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R G Bolte - One of the best experts on this subject based on the ideXlab platform.
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a retrospective review of pediatric patients with epididymitis testicular torsion and torsion of testicular appendages
Pediatrics, 1998Co-Authors: H A Kadish, R G BolteAbstract:Study Objective. To compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis, testicular torsion, and torsion of appendix testis. Methods. A retrospective review of patients with the diagnosis of epididymitis, testicular torsion, or torsion of appendix testis. Results. Ninety patients were included in the study (64 with epididymitis, 13 with testicular torsion, and 13 with torsion of appendix testis). Historical features did not differ among groups except for duration of symptoms. Of 13 patients with testicular torsion all had a tender testicle and an absent Cremasteric Reflex. When compared with the testicular torsion group, fewer patients with epididymitis had a tender testicle (69%) or an absent Cremasteric Reflex (14%). 62 (97%) patients with epididymitis had a tender epididymis and 43 (67%) had scrotal erythema/edema. By comparison, 3 (23%) and 5 (38%) patients with testicular torsion had a tender epididymis or scrotal erythema/edema, respectively. Doppler ultrasound showed decreased or absent blood flow in 8 patients, 7 of whom were diagnosed with testicular torsion. Ten out of 13 patients with testicular torsion had a salvageable testicle at the time of surgery. Conclusion. The physical examination is helpful in distinguishing among epididymitis, testicular torsion, and torsion of appendix testis. Patients presenting with a tender testicle and an absent Cremasteric Reflex were more likely to have a testicular torsion rather than epididymitis or torsion of appendix testis. An absent Cremasteric Reflex was the most sensitive physical finding for diagnosing testicular torsion. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal.
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A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages.
Pediatrics, 1998Co-Authors: H A Kadish, R G BolteAbstract:To compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis, testicular torsion, and torsion of appendix testis. A retrospective review of patients with the diagnosis of epididymitis, testicular torsion, or torsion of appendix testis. Ninety patients were included in the study (64 with epididymitis, 13 with testicular torsion, and 13 with torsion of appendix testis). Historical features did not differ among groups except for duration of symptoms. Of 13 patients with testicular torsion all had a tender testicle and an absent Cremasteric Reflex. When compared with the testicular torsion group, fewer patients with epididymitis had a tender testicle (69%) or an absent Cremasteric Reflex (14%). 62 (97%) patients with epididymitis had a tender epididymis and 43 (67%) had scrotal erythema/edema. By comparison, 3 (23%) and 5 (38%) patients with testicular torsion had a tender epididymis or scrotal erythema/edema, respectively. Doppler ultrasound showed decreased or absent blood flow in 8 patients, 7 of whom were diagnosed with testicular torsion. Ten out of 13 patients with testicular torsion had a salvageable testicle at the time of surgery. The physical examination is helpful in distinguishing among epididymitis, testicular torsion, and torsion of appendix testis. Patients presenting with a tender testicle and an absent Cremasteric Reflex were more likely to have a testicular torsion rather than epididymitis or torsion of appendix testis. An absent Cremasteric Reflex was the most sensitive physical finding for diagnosing testicular torsion. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal.
H A Kadish - One of the best experts on this subject based on the ideXlab platform.
