Near-Infrared Spectroscopy for Pediatric Acute Scrotum and Testicular Torsion
Principal Investigator: Linda A Baker
Abstract: DESCRIPTION (provided by applicant): The overall goal of this study is to improve the care of patients with testicular torsion. Testicular torsion is the spontaneous twisting of the testis and ts blood vessels. It affects at least 1 in 4,000 males younger than age 25 years and is primarily seen in the newborn or the adolescent male. Testicular torsion causes acute severe pain, vascular compromise and death of the testicle if unrelieved within 6-8 hours of onset. Thus, a rapid, accurate diagnosis with rapid surgical detorsion (surgical untwisting of the testis) is imperative. Unfortunately, diagnosis and treatment is often delayed and in 30-70% of torsion cases, the dead testis is surgically removed. This relatively common problem is one of several diagnoses that can cause a painful or "acute scrotum", making the clinical diagnosis challenging. While surgical exploration is the gold standard to prove whether torsion is present or absent, unnecessary surgical exploration is undesirable. As well, testicular ultrasound with color Doppler, the most commonly used radiological test, is 89-97% sensitive but slows the speed of the evaluation due to dependence upon a skilled technician. With only 6-8 hours to save the testis, this delay in diagnosis may decrease the chance of salvaging a torsed testis. New sensitive and rapid methods to accurately diagnose torsion are needed. Near-Infrared spectroscopy (NIRS) is a simple and non-invasive technique that assesses the oxygen saturation of deeper body tissue. It has a variety of adult and pediatric human health applications but has not been tested in testicular torsion. We propose to evaluate the usefulness of this modality in human testicular torsion. The overall objectives and specific aims are: 1) To evaluate the utility of NIRS in the diagnosis of testicular torsion versus other causes of the acut scrotum, 2) To assess the sensitivity and specificity of Doppler/ B-mode Ultrasound versus NIRS, and 3) To evaluate the utility of NIRS as an intraoperative and postoperative test for predicting testicular viability after surgical detorsion. Given the high safety profile, the speedof measurement, the non-invasive nature, the projected lower cost and high availability, and the ease of performance without a skilled technician, the innovative application of NIRS for diagnosing testicular torsion may revolutionize and accelerate the care of testicular torsion patients, potentially saving testes and decreasing unnecessary surgeries.
Funding Period: 2012-05-15 - 2014-04-30
more information: NIH RePORT
- Contemporary review of testicular torsion: new concepts, emerging technologies and potential therapeuticsDaniel G DaJusta
Children s Medical Center, University of Texas Southwestern Medical School, Dallas, TX, USA
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- Pilot feasibility study of transscrotal near infrared spectroscopy in the evaluation of adult acute scrotumBerk Burgu
Department of Urology, Ankara University, Ankara, Turkey
J Urol 190:124-9. 2013..We investigated the usefulness of transscrotal near infrared spectroscopy that measures testicular oxygen saturation (StO2%) in the diagnosis of testicular torsion vs other causes of the acute scrotum in adults...
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