Clinical Features and Misdiagnosis Analysis of Testicular Torsion in 313 Children

The objective of this study is to summarize the characteristics of testicular torsion (TT) in children and review the clinical diagnosis and treatment of misdiagnosed patients. The clinical data of patients with testicular torsion diagnosed in our specialized children’s hospital from January 1995 to August 2019 were collected retrospectively. A descriptive analysis was used to summarize the clinical characteristics. Presentations were considered acute (< 24 h) or delayed (≥ 24 h) based on time from onset of symptoms to diagnosis. The diagnosis and treatment characteristics of misdiagnosed patients were analyzed retrospectively, and the cases of acute presentation were reviewed as controls. Finally, the diagnostic efficiency of male reproductive color Doppler ultrasound (CDUS) was reviewed. A total of 313 patients were enrolled (infancy and adolescence were the peak periods), including 4 cases of bilateral disease and 309 cases of unilateral disease, mainly in the left side (76.36%). The median age of onset was 11, the median time from onset of symptoms to diagnosis was 24 h, and the median degree of torsion was 540°. At the first visit, 36 (11.50%) patients had cryptorchidism, with a median onset age of 4 years and a median delay of 48 h. The orchiectomy rates of cryptorchidism and other patients were 69.44% and 42.33% (P = 0.0032), respectively. Forty-six patients (14.70%) were misdiagnosed at first visit; the most common misdiagnosis was orchitis or epididymitis (54.35%), followed by gastroenteritis or intestinal spasm (10.87%). Most of the misdiagnosed patients received intravenous antibiotic treatment, resulting in a median delay of 6.5 days, while the median time from onset of symptoms to diagnosis in properly treated patients was only 6.98 h, P < 0.0001. As a result, the rates of orchiectomy in misdiagnosed patients and properly treated patients were 78.26% and 12.90%, respectively. In addition, the proportion of patients with abdominal pain as the chief complaint in misdiagnosis and properly treated patients was 15.21% and 0.00% (P = 0.0003), respectively. Only two of misdiagnosed patients completed the reproductive color Doppler ultrasound (the result was shown as orchitis) at initial visit, and the optimal diagnostic sensitivity and specificity of color Doppler ultrasound in this cohort were 95.37% and 87.50%, respectively. Atypical clinical manifestations, non-detailed physical examination, abuse of anti-inflammatory and analgesic drugs, and incomplete reproductive color Doppler ultrasound examinations were related to the misdiagnosis of patients with TT, and this disease could not be safely excluded from negative color Doppler ultrasound results.