An analysis of clinical outcomes using color Doppler testicular ultrasoundfor testicular torsion

Objectives. To delineate the clinical outcomes of color Doppler ultrasound (US) in the equivocal torsion patient. Methods. From 1992 to 1997, 130 patients (<23 years old) from 2 institution s underwent US imaging using a 7.5-mHz linear transducer to evaluate an acu te scrotum equivocal, or of low suspicion, for torsion. The US reports and hospital charts of these patients were retrospectively reviewed. Results. After clinical and radiologic evaluation, torsion was excluded in 110 patients without surgical exploration. In 3 patients, intermittent test icular torsion was diagnosed and in 17 patients, emergent exploration was p erformed for US diagnosis of testicular torsion. Twenty-five patients (22.7 %) were subsequently lost to followup. Follow-up of 85 patients with US neg ative for torsion (mean length of follow-up = 466.9 days) revealed no testi cular atrophy in 83. Two patients underwent delayed orchiectomy/contralater al orchiopexy for missed testicular torsion. Of 17 patients with US positiv e for torsion, 9 underwent orchiectomy for a necrotic torsed testis, 7 viab le torsed testes were found, and 1 torsed appendix testis was found. Theref ore, color Doppler US for the equivocal acute scrotum yielded a 1% false-po sitive rate, sensitivity of 88.9%, and specificity of 98.8%. Conclusion. When faced with ruling out testicular torsion, it is necessary to integrate the multiple pieces of patient data, knowing that each piece o f data may have inaccuracies. With this in mind, this analysis of outcomes verifies that color Doppler US is an excellent adjunctive study in the clin ically real situation in which the clinical evaluation is equivocal or low suspicion.