Clinical and ultrasound characteristics of testicular torsion and long-term outcomes after emergency department treatment

To describe the clinical and ultrasound characteristics of testicular torsion and to analyze long-term outcomes for patients treated in a hospital emergency department. Longitudinal retrospective study of a series of patients treated for acute scrotum and intravaginal testicular torsion confirmed intraoperatively in a hospital emergency service between October 2003 and May 2009. We recorded epidemiologic, clinical, ultrasound, and intraoperative variables and information for a period of 2 years after treatment. A total of 30 patients with a mean (SD) age of 21.7 (5.8) years (range, 12-31 years) were included. The median time between onset of symptoms and emergency department treatment was 8.5 hours (range, 2 hours to 2 weeks). High resolution ultrasound findings included a paratesticular mass in 30 patients (100%), spiral twisting in 5 (16.6%), and a color Doppler flow signal in 4 (3.3%) (patients with partial torsion). Testicular viability was confirmed intraoperatively in 24 (80%) and after 2 years' follow-up in 20 (83,3%). Viable testes were found (introperatively and at 2 years) in for all cases of partial torsion or in patients who came to the emergency department within 6 hours of onset of symptoms. Patients with acute scrotum should be assessed in the emergency department for the possibility of testicular torsion. Testicular viability may depend on time since onset of symptoms and degree of torsion. A finding of paratesticular mass on high-resolution ultrasound may assist diagnosis, but the presence of a Doppler flow signal does not rule out a diagnosis of testicular torsion.