Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children

Urology. 2018 Jun;116:150-155. doi: 10.1016/j.urology.2018.03.009. Epub 2018 Mar 20.


Objective: To prospectively correlate pain duration, red scrotal skin, ultrasound appearance of testis, and intraoperative testis color to future testis atrophy after acute testicular torsion.

Methods: Patients 2 months-18 years old with unilateral acute scrotum were consecutively enrolled in a National Institutes of Health transcutaneous near-infrared spectroscopy study, with a subgroup analysis of the true torsion group. Presence or absence of red scrotal skin, pain duration, testicular heterogeneity on preoperative ultrasound, and intraoperative testis color based on a novel visual chart 5 minutes after detorsion were recorded. All testes underwent orchiopexy regardless of appearance. Percent volume difference between normal and torsed testicles on follow-up ultrasound was compared between patients with and without risk factors.

Results: Thirty of 56 patients who had surgical detorsion underwent scrotal ultrasound at a mean of 117 days after surgery. A color of black or hemorrhagic 5 minutes after detorsion, pain duration >12 hours, and heterogeneous parenchyma on preoperative ultrasound were associated with significant testis volume loss in follow-up compared with normal testis. All patients with a black or hemorrhagic testis had >80% volume loss. Erythematous scrotal skin was not significantly associated with smaller affected testis volume in follow-up.

Conclusion: Based on the high atrophy rate, orchiectomy can be considered for testes that are black or hemorrhagic 5 minutes after detorsion. Pain duration >12 hours and parenchymal heterogeneity on preoperative ultrasound were also associated with testis atrophy. Red scrotal skin was not a reliable predictor of atrophy and should not delay exploration.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Atrophy / epidemiology
  • Atrophy / etiology
  • Child
  • Child, Preschool
  • Color
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Orchiectomy*
  • Orchiopexy / adverse effects*
  • Pain / etiology*
  • Postoperative Period
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Scrotum / diagnostic imaging
  • Spectroscopy, Near-Infrared
  • Spermatic Cord Torsion / complications
  • Spermatic Cord Torsion / surgery*
  • Testis / diagnostic imaging
  • Testis / pathology*
  • Time Factors
  • Ultrasonography