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Three Part Question

In [patients presenting with unilateral testicular pain] does [testicular pulse oximetry] enable [an accurate diagnosis of testicular torsion]?

Search Strategy

Databases: Medline (2013-2020), Embase (2011-2020), Cochrane (2017)

Search terms: (“Testicular Pain” OR “Scrotal Pain” OR “Acute Scrotum”).mp AND ("Pulse Oximetry" OR "Oxygen Saturation" OR "Oximetry").mp AND ("Testicular Torsion" OR "Spermatic Cord Torsion" OR "twisted testis").mp

Search Outcome

The search on Medline found 3 papers. The search on Embase found 5 papers. The search on Cochrane found 1 paper.

After duplications were removed, 5 papers remained; of these, one was relevant to the three-part question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Chen et al. 2014 Taiwan	16 patients (aged 1-to-19) undergoing scrotal examination.		SpO2 and HR were undetectable in the torted testis but were recorded in the non-affected testis.		Small sample of patients.

Comment(s)

Pulse oximetry allows haemodynamic changes in the testicles to be monitored, which may aid TT diagnosis. Only one study, which included 16 patients, presented evidence on the three-part question. This is not representative of wider populations and thus the conclusions from the search are inconclusive. Full texts were excluded if they discussed NIRS rather than pulse oximetry. Further research could be completed to assess this method to diagnose TT, however the overarching aim of these searches (to develop A&E guidelines), the availability and cost of the NIRS equipment must be considered. Such equipment is not widely available or affordable, and therefore it was not appropriate to include NIRS in the search.

Clinical Bottom Line

In resource-limited settings, pulse oximetry can be used to assess haemodynamic changes, however, where possible, other methods of assessing testicular blood flow should be used (e.g., CDUS).

References

1. Chen et al. Potential use of pulse oximetry for the diagnosis of testicular torsion