Author : Aldeen M Al Hakee, Salah
Basrah Journal of Surgery,
2015, Volume 21, Issue 2, Pages 22-33
The aim of this study is to evaluate the most useful clinical signs and symptoms in the diagnosis of spermatic cord torsion, and so decreasing unnecessary surgical exploration and testicular loss rates for these patients.
Between August 2013 and November 2014, patients with suspected spermatic cord torsion were included in this study; patient case sheets were prepared; history, examination, imaging, and post-operative results were recorded. The patients then divided into non-torsion and torsion groups, the torsion group further subdivided into salvaged and orchiectomy groups. Data evaluated and correlated with the result of the surgical exploration.
Seventy-seven patients were included, 11 (15%) patients without torsion and 66 (85%) with torsion. Of the torsion group 35 (53%) were salvaged while orchiectomy done to the remaining 31 (47%).
The patients' age ranged from 1 to 29 years with a mean of 16.22 years with standard deviation of 6 years, and they commonly presented during winter months, the salvageability rate decline with increase duration of symptoms especially after 24 hours.
There were a significant difference (p<0.05) between torsion and non-torsion groups in the testis lay, testis orientation, cremasteric reflex, high riding testis, left side, and cord knotting. There were significant difference (p<0.05) between salvaged and orchiectomy groups in duration of symptom, onset of symptom, and in presence of scrotal edema.
A univariate analysis showed that the pain was very sensitive but lacks specificity; the duration less than 6 hours, abnormal lay, absent cremasteric reflex, high riding testis, abnormal orientation, presence of cord knot, and presence of nausea and vomiting are highly specific.
The multivariate analysis then repeated for combination of nausea and vomiting, high riding testis, abnormal lay, and absence of cremasteric reflex; showed 100% specificity if three and more of these four feature were present.
In conclusion, careful history and physical examination can aid diagnosis of testicular torsion, no clinical signs and symptoms were highly specific and sensitive for torsion, and a constellation of clinical feature can aid the diagnosis.