The baseline demographic and clinical characteristics of the two pediatric cohorts are presented in Table 1.
Ninety-eight pediatric patients with AS were identified in the period 2011–2016. Eight patients were excluded from the study as they had other pathologies (e.g., EO, n = 4) or incomplete clinical histories (n = 4). Thus, 90 patients with TT and TAT met the inclusion criteria and constituted the final cohort.
Twenty-four TT cases (26.6%) (Group I) and 66 (73.4%) TAT cases (Group 2) were seen during the study period. Patients with TT in this study were significantly older [13.5 ± 2.6 years (range, ten days − 15.8 years)] than those with TAT [9.5 ± 2.8 years (range 0.7–14.7 years)] (p < 0.001).
Although TT and TAT affected the children across different ages, significant differences in both groups were observed. Thus, the peak incidence of TT was in the age of 12–16 years (75%), whereas the peak of TAT was in the age group of 7–11 years (57%) (p < 0.001 for both calculations).
There was no statistically significant difference between the two groups in laterality (p = 0.28). However, left-sided scrotal involvement was more common in TT cases (66%), whereas there was no significant difference in affected sides in TAT cases. Interestingly, we found that right-sided TT increases in adolescent patients: Left-side TT involvement was recorded in 100% of patients under 12 years. In comparison, the incidence on that side dropped to 55.6% in patients aged ≥ 12.
Scrotal pain, erythema of the scrotal skin, and scrotal swelling were the most common clinical symptoms in both observed groups (Table 1). Interestingly, scrotal pain (without recorded accurate localization of tenderness and its intensity) was statistically more present in TAT patients (p = 0.02). In contrast, nausea/vomiting and abdominal pain occurred more frequently among the TT patients (p = 0.003 and p < 0.001, respectively). Notably, fever and abdominal pain did not affect any TAT patients (Table 1).
The mean duration of symptoms for the entire cohort was 63.3 hours (range, 30 minutes to 480 hours) with a median of 48 hours. The mean duration of symptoms was significantly shorter in the TT group (42 hours, range, 1-336 hours) than in the TAT group (71 hours, range, 1-480 hours) (p < 0.001).
There was no significant difference in the seasons of onset between TT patients and those with TAT (p = 0.31). The lowest TT cases (21%) were recorded during the winter, whereas the largest TAT cases (28.7%) were recorded during the same season.
A vast majority of the cases (91.7% of TT and 83.3% of TAT cases) had a spontaneous torsion, whereas the remaining 8.3% of TT cases and 16.3% of TT cases were trauma-related. However, the difference was not statistically significant (p = 0.50).
Ultrasonographically, the two diseases presented strikingly different. Thus, twenty-three patients with TT (96%) and only five patients with TAT (7.5%) showed absent or decreased testicular blood flow in the affected testes, whereas 61 (92.5%) patients with TAT and only 1 (4%) patient with TT showed increased or normal testicular blood flow in the affected testes (Table 1). CDUS findings of absent or decreased testicular blood flow in the affected testes significantly correlated with TT's presence (p < 0.001). In contrast, CDUS findings of increased or normal blood flow had a significant correlation with the presence of TAT (p < 0.001).