Acute Scrotum: Is Scrotal Exploration the Best Management?

Abstract

Aim: Selective scrotal exploration of only those boys believed to have testicular torsion (TT), relying on history and clinical examination for diagnosis, can result in a missed or delayed diagnosis of TT. To minimise testicular loss we propose early scrotal exploration in all boys with acute scrotum (AS). To validate our approach we investigated the accuracy of clinical diagnoses of all boys with AS admitted to our unit. Clinical features and diagnoses were correlated with operative findings.

Methods: A retrospective review of the records of all boys (1–16 years of age) presenting with AS between 2003 and 2007 was done. Overall, 138 boys were seen during this period. Three boys were treated conservatively. The 135 boys who underwent scrotal exploration were divided into three groups: Group A (47 boys) with a history and clinical features considered preoperatively to be consistent with torsion of appendix of testis (TAT); Group B (46 boys) whose characteristics were thought to be more consistent with TT; and finally Group C (42 boys) in whom a preoperative definitive diagnosis could not be made. The preoperative clinical features and diagnoses of the 135 boys were correlated with the operative findings.

Results: In Group A, exploration confirmed TAT in 37 (78%) boys, but in 7 (15%) boys it revealed TT. In Group B, exploration confirmed torsion in 31 (68%) boys, but 13 (28%) had TAT. In Group C, exploration revealed 39 (93%) cases of TAT and 3 (7%) cases of TT.

Conclusion: Surgical exploration in all cases of paediatric AS offers an accurate diagnosis and treatment, thus minimising the risk of testicular loss.

Key words

acute scrotum - testicular torsion - diagnosis

References

• 1 Anderson J, Williamson R. Testicular torsion in Bristol: a 25 year review.  Br J Surg. 1988;  75 988-992
• 2 Gatti JM, Murphy JP. Current management of the acute scrotum.  Seminars in Pediatric Surgery. 2007;  16 58-63
• 3 Schalamon J, Ainoedhofer H, Schleef J. et al . Management of acute scrotum in children – the impact of Doppler ultrasound.  J Pediatr Surg. 2006;  41 (8) 1377-1380
• 4 Murphy FL, Fletcher L, Pease P. Early scrotal exploration in all cases is the investigation and intervention of choice in the acute paediatric scrotum.  Pediatr Surg Int. 2006;  25 (5) 413-416
• 5 Cuckow PM, Frank JD. Torsion of the testis.  BJU International. 2000;  86 349-353
• 6 Visser AJ, Heyns CF. Testicular function after torsion of the spermatic cord.  BJU Int. 2003;  92 (3) 200-203
• 7 Matteson JR, Stock JA, Hanna MK. et al . Medicolegal aspects of testicular torsion.  Urology. 2001;  57 (4F) 783-786
• 8 Ben Chaim J, Leibovitch I, Ramon J. et al . Etiology of acute scrotum at surgical exploration in children, adolescents and adults.  Eur Urol. 1992;  21 45-47
• 9 Kapasi Z, Halliday S. Ultrasound in the diagnosis of testicular torsion.  Emerg Med J. 2005;  22 559-560
• 10 Thomas WEG, Crane GA, Cooper MJ. et al . Testicular exocrine malfunction after torsion.  Lancet. 1984;  2 1357-1360

Correspondence