DIAGNOSIS
OF TESTICULAR
USING DOPPLER IAN M. THOMPSON,
ULTRASONIC
FLOWMETER
M.D.
HARRY LATOURETTE, STEPHEN
TORSION
CHADWICK,
GILBERT
ROSS, M.D.
EDWARD
LICHTI,
M.D. M.D.
PH.D.
From the Section of Urology, University of Missouri School of Medicine, Columbia, Missouri
ABSTRACT - Thirty-one patients with intrascrotal disease processess have been studied with the Doppler ultrasonic flowmeter to determine if testicular torsion can be differentiated from acute epididymitis when clinical characteristics are ambiualent. In all instances of proved torsion there was a loss of bloodfiw in the involved testes, whereas in acute epididymitis or other epididymal and gonadal diseases blood $0~ ranged -from normal to hyperemic.
Use of the Doppler ultrasonic flowmeter for the definition of blood flow in small vessels and tissue has been invaluable in a variety of conditions.’ Employment of the Doppler flowmeter in the diagnosis of torsion of the testes seemed logical since testicular blood flow should be absent in torsion and relatively unaffected in most other intrascrotal conditions which may simulate it. Seven patients with testicular torsion and 24 patients with other epididymal and testicular diseases form the substrate of this preliminary report. Results Of 14 patients who were subsequently shown to have acute epididymitis all but one had normal testicular blood flow patterns when examined with the Doppler probe.. The exception was a child in whom pain from manipulation was such that it was difficult to position the probe and testes in a manner necessary for optimal readings. Subsequent to administration of anesthesia the Doppler probe and testes were maneuvered to a position of optimal contact, and normal testicular blood flow was described in the affected organ.
706
The Doppler flowmeter delineated lack of blood flow in the testicle of all of the 7 patients in whom torsion was proved at operation. Detorsion with return of blood flow as noted with a sterile Doppler probe at operation was achieved in 6 patients. In 1 patient testicular infarction required orchiectomy. The clinical differentiation between torsion and acute epididymitis in a number of these patients would have been uncertain without the Doppler findings. When the picture was not clear-cut, certain of the patients with acute epididymitis were explored and operative findings were in agreement with Doppler interpretation. One patient with the typical clinical picture of torsion is worthy of description in more detail. The history and palpatory findings of epididymal rotation instigated the Doppler examination which showed no blood flow to the testis. During preoperative preparation the pain was relieved. Reexamination demonstrated spontaneous detorsion, and the Doppler flowmeter depicted a pattern of normal, if somewhat hyperemic, blood flow to the affected organ. At operation a typical bell-clapper anatomic malformation was fount! and fixation of both testes was carried out.
UROLOGY
/ DECEMBER
1975 / VOLUME
VI, NUMBER f
FIGURE 1. Doppkr probe in contact with testes.
Ten patients with chronic epididymitis, epididymo-orchitis, and one testicular tumor have been studied with the Doppler flowmeter and had relatively normal arterial flow. In the case of epididymitis it has been noted that flow tends to be hyperemic. When the Doppler flowmeter is used for evaluation of testicular blood flow, the probe must be as close to the testicle as possible. The operator must firmly maneuver the testes against the scrotum without compression. To ascertain that the flow noted is testicular, the scrotum may be elevated and examined with the Doppler probe. K-Y jelly or some other substitute is used as an ultrasound conductance pathway between the probe and the dermis (Fig. 1).
UROLOGY
/ DECEIMBERIQ~~ / VOLUMEVI, NUMBER6
Although our experiences with the ultrasonic flowmeter in testicular torsion is not large, it would verify prior reports that the technique is and can be helpful in simple, noninvasive, differentiating torsion from other intrascrotal conditions. * Columbia, Missouri 65201 (DR. THOMPSON) References 1. KEITZER,W. F., and LICHTI, E. L.: Applications of the Doppler, Angiology 26: 172 (1975). 2. LEVY, B. J.: The diagnosis of torsion of the testicle using the Doppler ultrasonic stethoscope, J. Ural. 113: 63 (1975).
