Sonographic diagnostic accuracy and imaging patterns of testicular torsion in a quaternary facility in Ghana: a five-year retrospective study

Abstract

Testicular torsion is a time-critical urological emergency in which delayed diagnosis and intervention significantly increase the risk of testicular loss. In low-resource settings such as Ghana, late presentation and variability in imaging expertise may affect diagnostic accuracy and clinical outcomes. This study evaluated the sonographic diagnostic accuracy and imaging patterns of testicular torsion in a quaternary healthcare facility in Ghana over a five-year period. This study was a cross-sectional design that reviewed and evaluated the medical records of all eligible patients with acute scrotal pain who were clinically labelled cases of testicular torsion and subsequently underwent surgical exploration from January 2020 to December 2024. The data collected were analyzed using SPSS and Python. Fisher’s exact test was employed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated. Statistical significance level was set at p ≤ 0.05. The mean age of patients with confirmed testicular torsion was 15.36 ± 8.97 years, mostly observed in the 13–18 years age group ( p = 0.049). The mean duration of symptoms prior to presentation was 11.45 ± 8.01 h, with only 26.8% ( p < 0.001) of patients presenting within 6 h of symptom onset, while 73.2% presented after 6 h ( p < 0.001). Absent intratesticular blood flow, whirlpool sign, and heterogeneous echotexture were seen in 81.7% ( p < 0.001), 64.8% ( p = 0.001), and 62.0% ( p = 0.027) of patients with confirmed testicular torsion, respectively. Ultrasound demonstrated a sensitivity of 92.96%, specificity of 66.67%, and overall diagnostic accuracy of 86.96%, with a PPV of 90.41% and an NPV of 73.68%. The cumulative incidence rate of testicular torsion from 2020 to 2024 was 3.43 (95% CI = 2.63–4.23) per 100,000 males. Testicular torsion predominantly affected adolescents and was characterized by delayed presentation and advanced sonographic features of ischemia. Scrotal ultrasound showed high sensitivity and diagnostic accuracy but moderate specificity and NPV. The steady increase in the incidence of testicular torsion from 0.29 per 100,000 in 2020 to 1.16 per 100,000 in 2024 suggests improved recognition and reporting, as well as greater healthcare access over time.