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Distinguishing testicular torsion from torsion of the appendix testis by clinical features and signs in patients with acute scrotum

Authors Fujita N, Tambo M, Okegawa T, Higashihara E, Nutahara K

Received 24 April 2017

Accepted for publication 21 June 2017

Published 28 August 2017 Volume 2017:9 Pages 169—174


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Jan Colli

Naoyuki Fujita,1 Mitsuhiro Tambo,1 Takatsugu Okegawa,1 Eiji Higashihara,2 Kikuo Nutahara1

1Department of Urology, 2Department of Autosomal Dominant Polycystic Kidney Disease (ADPKD) Research, Kyorin University School of Medicine, Mitaka, Tokyo

Purpose: Many physicians encounter confusion and difficulty in distinguishing testicular torsion (TT) from torsion of the appendix testis (TAT) in patients with acute scrotum because of the overlapping signs and symptoms. The objective of our study was to evaluate the clinical features and signs that can help distinguish TT from TAT.
Patients and methods: We performed a retrospective study of patients with surgically confirmed TT and TAT at our institute from January 1990 to December 2013. Clinical findings, physical examination findings, climatic conditions, laboratory data, and color Doppler ultrasound (CDUS) findings were compared between the TT and TAT groups.
Results: Seventy patients were included in this study (49 with TT and 21 with TAT). Patients with TT were significantly older than those with TAT (p < 0.001). The ambient temperature at onset was significantly lower in patients with TT than in patients with TAT (p = 0.038). Testicular swelling, high-riding testes, onset during sleep, high leukocyte counts, and high creatine phosphokinase levels were significantly more common in patients with TT than with TAT (p = 0.021, 0.032, 0.006, 0.003, and 0.043, respectively). Multivariate analysis showed that age and onset during sleep were significant independent factors for detection of TT. Eight patients (16.3%) underwent preoperative CDUS evaluation, and an absent or decreased blood signal in the involved testes was significantly correlated with the presence of TT (p = 0.018).
Conclusion: In clinical features, age and onset during sleep might be helpful to distinguish TT from TAT. When supported by findings, urgent surgical exploration is warranted in patients with suspected TT based on symptoms and CDUS features.

Keywords: acute scrotum, testicular torsion, torsion of appendix testis, color Doppler ultrasound

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