Advances in Life Science and Technology www.iiste.org ISSN 2224-7181 (Paper) ISSN 2225-062X (Online) Vol.54, 2017 68 Role of Echo Doppler in Diagnosing the Testicular Torsion-Retrospective Study Baton Kelmendi 1* Hysni Jashari 1 Fisnik Kurshumliu 2 Doruntina Bunjaku 3 Sokol Buba 4 Marinela Kumaraku 5 1.Pediatric Surgeon-Department of Pediatric Surgery/University Clinical Center of Kosova 2.Pathologist-Institute of Pathology. Medical School/University Clinical Center of Kosova 3.Anesthesiologist-Department of Anesthesia and Intensive Care/University Clinical Center of Kosova 4.Pediatric Surgeon, Mother Teresa University Hospital Centre and Professor at U. of Medicine Tirana 5.Pediatrician, Mother Teresa University Hospital Centre, Tirana, Albania Abstract Introduction: Acute scrotum is a wide term that is used for cases that presenting with scrotal swelling and pain. Etiology can be infectious or strangulation from torsion of the testis, depending on its clinical diagnosis, requires surgical intervention or medical treatment.Aim of study: Aim of this study was to determine the rate of accuracy of the Echo Doppler scanning in the diagnosis of the testicular torsion. Considering that there are different protocols in diagnosis, some suggest surgical exploration, while some Hospitals report 100% accuracy in diagnosis of testicular torsion with Doppler ultrasound.Materials and methods: We retrospectively evaluated 4 year period, from 2011-2014, during this time all the patients that were admitted as acute scrotum where evaluated excluding the cases that were incarcerated hernias. In all admitted patients, physical examination, lab analysis and Echo Doppler study were performed.Results: In total, there were 83 patients, based on physical examination, lab and Echo Doppler scan, 50 cases were diagnosed as epididymo-orchititis, 21 cases were patients with testicular torsion and 12 cases were torqued hydatid of Morgagni. In 3 patients false positive blood circulation in affected testis was detected with Echo Doppler scan. In following days they were operated and gangrene of testis was found.Discussion: Complete absence of intratesticular blood flow and normal extratesticular blood flow on color Doppler images is diagnostic, if the flow is normal in the contra lateral testis. Color Doppler has a very high accuracy in detecting the obstacles in blood flow, but as with other diagnostic techniques, this should be not taken as granted.Conclusion: Testicular torsion is real urological emergency. Delay in diagnosis and management can lead to the loss of the testis. If there any doubts are present, urgent surgical exploration is indicated. Keywords: Testicular torsion, acute scrotum, echo Doppler, diagnostic techniques, management Introduction Acute Scrotum is a potentially emergency condition and is characterized with pain, redness and testicular edema. The term acute scrotum in Urology is analog with the term acute abdomen that is used in General Surgery. Scrotal pain and edema could arise from different pathologies like: Ischemic, traumatic, Infection and hernias. Twisting or torsion of the testis results in occlusion of the gonadal blood supply, which, if unrelieved, leads to necrosis. Torsion of the testis was first described in 1840 by Delasiuve[1]. Torsion of a testicular appendage was first described by Cole [2].Although it is not the most common cause of the acute scrotum in childhood, it is certainly the most important. Torsion of testis usually occurs in a fully descended testis and is surgical emergency because of the high incidence of gonadal necrosis. Extratunical or extravaginal torsion is less common and is confined to the perinatal period, beyond the newborn period, testicular torsion is almost always associated with the bell-clapper deformity. Trauma and physical activity may be important, as may action of the cremaster muscle[3].Clinical presentation of testicular torsion is usually heralded by the sudden onset of pain in the testis, lower abdomen, or groin, associated with nausea and vomiting. A horizontal lie of the testis when the boy stands indicates high investment of the spermatic cord. Unless the testis and epididymis are necrotic, local palpation is exquisitely painful. Proper anamnesis and physical examination are crucial and usually determining treatment, whether conservative or surgical. Imagery studies usually supplement the clinical diagnosis. With Doppler scan being the first choice, it’s quick, cheap and accurate. Low percentage of surgical exploration is acceptable for minimizing critical misdiagnosis. Results and Discussion Main challenge in pediatric surgery is differentiation between ischemic and infective pathology. Anamnesis and physical examination have important role in diagnosing, and for the imagery study in general is Echo Doppler scan. With high degree of suspicion, surgical exploration is mandatory. Epididymo-orchitis which as a pathology is commonly encountered usually is consequence of infection brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by International Institute for Science, Technology and Education (IISTE): E-Journals