707
OF TESTICULAR
USING DOPPLER IAN M. THOMPSON,
ULTRASONIC
FLOWMETER
M.D.
HARRY LATOURETTE, STEPHEN
TORSION
CHADWICK,
GILBERT
ROSS, M.D.
EDWARD
LICHTI,
M.D. M.D.
PH.D.
From the Section of Urology, University of Missouri School of Medicine, Columbia, Missouri
ABSTRACT - Thirty-one patients with intrascrotal disease processess have been studied with the Doppler ultrasonic flowmeter to determine if testicular torsion can be differentiated from acute epididymitis when clinical characteristics are ambiualent. In all instances of proved torsion there was a loss of bloodfiw in the involved testes, whereas in acute epididymitis or other epididymal and gonadal diseases blood $0~ ranged -from normal to hyperemic.
Use of the Doppler ultrasonic flowmeter for the definition of blood flow in small vessels and tissue has been invaluable in a variety of conditions.’ Employment of the Doppler flowmeter in the diagnosis of torsion of the testes seemed logical since testicular blood flow should be absent in torsion and relatively unaffected in most other intrascrotal conditions which may simulate it. Seven patients with testicular torsion and 24 patients with other epididymal and testicular diseases form the substrate of this preliminary report. Results Of 14 patients who were subsequently shown to have acute epididymitis all but one had normal testicular blood flow patterns when examined with the Doppler probe.. The exception was a child in whom pain from manipulation was such that it was difficult to position the probe and testes in a manner necessary for optimal readings. Subsequent to administration of anesthesia the Doppler probe and testes were maneuvered to a position of optimal contact, and normal testicular blood flow was described in the affected organ.
706
The Doppler flowmeter delineated lack of blood flow in the testicle of all of the 7 patients in whom torsion was proved at operation. Detorsion with return of blood flow as noted with a sterile Doppler probe at operation was achieved in 6 patients. In 1 patient testicular infarction required orchiectomy. The clinical differentiation between torsion and acute epididymitis in a number of these patients would have been uncertain without the Doppler findings. When the picture was not clear-cut, certain of the patients with acute epididymitis were explored and operative findings were in agreement with Doppler interpretation. One patient with the typical clinical picture of torsion is worthy of description in more detail. The history and palpatory findings of epididymal rotation instigated the Doppler examination which showed no blood flow to the testis. During preoperative preparation the pain was relieved. Reexamination demonstrated spontaneous detorsion, and the Doppler flowmeter depicted a pattern of normal, if somewhat hyperemic, blood flow to the affected organ. At operation a typical bell-clapper anatomic malformation was fount! and fixation of both testes was carried out.
UROLOGY
/ DECEMBER
1975 / VOLUME
VI, NUMBER f
FIGURE 1. Doppkr probe in contact with testes.
Ten patients with chronic epididymitis, epididymo-orchitis, and one testicular tumor have been studied with the Doppler flowmeter and had relatively normal arterial flow. In the case of epididymitis it has been noted that flow tends to be hyperemic. When the Doppler flowmeter is used for evaluation of testicular blood flow, the probe must be as close to the testicle as possible. The operator must firmly maneuver the testes against the scrotum without compression. To ascertain that the flow noted is testicular, the scrotum may be elevated and examined with the Doppler probe. K-Y jelly or some other substitute is used as an ultrasound conductance pathway between the probe and the dermis (Fig. 1).
UROLOGY
/ DECEIMBERIQ~~ / VOLUMEVI, NUMBER6
Although our experiences with the ultrasonic flowmeter in testicular torsion is not large, it would verify prior reports that the technique is and can be helpful in simple, noninvasive, differentiating torsion from other intrascrotal conditions. * Columbia, Missouri 65201 (DR. THOMPSON) References 1. KEITZER,W. F., and LICHTI, E. L.: Applications of the Doppler, Angiology 26: 172 (1975). 2. LEVY, B. J.: The diagnosis of torsion of the testicle using the Doppler ultrasonic stethoscope, J. Ural. 113: 63 (1975).
707
