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Ultrasound technologies in the diagnosis, treatment, and rehabilitation of children with testicular torsion

AIM: This study improves the diagnosis of testicular inversion in children to select different treatment strategies by determining the effectiveness of conservative and surgical testicular detorsion criteria. 
MATERIALS AND METHODS: The clinical data from 2010 to 2020 included 110 children with testicular torsion. In 64% of cases, the left testicle predominated. Testicular torsion occurred in 50% of children in the 12- to 14-year-old age group. The time from disease onset to seeking medical help ranged from 1.5 hours to 11 days. It was less than 6 hours in 41.8% of children, from 6 to 12 hours in 13.6% of boys, 12 to 24 hours in 11% of patients, and more than 24 hours in 33.6% of boys and adolescents. The protocol for the diagnosis, treatment and rehabilitation of all children included various techniques for ultrasound examination of the scrotal organs. 
RESULTS: The analysis showed the absence of reliable criteria for detecting testicle torsion in the early periods (61%100%): spiral course of the spermatic vessels (63.9%), change in the position of the testicle (19.8%), increase in the volume of the testicle and appendage (98.3%), a change in testicle shape and the inability to withdraw its poles (47.5%), and a hydrocele (67.2%). The index of false-negative results of the ultrasound scan of the scrotal organs reaches 40%. Conservative navigation detorsion was performed in 39 (35.5%) boys and adolescents during the early disease stages. The ultrasound criteria for the effectiveness of conservative detorsion were established. The main criteria normalized blood flow in the testis (100%). Surgical treatment of testicular inversion was performed in 71 (64.5%) boys and adolescents. 
CONCLUSIONS: Compliance with the protocol for diagnosing, treating, and rehabilitating children in different age groups with testicular torsion allowed us to determine adequate emergency treatment strategies and follow-up. An ultrasound differential diagnosis is performed with testicular hydatid torsion and inflammatory diseases of the scrotal organs. The informativeness of the ultrasound methods amounted to 60%.