BETWEEN ORCHIOPEXY AND ORCHIECTOMY CAN ULTRASOUND PLAY A ROLE?
SURGICAL CORRELATIONS OF ULTRASOUND FINDINGS IN TESTICULAR TORSION
Hikmat Luaibi Salim Alsaad, Riyadh Adel Jaed Abdulazeez, Ali Abdulbaqi Ali Ismael
Department of Surgery, College of Medicine, University of Thi-Qar. Thi-Qar, Iraq.
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permatic cord torsion (SCT) is a condition of spermatic cord (SC) structures twisting, accompanied by venous-congestion, arterial inflow losing and subsequent ipsilateral testis ischemia. Ultrasound is a diagnostic modality of SCT, with 93% sensitivity and 100% specificity.
Purpose. To assess the validity of ultrasound in rolling-out between orchiopexy and orchiectomy in patients with SCT and to evaluate the correlation between ultrasound findings in testicular torsion and surgical approaches.
Materials and methods. A prospective study was conducted in the Radiology department. A total of 57 male patients aged between 5 years to 35 years referred for suspected having testicular torsion. Radiological images of the scrotum were performed in all cases using a Color Doppler with a 9-15 MHz linear-array transducer.
Results. The mean age was 19.07±8.61 years with median of 17 years. Regarding to the scrotal US indices, the following positive findings noticed as followed: in 29 cases (50.9%) – testicular heterogeneity, in 23 cases (40.4%) – presence of blood flow to affected testis, in 45 cases (78.9%) – enlarged epididymis, in 31 cases (54.4%) – heterogeneous epididymis, in 44 cases (77.2%) – blood flow to epididymis, in 31 cases (54.4%) – thickened scrotal wall, in 14 cases (24.6%) – hydrocele, in 9 cases (15.8%) – varicocele, in 6 cases (10.5%) – necrosis and in 5 cases (8.8%) – hemorrhage. In addition, Whirl pool sign was found in 29 cases (50.8%), Resistive index (RI) was elevated in 22 patients (38.6%) and peripheral testicular re-vasculation was found in 25 patients (43.9%). Out of 57 cases, 44 patients (77.2%) underwent orchiopexy whereas 7 patients (12.3%) underwent orchiectomy and 6 patients (10.5%) underwent detorsion.
Discussion. Shields et al. studied male aged one year to 18 years diagnosed with TT. Of the 140 cases with TT, 56 patients (40%) had a non-viable testis and underwent an orchiectomy, while 84 (60%) had a viable testis and orchiopexy. Burud et al. studied 88 cases with acute pain of scrotum. Only 53 patients completed the enrollment, their mean age was 18.11 years and swelling has a positive predictive value for TT. Out of 53 patients, 33 (65.5%) required orchidectomy. They found that the pain duration was not a significant factor in determining TT. However, orchidectomy was more common in patients with pain duration >24 hours and pain duration within 6-24 hours. In a large cohort involved 1005 men surgically exploration for suspected TT done by Yi et al., found that the age group with the greatest number of TT surgeries was 12-18 years old (mean age=17.67±8.51 years) with frequent symptoms were scrotal swelling and pain. In the current study, the scrotal US and Doppler findings are testicular heterogeneity, presence of blood flow to affected testis, enlarged epididymis, heterogeneous epididymis, blood flow to epididymis, thickened scrotal skin, hydrocele, necrosis and hemorrhage. These are agree with Shields et al. that observed 3 signs on the US were significantly associated with a non-viable testis by univariate study, which were testicular heterogeneity, epididymis heterogeneity and thickened scrotal wall. Similarly, Burud et al. reported echogenicity on US showed that heteroechogenicity was more in TT. Doppler US showed reduced perfusion of the affected testis to be more in the TT. The testis size on US had a significant difference in TT and non-TT group.
Conclusions. Testicular heterogeneity, presence of blood flow to affected testis, enlarged epididymis, heterogeneous epididymis, blood flow to epididymis and thickened scrotal wall are main features of scrotal US in TT. Whirl pool sign, Resistive index (RI) elevated and peripheral testicular re-vasculation are main feature of colour Doppler in TT. Testicular heterogeneity, blood flow to affected side, enlarged epididymis and thickened scrotal skin positively impact the decision of surgery types. The perfusion reduction rate in orchiectomy is lower than in patients underwent orchiopexy. Testicular size post orchiopexy decreased more in comparison to post orchiectomy. Ultrasound when combined with clinical presentations, lead to the reduction of the rate of negative surgical exploration.
Keywords: orchiopexy, orchiectomy, color doppler ultrasound, testicular torsion, cremasteric reflex.
Corresponding author: Hikmat Luaibi Salim Alsaad, e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Hikmat Luaibi Salim Alsaad, Riyadh Adel Jaed Abdulazeez, Ali Abdulbaqi Ali Ismael. Between orchiopexy and orchiectomy can ultrasound play a role? Surgical correlations of ultrasound findings in testicular torsion. REJR 2025; 15(3):182-196. DOI: 10.21569/2222-7415-2025-15-3-182-196.
Received: 11.05.25 Accepted: 25.06.25