Retrospective Review of Diagnosis and Treatment in Children Presenting to the Pediatric Department With Acute Scrotum

1 Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
American Journal of Roentgenology (Impact Factor: 2.73). 05/2013; 200(5):W444-9. DOI: 10.2214/AJR.12.10036
Source: PubMed


Testicular torsion is a common acute condition in boys requiring prompt accurate management. The objective of this article was to evaluate ultrasound accuracy, findings, and clinical predictors in testicular torsion in boys presenting to the Stollery pediatric emergency department with acute scrotal pain.

Retrospective review of surgical and emergency department ultrasound records for boys from 1 month to 17 years old presenting with acute scrotal pain from 2008 to 2011 was performed. Clinical symptoms, ultrasound and surgical findings, and diagnoses were recorded. Surgical results and follow-up were used as the reference standard.

Of 342 patients who presented to the emergency department with acute scrotum, 35 had testicular torsion. Of 266 ultrasound examinations performed, 29 boys had torsion confirmed by surgery. The false-positive rate for ultrasound was 2.6%, and there were no false-negative findings. Mean times from presentation at the emergency department to ultrasound and surgery were 209.4 and 309.4 minutes, respectively. Of the torsed testicles, 69% were salvageable. Sensitivity, specificity, and diagnostic accuracy of ultrasound for testicular torsion were 100%, 97.9%, and 98.1%, respectively. Sonographic heterogeneity was seen in 80% of nonviable testes at surgery and 58% of patients with viable testes (p = 0.41). Sudden-onset scrotal pain (88%), abnormal position (86%), and absent cremasteric reflex (91%) were most prevalent in torsion patients.

Color Doppler ultrasound is accurate and sensitive for diagnosis of torsion in the setting of acute scrotum. Despite heterogeneity on preoperative ultrasound, many testes were considered to be salvageable at surgery. The salvage rate of torsed testes was high.

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    • "Testicular torsion is a common acute surgical emergency with the annual incidence of 1 in 4000 males younger than 25 years [1]. It has two peaks in age distribution occurring in the perinatal and early adolescent age groups [2]. "
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    ABSTRACT: Introduction: Testicular torsion is a surgical emergency which requires early diagnosis and prompt surgical management to avoid testicular damage. The aim of this study is to survey the clinical findings and outcome of the patients treated for testicular torsion in a university hospital in Babol, northern Iran. Methods: In this cross sectional study, a retrospective survey of all cases presenting with acute scrotum and primarily diagnosed as testicular torsion was conducted during 2001 and 2012 in Babol, northern Iran. All 103 cases were reviewed and several clinical data, including duration of symptoms and operative findings were collected. Findings: Of 103 patients who presented to the emergency department with acute scrotum, the median age of the cases was 16.0 years. Thirty four percent of the patients presented emergency unit less than 6 hours from symptom exposure. Pain (95.1%) was the major symptom in all patients. Surgery revealed that 72 (70.9%) cases were diagnosed firmly as testicular torsion that 23 patients under- went orchidectomy for a necrotic torsed testis. There were significant differences between orchi- ectomized versus non-orchiectomized torsion cases in affected side, symptom presentation to operation time. Conclusion: According to our results more than half of the cases presented more than in the golden time. Late presentation to hospital was the major cause of delay leading to or- chidectomy in patients with testicular torsion. Greater effort in health education and direct or self- referal to hospital may reduce this delay.
    Full-text · Article · May 2014 · Open Journal of Urology
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    ABSTRACT: Men or boys, who present with acute scrotal pain without prior trauma or a known mass, most commonly suffer from torsion of the spermatic cord; epididymitis or epididymoorchitis; or torsion of the testicular appendages. Less common causes of pain include a strangulated hernia, segmental testicular infarction, or a previously undiagnosed testicular tumor. Ultrasound is the study of choice to distinguish these disorders; it has supplanted Tc-99 m scrotal scintigraphy for the diagnosis of spermatic cord torsion. MRI should be used in a problem solving role if the ultrasound examination is inconclusive. The ACR Appropriateness Criteria ® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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    ABSTRACT: Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. It accounts for 10% to 15% of acute scrotal disease in children, and results in an orchiectomy rate of 42% in boys undergoing surgery for testicular torsion. Prompt recognition and treatment are necessary for testicular salvage, and torsion must be excluded in all patients who present with acute scrotum. Testicular torsion is a clinical diagnosis, and patients typically present with severe acute unilateral scrotal pain, nausea, and vomiting. Physical examination may reveal a high-riding testicle with an absent cremasteric reflex. If history and physical examination suggest torsion, immediate surgical exploration is indicated and should not be postponed to perform imaging studies. There is typically a four- to eight-hour window before permanent ischemic damage occurs. Delay in treatment may be associated with decreased fertility, or may necessitate orchiectomy.
    No preview · Article · Dec 2013 · American family physician
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