Stesura Seveso


371Archivio Italiano di Urologia e Andrologia 2014; 86, 4

ORIGINAL PAPER

Modifications of echogenicity of the testis during acute
torsion may be a predictive factor of organ damage?

Giuseppe Benedetto, Filippo Nigro, Emiliano Bratti, Andrea Tasca

Department of Urology, San Bortolo Hospital, Vicenza, Italy

In the setting of symptoms of testicular
torsion the absence of diastolic flow or

color flow on Doppler ultrasound has traditionally
prompted emergent scrotal exploration. This practice
emanates  from the difficulty on ultrasound of distin-
guishing salvageable testes from those that are not sal-
vageable. We evaluated the changes of echogenicity in the
course of testicular torsion of the testis to identify charac-
teristics predictive of irreversible organ damage.

KEY WORDS: Testicular torsion; Echogenicity of testicular 
torsion.

Submitted 3 October 2014; Accepted 31 October 2014

Summary

No conflict of interest declared.

flow in the testis wrong. Six boys underwent orchiecto-
my for testicular necrosis and histological examination
documented hemorrhagic necrosis of the testis consis-
tent with testicular torsion. 
The ultrasound pattern of these patients documented in
all the presence of a dishomogeneous and heterogeneous
echotexture of the testis. 
In the other eight patients an hypoechoic and isoechoic
homogeneous testicular framework was documented,
compatible with the integrity of the testis as assessed at
scrotal exploration 
The average time between the onset of symptoms and
the scrotal exploration was 9 hours (range 6-18) in
patients in whom the testis was preserved, and 15 hours
(range 9-21) in patients undergoing then to orchiectomy.
There were no intra- and postoperative complications in
patients undergoing orchiectomy 

DISCUSSION
In our series the heterogeneously hypoechoic testicular
parenchyma showed an irreversible organ damage that
required removal of the organ. 

DOI: 10.4081/aiua.2014.4.371

Presented at 19th National Congress SIEUN, Fermo 2014

INTRODUCTION AND AIMS
During the acute torsion of the testis, in addition to clin-
ical signs and symptoms, the scrotal Doppler ultrasound
can be of support in evaluating the absence of testicular
flow. We evaluated the changes of echogenicity in the
course of testicular torsion of the testis to identify char-
acteristics predictive of irreversible organ damage. 

MATERIAL AND METHODS
We retrospectively analyzed, the scrotal
ultrasound of patients undergoing scrotal
exploration for testicular torsion in the last
year in our department, evaluating the sono-
graphic features and comparing them to the
outcome of the scrotal exploration, and in
case of orchiectomy to outcome for histology. 
Was also evaluated the average time between
the onset of symptoms and evaluation in the
emergency room and the scrotal exploration. 

RESULTS
During the past year, 14 children were eval-
uated at our department for acute torsion of
the testis and underwent scrotal exploration.
All underwent preoperative scrotal Doppler
ultrasound that documented the absence of

Figure. 
Dishomogeneous torsion testis alteration.

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Archivio Italiano di Urologia e Andrologia 2014; 86, 4

G. Benedetto, F. Nigro, E. Bratti, A. Tasca

372

Therefore, taking into account echotexture and obvious
signs of torsion scrotal exploration cannot be emergent.
On the other hand, an homogeneous echotexture her-
alds testicular viability and the need to scrotal explo-
ration in emergency. 

CONCLUSION
We evaluated the changes of echogenicity in the course
of testicular torsion of the testis to identify characteristics
predictive of irreversible organ damage. 

However the smallness of our sample requires confirma-
tion by in-depth studies of larger series.

REFERENCES
1. Kaye JD, Shapiro EY, Levitt SB, et al. Parenchymal echo texture
predicts testicular salvage after torsion: potential impact on the need
for emergent exploration.J Urol. 2008; 180(4 Suppl):1733-6.

2. Nistal M, Paniagua R, Gonzalez-Peramato P, Reyes-Múgica M.
Testicular torsion, testicular appendix torsion and other forms of tes-
ticular infarction. Pediatr Dev Pathol. 2014. 

Correspondence
Giuseppe Benedetto, MD
g_benedetto@yahoo.it
Filippo Nigro, MD
Filippo.nigro@ulssvicenza.it
Emiliano Bratti, MD
Emiliano.bratti@ulssvicenza.it
Andrea Tasca, MD
Andrea.Tasca@ulssvicenza.it
UOC Urologia, Ospedale San Bortolo, 
Via Rodolfi, 37 - Vicenza, Italy

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