Pediatric Radiology

, Volume 35, Issue 6, pp 597–600 | Cite as

Colour Doppler ultrasonography replacing surgical exploration for acute scrotum: myth or reality?

  • Winnie Wing-Chuen Lam
  • Te-Lu Yap
  • Anette Sundfor Jacobsen
  • Harvey James Eu-Leong Teo
Original Article

Abstract

Background: Traditionally, every patient with an acute scrotum needed surgical exploration for definitive exclusion of testicular torsion. Objective: In this study, we aimed to evaluate the improved accuracy in clinical diagnosis with colour Doppler Ultrasonography (US) added to normal clinical assessment. Materials and methods: We retrospectively reviewed 626 patients, who presented with acute scrotal pain between January 1998 and June 2004. Following history and physical examination, the patients either proceeded directly to surgery or underwent US examination. If clinical suspicion of testicular torsion persisted after US, the patients would still undergo scrotal exploration. Results: Of the 294 patients who had routine scrotal exploration without preliminary US, only 23 (7.8%) were found to have testicular torsion. Amongst the 332 cases that had initial US, 9 (2.7%) patients revealed testicular torsion that was confirmed at subsequent surgery. The remaining 323 patients had initial negative US, but 29 were explored eventually on clinical indications. Of these, 4 (1.2% of 323) cases were diagnosed intra-operatively as testicular torsion. None of the remaining 294 patients who were managed conservatively proved to have testicular torsion after a minimum follow-up of 2 weeks. For testicular torsion, US yielded a sensitivity of 69.2% (95% confidence interval =38.9–89.5), specificity of 100% (95% CI=98.5–100), positive predictive value of 100% and negative predictive value of 97.5%. Conclusions: US has proven to decrease the number of emergency scrotal explorations, length of hospital stay and hence reduce the cost of management of acute scrotum.

Keywords

Testis Torsion Ultrasound Children 

References

  1. 1.
    Dubinsky TJ, Chen P, Maklad N (1998) Color-flow and power Doppler imaging of the testes. World J Urol 16:35–40Google Scholar
  2. 2.
    Kass E, Stone K, Cacciarelli A, et al (1993) Do all children with an acute scrotum require exploration? J Urol 150:667–669Google Scholar
  3. 3.
    Lewis A, Bukowski T, Jarvis P, et al (1995) Evaluation of acute scrotum in the emergency department. J Pediatr Surg 30:277–282Google Scholar
  4. 4.
    Stehr M, Boehm R (2003) Critical validation of colour Doppler ultrasound in diagnostics of acute scrotum in children. Eur J Pediatr Surg 13:386–392Google Scholar
  5. 5.
    Weber DM, Rosslein R, Fliegel C (2000) Color Doppler sonography in the diagnosis of acute scrotum in boys. Eur J Pediatr Surg 10:235–241Google Scholar
  6. 6.
    Galejs L, Kass E (1998) Color Doppler ultrasound evaluation of the acute scrotum. Tech Urol 4:182–184Google Scholar
  7. 7.
    Yazbeck S, Patriquin H (1994) Accuracy of Doppler sonography in the evaluation of acute conditions of the scrotum in children. J Pediatr Surg 29:1270–1272Google Scholar
  8. 8.
    Allen T, Elder J (1995) Shortcomings of color Doppler sonography in the diagnosis of testicular torsion. J Urol 154:1508–1510CrossRefPubMedGoogle Scholar
  9. 9.
    Baker LA, Sigman D, Mathews RI, et al (2000) An analysis of clinical outcomes using colour Doppler testicular ultrasound for testicular torsion. Pediatrics 105:604–607Google Scholar
  10. 10.
    Ingram S, Hollman A (1994) Colour Doppler sonography of the normal paediatric testis. Clin Radiol 49:266–267Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Winnie Wing-Chuen Lam
    • 1
  • Te-Lu Yap
    • 1
  • Anette Sundfor Jacobsen
    • 1
  • Harvey James Eu-Leong Teo
    • 2
  1. 1.Department of Paediatric SurgeryKK Women’s and Children’s HospitalSingapore
  2. 2.Department of Diagnostic ImagingKK Women’s and Children’s HospitalSingapore

Personalised recommendations