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a retrospective review of pediatric patients with epididymitis testicular torsion and torsion of testicular appendages
Pediatrics, 1998Co-Authors: H A Kadish, R G BolteAbstract:Study Objective. To compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis, testicular torsion, and torsion of appendix testis. Methods. A retrospective review of patients with the diagnosis of epididymitis, testicular torsion, or torsion of appendix testis. Results. Ninety patients were included in the study (64 with epididymitis, 13 with testicular torsion, and 13 with torsion of appendix testis). Historical features did not differ among groups except for duration of symptoms. Of 13 patients with testicular torsion all had a tender testicle and an absent Cremasteric Reflex. When compared with the testicular torsion group, fewer patients with epididymitis had a tender testicle (69%) or an absent Cremasteric Reflex (14%). 62 (97%) patients with epididymitis had a tender epididymis and 43 (67%) had scrotal erythema/edema. By comparison, 3 (23%) and 5 (38%) patients with testicular torsion had a tender epididymis or scrotal erythema/edema, respectively. Doppler ultrasound showed decreased or absent blood flow in 8 patients, 7 of whom were diagnosed with testicular torsion. Ten out of 13 patients with testicular torsion had a salvageable testicle at the time of surgery. Conclusion. The physical examination is helpful in distinguishing among epididymitis, testicular torsion, and torsion of appendix testis. Patients presenting with a tender testicle and an absent Cremasteric Reflex were more likely to have a testicular torsion rather than epididymitis or torsion of appendix testis. An absent Cremasteric Reflex was the most sensitive physical finding for diagnosing testicular torsion. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal.
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A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages.
Pediatrics, 1998Co-Authors: H A Kadish, R G BolteAbstract:To compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis, testicular torsion, and torsion of appendix testis. A retrospective review of patients with the diagnosis of epididymitis, testicular torsion, or torsion of appendix testis. Ninety patients were included in the study (64 with epididymitis, 13 with testicular torsion, and 13 with torsion of appendix testis). Historical features did not differ among groups except for duration of symptoms. Of 13 patients with testicular torsion all had a tender testicle and an absent Cremasteric Reflex. When compared with the testicular torsion group, fewer patients with epididymitis had a tender testicle (69%) or an absent Cremasteric Reflex (14%). 62 (97%) patients with epididymitis had a tender epididymis and 43 (67%) had scrotal erythema/edema. By comparison, 3 (23%) and 5 (38%) patients with testicular torsion had a tender epididymis or scrotal erythema/edema, respectively. Doppler ultrasound showed decreased or absent blood flow in 8 patients, 7 of whom were diagnosed with testicular torsion. Ten out of 13 patients with testicular torsion had a salvageable testicle at the time of surgery. The physical examination is helpful in distinguishing among epididymitis, testicular torsion, and torsion of appendix testis. Patients presenting with a tender testicle and an absent Cremasteric Reflex were more likely to have a testicular torsion rather than epididymitis or torsion of appendix testis. An absent Cremasteric Reflex was the most sensitive physical finding for diagnosing testicular torsion. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal.
Joao Arthur Brunhara Alves Barbosa - One of the best experts on this subject based on the ideXlab platform.
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Validation of the TWIST score for testicular torsion in adults.
International urology and nephrology, 2020Co-Authors: Joao Arthur Brunhara Alves Barbosa, Miguel Srougi, Pedro Felipe Silva Freitas, Sergio Andurte Duarte Carvalho, Augusto Quaresma Coelho, Marco Aurelio Watanabe Yorioka, Leonardo Lima Borges, William C. Nahas, Maykon William Aparecido Pires Pereira, Marco Antonio ArapAbstract:The TWIST (Testicular Work-up for Ischemia and Suspected Torsion) score was developed to allow for expedited diagnosis of testicular torsion (TT) in children based on clinical variables: edema (2 points), hard mass (2), absent Cremasteric Reflex (1), high-riding testis (1) and nausea/vomiting (1). We sought to validate the TWIST Score applied by non-expert physicians for the diagnosis of testicular torsion in an adult population. We prospectively analyzed all consecutive males presenting to a tertiary hospital with acute scrotum. Patients with previous scrotal pathology or trauma were excluded. Physical examination was performed by a general surgeon and variables of TWIST were recorded. All patients underwent Scrotal Doppler Ultrasound. Measures of accuracy of the TWIST score and ROC curves were generated to evaluate its performance in diagnosing TT in adults. Of 68 patients, 34 had TT (50%). Median age was 24.9 years. According to the original cutoffs of TWIST, 23 patients had a score ≤ 2 among which none had TT. Fifteen patients had a score of 3–4, among which seven had TT. Thirty patients had a score ≥ 5, among which 27 had TT. All 18 patients with a score of 6 or greater had TT (100% PPV). ROC curve revealed an AUC of 0.95. The TWIST Score is valid for the diagnosis of Testicular Torsion in adults, presenting a PPV of 90% for a cutoff of 5 points and 100% for six points. In all patients with a score of 2 or less, the disease could be safely excluded (100% NPV).
