A recent case study published in the Canadian Urological Association Journal demonstrates the potential for a non-invasive bedside method of detecting testicular torsion. Testicular torsion is a surgical emergency due to the risk of testicular loss if not identified quickly.
In current management, if true torsion is suspected clinically, you don’t necessarily need imaging — urology can immediately take a patient to the OR for surgical intervention. However, urology often does request a testicular ultrasound be performed if it’s not a straightforward presentation, which can take time, especially if your urologist is not onsite. That’s why a non-invasive bedside method for detecting torsion could have utility.
In this case, a 14-month old boy with left scrotal swelling, erythema, and tenderness that did not respond to one day of antibiotics and analgesics, and was showing a low likelihood of testicular torsion based on traditional tests. There was no direct evidence of testicular torsion, and color Doppler ultrasound results were equivocal with a trend toward epididymitis.
Spatially resolved near-infrared spectroscopy (SR-NIRS) was used to compare the tissue saturation indices (TSIs) of the left and right spermatic cords. Real time data was collected on each side for 1 minute and compared. A significant difference was found (68.8% on the left versus 75.6% on the right). Using the same device, TSIs were measured in the left and right quadriceps as controls (75.5% and 75.2%).
Surgical exploration found a 1080-degree torsion and a non-viable left testicle. This case demonstrates the need for further study of NIRS in the evaluation of testicular torsion. If the technology can be proven to be reliable, sensitive, and specific enough, it has the potential to diagnose testicular torsion more rapidly.