An Evaluation of Testicular Torsion Management in the Emergency Department

Abstract

Objective: The aim of this study was to investigate the adequacy of colored Doppler ultrasonography (CDUS) and the capability of emergency department (ED) doctors in managing testicular torsion (TT), which is a urologic emergency.

Design: The study was conducted retrospectively between January 2012 and December 2015.

Setting: The study group consisted of patients who presented to Adiyaman Research and Education Hospital at the ED.

Subjects: Patients with acute scrotal or testicular pain and a presumptive diagnosis of TT which was later confirmed by colored Doppler ultrasonography

Intervention: None

Main Outcome Measure(s): Capability of ED doctors in requesting colored Doppler ultrasonography for diagnosis of TT

Results: Two hundred and twenty-five male patients, with a mean age of 24.1 +/- 17.6 were included in the study, all of whom underwent CDUS. A female doctor, who was the patient's primary physician, examined 18 (8%) of the patients, and a female radiological operator evaluated 24 (10.7%) of the CDUS images. Of the 225 patients, 9 (4%) were confirmed radiologically as having TT. The most prevalent diagnosis was epididymo-orchitis (EO) (n = 87 [38.7%], p < 0.005), and the least common diagnoses were hydroceles and testicular masses (both n = 3 [1.3%], p < 0.001). The gender of the attending physician or radiological operator and the time of the CDUS (day/night shift) did not influence the diagnosis of TT (p > 0.05, each one).

Conclusion: The results suggest that ED doctors are not sufficiently familiar with performing genital exams and managing TT. This may lead to unnecessary delays.