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Validation of the TWIST score for testicular torsion in adults
International Urology and Nephrology, 2020Co-Authors: Joao Arthur Brunhara Alves Barbosa, Miguel Srougi, Pedro Felipe Silva Freitas, Sergio Andurte Duarte Carvalho, Augusto Quaresma Coelho, Marco Aurelio Watanabe Yorioka, Maykon William Aparecido Pereira, Leonardo Lima Borges, William C. Nahas, Marco Antonio ArapAbstract:Purpose The TWIST (Testicular Work-up for Ischemia and Suspected Torsion) score was developed to allow for expedited diagnosis of testicular torsion (TT) in children based on clinical variables: edema (2 points), hard mass (2), absent Cremasteric Reflex (1), high-riding testis (1) and nausea/vomiting (1). We sought to validate the TWIST Score applied by non-expert physicians for the diagnosis of testicular torsion in an adult population. Methods We prospectively analyzed all consecutive males presenting to a tertiary hospital with acute scrotum. Patients with previous scrotal pathology or trauma were excluded. Physical examination was performed by a general surgeon and variables of TWIST were recorded. All patients underwent Scrotal Doppler Ultrasound. Measures of accuracy of the TWIST score and ROC curves were generated to evaluate its performance in diagnosing TT in adults. Results Of 68 patients, 34 had TT (50%). Median age was 24.9 years. According to the original cutoffs of TWIST, 23 patients had a score ≤ 2 among which none had TT. Fifteen patients had a score of 3–4, among which seven had TT. Thirty patients had a score ≥ 5, among which 27 had TT. All 18 patients with a score of 6 or greater had TT (100% PPV). ROC curve revealed an AUC of 0.95. Conclusion The TWIST Score is valid for the diagnosis of Testicular Torsion in adults, presenting a PPV of 90% for a cutoff of 5 points and 100% for six points. In all patients with a score of 2 or less, the disease could be safely excluded (100% NPV).
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development and initial validation of a scoring system to diagnose testicular torsion in children
The Journal of Urology, 2013Co-Authors: Joao Arthur Brunhara Alves Barbosa, Bruno Camargo Tiseo, Ghassan Barayan, Brian M Rosman, Fabio Cesar Miranda Torricelli, Carlo C Passerotti, Miguel Srougi, Alan B RetikAbstract:Purpose: Testicular torsion is a surgical emergency requiring prompt intervention. Although clinical diagnosis is recommended, scrotal ultrasound is frequently ordered, delaying treatment. We created a scoring system to diagnose testicular torsion, decreasing the indication for ultrasound.Materials and Methods: We prospectively evaluated 338 patients with acute scrotum, of whom 51 had testicular torsion. Physical examination was performed by a urologist, and all patients underwent scrotal ultrasound. Univariate analysis and logistic regression were performed, and a scoring system for risk stratification of torsion was created. Retrospective validation was performed with 2 independent data sets.Results: The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent Cremasteric Reflex (1), nausea/vomiting (1) and high riding testis (1). Cutoffs for low and high risk were 2 and 5 points, respectively. Ultrasound would be indicated only for the intermediate risk group. In the prospe...
Boaz Karmazyn - One of the best experts on this subject based on the ideXlab platform.
