  CAS  PubMed  Google Scholar 

  16. Dewire DM, Begun FP, Lawson RK, et al. Color Doppler ultrasonography in the evaluation of the acute scrotum. J Urol. 1992;147:89–91.

    Article  CAS  PubMed  Google Scholar 

  17. Fitzgerald SW, Erickson S, De Wire DM, et al. Color Doppler sonography in the evaluation of the adult acute scrotum. J Ultrasound Med. 1992;11:543–8.

    Article  CAS  PubMed  Google Scholar 

  18. Blaivas M, Sierzenski P, Lambert M. Emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography. Acad Emerg Med. 2001;8:90–3.

    Article  CAS  PubMed  Google Scholar 

  19. Vijayaraghavan SB. Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. J Ultrasound Med. 2006;25:563–74.

    Article  PubMed  Google Scholar 

  20. Naveen C, Agrawal A, Tripathi P, Shankhwar A. Role of ultrasound with color Doppler in acute scrotum management. J Fam Med Prim Care. 2014;3:410.

    Google Scholar 

  21. Prajapati N, Madhok R, Tapasvi C, Prasad U. High frequency & color doppler ultrasound evaluation of scrotal and testicular pathologies. Int J Res Heal Sci. 2014;2:153–61.

    Google Scholar 

  22. Shah B, Naik S, Singh A, et al. Feasibility of scrotal colour Doppler and ultrasonography training during surgical residency. Int J Appl Res. 2016;2:577–80.

    Google Scholar 

  23. Singh JP, Josh PS, Neki NS. Color Doppler Evaluation of Scrotal Swellings. Int J Curr Res Med Sci. 2018;4:81–90.

    Article  Google Scholar 

  24. Wilbert DM, Schaerfe CW, Stern WD, et al. Evaluation of the acute scrotum by color-coded Doppler ultrasonography. J Urol. 1993;149:1475–7.

    Article  CAS  PubMed  Google Scholar 

  25. Schwaibold H, Fobbe F, Klän R, et al. Evaluation of acute scrotal pain by color-coded duplex sonography. Urol Int. 1996;56:96–9.

    Article  CAS  PubMed  Google Scholar 

  26. Altinkilic B, Pilatz A, Weidner W. Detection of normal intratesticular perfusion using color coded duplex sonography obviates need for scrotal exploration in patients with suspected testicular torsion. J Urol. 2013;189:1853–8.

    Article  PubMed  Google Scholar 

  27. Dunne PJ, O’Loughlin BS. Testicular torsion: time is the enemy. Aust N Z J Surg. 2000;70:441–2.

    Article  CAS  PubMed  Google Scholar 

  28. Jaison A, Mitra B, Cameron P, et al. Use of ultrasound and surgery in adults with acute scrotal pain. ANZ J Surg. 2011;81:366–70.

    Article  PubMed  Google Scholar 

  29. Pepe P, Pennisi P, Pennisi M, Aragona F. Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?. Eur J Radiol. 2006;60:120–4.

    Article  PubMed  Google Scholar 

  30. Valentino M, Bertolotto M, Derchi L, et al. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol. 2011;21:1831–40.

    Article  PubMed  Google Scholar 

  31. Hod N, Maizlin Z, Strauss S, et al. The relative merits of Doppler sonography in the evaluation of patients with clinically and scintigraphically suspected testicular torsion. Isr Med Assoc J. 2004;6:13–5.

    PubMed  Google Scholar 

  32. Yagil Y, Naroditsky I, Milhem J, et al. Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. J Ultrasound Med. 2010;29:11–21.

    Article  PubMed  Google Scholar 

  33. Bickerstaff KI, Sethia K, Murie JA. Doppler ultrasonography in the diagnosis of acute scrotal pain. Br J Surg. 1988;75:238–9.

    Article  CAS  PubMed  Google Scholar 

  34. Almufti RA, Ogedegbe AK, Lafferty K. The use of Doppler ultrasound in the clinical management of acute testicular pain. Br J Urol. 1995;76:625–7.

    Article  CAS  Google Scholar 

  35. Yuan Z, Luo Q, Chen L, et al. Clinical study of scrotum scintigraphy in 49 patients with acute scrotal pain: a comparison with ultrasonography. Ann Nucl Med. 2001;15:225–9.

    Article  CAS  PubMed  Google Scholar 

  36. Andipa E, Liberopoulos K, Asvestis C. Magnetic resonance imaging and ultrasound evaluation of penile and testicular masses. World J Urol. 2004;22:382–91.

    Article  CAS  PubMed  Google Scholar 

  37. Abul F, Al-Sayer H, Arun N. The acute scrotum: a review of 40 cases. Med Princ Pract. 2005;14:177–81.

    Article  PubMed  Google Scholar 

  38. Liu C, Huang S-P, Chou Y, et al. Clinical presentation of acute scrotum in young males. Kaohsiung J Med Sci. 2007;23:281–6.

    Article  CAS  PubMed  Google Scholar 

  39. Terai A, Yoshimura K, Ichioka K, et al. Dynamic contrast-enhanced subtraction magnetic resonance imaging in diagnostics of testicular torsion. Urology. 2006;67:1278–82.

    Article  PubMed  Google Scholar 

  40. Yusuf GT, Sidhu PS. A review of ultrasound imaging in scrotal emergencies. J Ultrasound. 2013;16:171–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Blaivas M, Brannam L. Testicular ultrasound. Emerg Med Clin North Am. 2004;22:723–48.

    Article  PubMed  Google Scholar 

  42. Kühn AL, Scortegagna E, Nowitzki KM, et al. Ultrasonography of the scrotum in adults. Ultrason (Seoul, Korea). 2016;35:180–97.

    Google Scholar 

  43. Dudea SM, Ciurea A, Chiorean A, et al. Doppler applications in testicular and scrotal disease. Med Ultrason. 2010;12:43–51.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 596-8686, Japan

    Koshi Ota, Masahiro Oka, Kanna Ota, Masahide Sakaue & Akira Takasu

  2. Research and Development Center, Osaka Medical College, Takatsuki, Japan

    Keisuke Fukui

  3. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Koji Oba

  4. McCann Public Health, McCann Healthcare Worldwide Japan Inc, Tokyo, Japan

    Akihiro Shimoda

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  1. Koshi Ota
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  2. Keisuke Fukui
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Correspondence to Koshi Ota.

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Ota, K., Fukui, K., Oba, K. et al. The role of ultrasound imaging in adult patients with testicular torsion: a systematic review and meta-analysis. J Med Ultrasonics 46, 325–334 (2019). https://doi.org/10.1007/s10396-019-00937-3

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  • DOI: https://doi.org/10.1007/s10396-019-00937-3

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