Introduction

testicular torsion 1840 by Delasiuave

under 25 years 1 : 4000 male
delay in diagnosis loss testicular
circulation
exploration is gold standard
diagnosis & treatment
overlap symptoms epididymo-orchitis
risk traumatic surgery for children
cloud treated conservatively
very high.

Introduction
alternative ways
noninvasive examination
minimally invasive surgery

Doppler ultrasound & scoring system

Novel surgical interventions not yet
invented
Purpose introduce a minimally invasive
method with high sensitivity and
specificity in diagnosing testicular torsion

Patients and Methods: Patient and

preoperative examinations

February 2010 - June 2013

14 patients
aged 12 - 24 years
acute onset of scrotum pain
the urological center of Changhai
Hospital
No predisposing factors or fever
longest time to admission 10 hours

 hemiscrotum mildly - moderately

congested and swollen
ipsilateral testis and epididymis were
not palpable
urine + blood tests + color Doppler
ultrasound
blood flow decreased 7 cases and
normal 7 cases

Patients and Methods: Surgical

procedure
sign informed consent
10F pediatric cystoscope for
scrotoscope
Previous study 7F semirigid
ureteroscope could not be operated
flexibly
General anesthesia + supine position
8 mm incision 1/3 laterally and
inferiorly to the hemiscrotum

 dissection scrotal skin + dartos muscle

insert the sheath to parietal layer of tunica
vaginalis
scope introduced to the sheath
purse-string suture cinched / Allis clamps
secured at incision edge
Scrotoscope testis + epididymis + torsion
of spermatic cord
saline irrigation for adequate space + clear
surgical vision.

Results
Scrotoscopy 14 patients
Torsioned testis identified and
spermatic cord twisted (5 cases)

 4 of 5 cases rotated by 360 warm and

moist gauze for 15 - 20 minutes
fixed four sites with nonabsorbable sutures
Contralateral orchiopexy
1 cases 540 still nonviable Orchiectomy
9 cases significant edema and congestion of
the epididymis epididymitis
scrotal sutured one stitch. drainage strip
placed in hemiscrotum removed 24 hours
postoperatively + 7 day antibiotics

 Average time scrotoscopy 29.4

(range 2145) minutes
first case 45 minutes gradually
decreased
stabled at about 25 minutes
5 cases scrotal incision and testicular
fixation scrotal edema day 1 3
cases resolved after 2 weeks 2
cases resolved after 3 months

 pain measured with NRS (Numeric

Rating Scale) was listed in Table 1
USG Doppler follow-up
No bleeding of scrotum, testicular
atrophy, or relapse
14 patients followed 2 years

Discussion
Testicular torsion, epididymo-orchitis,
and torsion of the testicular appendix
most common
different management and outcomes
distinguish
MRI and nuclear scintigraphy high
detection rate costly, not universally
available, time consuming and may
miss optimal time for surgery

 Doppler USG
excellent imaging of anatomical details and
perfusion,
high availability,
short duration, and
low costs
testicular torsion especially in infants and children(high
false-negative rate) and high operator dependency
specificity 71.4%.

many patients without testicular torsion had

surgery because ideal and noninvasive
examination of not available

 minimizing surgical trauma optimize

the current treatment modality of
testicular torsion
Scrotoscopy use of endoscopy in
diagnosis and treatment described
by Gerris & Shafik

 Gerris and colleaguesscrotoscopy

evaluation of infertile patients
Shafik diagnosis testis masses,
epididymis, and spermatic cord to
perform testicular biopsies in infertile
patients and venography and
vasography

 Shafik suitable endoscope distended

tunica vaginalis 40-60mL saline 18F
scrotoscope
scrotal layer swelling cannot be well
distended hydrodistention damage
ipsilateral testis.
7F semirigid ureteroscope
easy insertion
easier to navigate and
observe better in limited space
long shaft difficult to operate precisely.

 Yin and colleagues

adult cystoscopy
easy to operate
more damage

10F pediatric cystoscope

easier navigation
more precise manipulation

provide enough space for scrotoscopy

hydropressure distend cavity small incision
purse string suture around incision or pair of
Allis clamps adequate irrigation pressure

 The key point scrotoscopic distinguish

normal or abnormal testis and epididymis
1st scrotal anatomy testis & cauda
epididymis, corpus epididymis, caput
epididymis, and spermatic cord
2nd testis color torsioned or not biased
color of the testis because light source
white balancing on a gauze
3RD Urologist avoid retracting scope from
the cavity move slowly

 scrotoscopy vs scrotal exploration

Emergency time substituting
general anesthesia with local
anesthesia
Future studies larger sample
validate this technique
Younger child with communicating
hernia contraindication

Conclusions
Scrotoscopy safe and efficacious
confirming diagnosis with minimally
invasive
reducing surgical trauma and
acquiring timely intervention