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clinical and sonographic criteria of acute scrotum in children a retrospective study of 172 boys
Pediatric Radiology, 2005Co-Authors: Boaz Karmazyn, Ran Steinberg, Liora Kornreich, Enrique Freud, Sylvia Grozovski, Michael Schwarz, N Ziv, Pinchas LivneAbstract:Background: Diagnosis of testicular torsion in children is challenging, as clinical presentation and findings may overlap with other diagnoses. Objective: To define the clinical and ultrasound criteria that best predict testicular torsion. Materials and methods: The records of children hospitalized for acute scrotum from 1997 to 2002 were reviewed. The clinical and ultrasound findings of children who had a final diagnosis of testicular torsion were compared with those of children who had other diagnoses (torsion of the testicular appendix, epididymitis, and epididymo-orchitis). Results: Forty-one children had testicular torsion; 131 had other diagnoses. Stepwise regression analysis yielded three factors that were significantly associated with testicular torsion: duration of pain ≤6 h; absent or decreased Cremasteric Reflex; and diffuse testicular tenderness. When the children were scored by final diagnosis for the presence of these factors (0–3), none of the children with a score of 0 had testicular torsion, whereas 87% with a score of 3 did. The ultrasound finding of decreased or absent testicular flow had a sensitivity of 63% and a specificity of 99%. Eight of ten children with testicular torsion and normal or increased testicular flow had a coiled spermatic cord on ultrasound. Conclusion: We suggest that all children with acute scrotal pain and a clinical score of 3 should undergo testicular exploration, and children with a lower probability of testicular torsion (score 1 or 2) should first undergo diagnostic ultrasound. Because the presence of testicular flow does not exclude torsion, the spermatic cord should be meticulously evaluated in all children with acute scrotum and normal or increased testicular blood flow.
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Testicular torsion in the pediatric age group: diagnosis and treatment.
Pediatric endocrinology reviews : PER, 2003Co-Authors: Pinhas M. Livne, Bezalel Sivan, Boaz Karmazyn, David Ben-meirAbstract:PURPOSE To review and update several aspects of testicular torsion. INCIDENCE The relative incidence of testicular torsion, torsion of testicular appendix and epididymo-orchitis is variable and depends on mode of diagnosis and patients' age. AGE: Testicular torsion can occur at any age. The peak is in adolescents below the age of 18 years. SYMPTOMS Classical symptoms are not always present. Range of duration is varied. Nausea and vomiting are positive predictive value for testicular torsion. PHYSICAL EXAMINATION Main findings predicting testicular torsion are absence of Cremasteric Reflex and diffuse tenderness. IMAGING Color Doppler Ultrasound can assess in equivocal and low clinical suspicious conditions for testicular torsion. NEONATAL TORSION There are two conditions in this age group; the prenatal that urgent exploration is in controversy and postnatal that urgent surgery is required. LATE OUTCOME Early salvage rate and late atrophy depends on duration and degree of torsion. MEDICOLEGAL Testicular torsion is an active area of malpractice litigation. Late presentation and atypical presentations do not affect the medicolegal outcome.
Alan B Retik - One of the best experts on this subject based on the ideXlab platform.
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development and initial validation of a scoring system to diagnose testicular torsion in children
The Journal of Urology, 2013Co-Authors: Joao Arthur Brunhara Alves Barbosa, Bruno Camargo Tiseo, Ghassan Barayan, Brian M Rosman, Fabio Cesar Miranda Torricelli, Carlo C Passerotti, Miguel Srougi, Alan B RetikAbstract:Purpose: Testicular torsion is a surgical emergency requiring prompt intervention. Although clinical diagnosis is recommended, scrotal ultrasound is frequently ordered, delaying treatment. We created a scoring system to diagnose testicular torsion, decreasing the indication for ultrasound.Materials and Methods: We prospectively evaluated 338 patients with acute scrotum, of whom 51 had testicular torsion. Physical examination was performed by a urologist, and all patients underwent scrotal ultrasound. Univariate analysis and logistic regression were performed, and a scoring system for risk stratification of torsion was created. Retrospective validation was performed with 2 independent data sets.Results: The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent Cremasteric Reflex (1), nausea/vomiting (1) and high riding testis (1). Cutoffs for low and high risk were 2 and 5 points, respectively. Ultrasound would be indicated only for the intermediate risk group. In the prospe...