Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
Send us all your questions or requests, and our expert team will assist you.
The diagnostic gold standard for testicular torsion is high-frequency color Doppler Ultrasound. This imaging modality assesses both the anatomy and the physiology of the scrotal contents. The primary diagnostic criterion is the absence or significant reduction of intratesticular blood flow compared to the contralateral, healthy testis. In a complete torsion, the Doppler signal is absent.
Modern ultrasound technology uses sensitive settings to detect low-velocity flow, which is crucial for identifying partial or intermittent torsion, where flow may be preserved but compromised. The “Whirlpool Sign” is a specific sonographic finding where the twisted spermatic cord appears as a spiral mass at the external inguinal ring, resembling a whirlpool. This direct visualization of the twist increases the diagnostic specificity.
Furthermore, ultrasound evaluates the echotexture of the testicular parenchyma. A homogeneous echotexture suggests viable tissue, while heterogeneity and hypoechogenicity indicate necrosis and hemorrhage, signaling a poor prognosis. This structural information helps the clinical strategist anticipate the potential need for orchiectomy versus salvage.
While ultrasound is the standard, it is operator-dependent and may not always be immediately available. Near Infrared Spectroscopy (NIRS) is an emerging non-invasive technology that measures tissue oxygen saturation. By placing a sensor on the scrotal skin, NIRS can detect the difference in oxygenated hemoglobin between the two testes. A significant drop in oxygen saturation on the painful side indicates ischemia.
This technology offers a rapid, bedside diagnostic tool that provides real-time metabolic data. It assesses the actual delivery of oxygen to the mitochondria, which is the fundamental variable in ischemic injury. NIRS could potentially reduce the “door to detorsion” time by providing an immediate objective measure of ischemia in the emergency department, bypassing the delays associated with radiology transport and scheduling.
Historically, scrotal scintigraphy (nuclear scan) was used to diagnose torsion. This involves injecting a technetium-based radiotracer to visualize blood flow. A “cold spot” on the scan indicates a perfusion deficit. While highly accurate, this modality has largely been replaced by ultrasound due to the time required to prepare the tracer and perform the scan, as well as the radiation exposure. In the context of torsion, where “time is testis,” the delay inherent in scintigraphy is often unacceptable. However, it remains a historical reference point for understanding perfusion dynamics.
A critical diagnostic challenge is distinguishing torsion from epididymo-orchitis (infection). Both present with pain, swelling, and redness. Ultrasound is the discriminator: torsion shows decreased flow, while infection shows increased flow (hyperemia) due to inflammation.
Biochemical markers can also assist. Urinalysis is typically routine in torsion but may show pyuria (white blood cells) and bacteriuria in infection. Serum inflammatory markers, such as C-reactive protein (CRP) and white blood cell count, may be elevated in both, but are typically much higher in advanced disease. However, relying on labs can be dangerous; a patient can have a torsion and a coincidental urinary tract infection. Therefore, blood flow imaging remains the adjudicator.
When clinical suspicion is high and imaging is equivocal or unavailable, surgical exploration is the diagnostic test of choice. The dictum “exploration is better than observation” applies. The surgeon makes an incision to visualize the spermatic cord and testis directly. If the testis is twisted, the diagnosis is confirmed, and treatment proceeds immediately. If the testis is not twisted, the surgeon looks for other causes, like torsion of the appendix testis.
This surgical approach underscores the philosophy that a negative exploration (no torsion found) is preferable to a missed torsion, which can result in organ loss. During exploration, the testis’s viability is assessed visually. A “black testis” indicates severe ischemia. The return of color (“the pink pulse”) after detorsion is the ultimate diagnostic confirmation of reperfusion and viability.
Send us all your questions or requests, and our expert team will assist you.
High-resolution color Doppler ultrasound is highly accurate, with a sensitivity of roughly 90-100% in experienced hands. It can visualize the blood flow directly. However, in very early torsion or partial torsion (less than 360 degrees), arterial flow may still be present, leading to a false-negative result. Therefore, clinical judgment remains paramount; if the scan is routine but the pain is severe and suggestive, surgery is still indicated.
The Whirlpool Sign is a specific ultrasound appearance. It occurs when the spermatic cord twists on itself, creating a spiral pattern resembling a whirlpool or a snail shell in cross-section. Seeing this sign confirms torsion of the spermatic cord, even if some blood flow is still trickling through.
There is no specific blood test that can diagnose testicular torsion. Blood tests like white blood cell count or CRP are non-specific markers of inflammation. While researchers are investigating markers such as Ischemia Modified Albumin, the current diagnosis relies on physical exam and imaging. Blood tests are mainly used to rule out infection or prepare for surgery.
A urine test is performed primarily to rule out epididymo-orchitis, an infection of the testicle and epididymis that mimics torsion. If the urine contains bacteria and white blood cells, it points towards infection. However, a routine urine test does not prove it is torsion, and an abnormal one does not rule torsion out completely.
Shear Wave Elastography is an advanced ultrasound technique that measures tissue stiffness. Ischemic or necrotic testicular tissue becomes stiffer than healthy tissue. This technology can help assess testicle viability, potentially helping doctors decide whether a testicle is dead or salvageable before or during surgery.
Leave your phone number and our medical team will call you back to discuss your healthcare needs and answer all your questions.
Your Comparison List (you must select at least 2 packages)
