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Evidence summaries

Doppler Stethoscope in the Diagnosis of Testicular Torsion

Assessment of blood flow with Doppler stethoscope may have moderate sensitivity in the diagnosis of testicular torsion. Level of evidence: "C"

In 30 patients who had acute scrotal swelling, every case of epididymitis and torsion of the appendix testis demonstrated an increased testicular blood flow with the Doppler stethoscope 1. The cases of spermatic cord torsion had no blood flow on ultrasound examination.

In 80 adult patients with acute scrotal pain evaluated during a one-year period using the Doppler ultrasonic stethoscope, 16 patients had spermatic cord torsion 2. The Doppler examination was correct in seven (44%), indeterminate in four (25%), and falsely negative in five (31%).

Testicular handheld Doppler ultrasonic assessment was performed on 56 patients admitted with acute scrotal pain 3. The decision to explore the testis was made purely on clinical grounds. The operating surgeons were not informed of the result of Doppler examinations before surgical exploration. 22 patients were subsequently shown to have torsion of the testis at surgical exploration, all of whom had no Doppler signal over the affected side. Of the remaining 34 patients, who were subsequently shown not to have torsion at operation, normal testicular blood flow and cord-compression tests were demonstrated confidently in 33 patients when examined pre-operatively. Thus the sensitivity was 100% (22/22) and the specificity 97% (33/34).

Comment: The quality of evidence is downgraded by study limitations and inconsistency (variability of results across studies).

    References

    • Perri AJ, Slachta GA, Feldman AE, Kendall AR, Karafin L. The Doppler stethoscope and the diagnosis of the acute scrotum. J Urol 1976 Nov;116(5):598-600. [PubMed]
    • Haynes BE. Doppler ultrasound failure in testicular torsion. Ann Emerg Med 1984 Dec;13(12):1103-7. [PubMed]
    • al Mufti RA, Ogedegbe AK, Lafferty K. The use of Doppler ultrasound in the clinical management of acute testicular pain. Br J Urol 1995 Nov;76(5):625-7. [PubMed]

Primary/Secondary Keywords