Acute Scrotal Pain in Pediatric Emergency Medicine: Assessment, Diagnosis, Management, and Treatment

Prospective Validation of Clinical Score for Males Presenting With an Acute Scrotum

“…This patient's urinalysis was negative for all components. Some authors recommend that males with epididymitis be managed conservatively with NSAIDs and scrotal elevation without empiric antibiotics and also recommend urine cultures be sent and antibiotic therapy determined from these results . Based on our results, it may be reasonable to consider this approach in males with no past urologic history, who are at low risk for infection.…”

“…Urinalysis in the setting of an acute scrotum is for the identification of pyuria as a potential marker for infectious epididymitis, which may occur secondary to retrograde flow of infected urine from the urethra through the ejaculatory ducts and vas deferens into the epididymis . Previous studies have demonstrated that most pediatric males with epididymitis do not have pyuria on urinalysis or a positive urine culture and, therefore, do not require routine antibiotic treatment .…”

“…Males with testicular torsion most commonly present with acute scrotal/testicular pain and swelling (the acute scrotum), which can also be the presenting symptoms for epididymitis‐orchitis, torsion of the appendix testis, and scrotal trauma . Testicular torsion is caused by the twisting of the spermatic cord along with the vasculature of the testicle and requires prompt surgical intervention to prevent testicular loss from ischemia .…”

“…This occurs in approximately 1 in 1,500 to 1 in 4,000 males by the age of 25 . It is important to quickly differentiate between the different testicular conditions associated with the acute scrotum to optimize the time to surgery to preserve testicular viability for those with testicular torsion . One study found that for males treated within 6 hours of the onset of symptoms there is a 90% to 100% rate of testicular salvage.…”

“…Nonetheless, the use of DUS may prolong the time in testicular ischemia and delay time to surgery for those with testicular torsion . In addition to DUS, laboratory testing with urinalysis and urine culture and for sexually transmitted infections (STIs) is used in the evaluation of testicular complaints to evaluate for other causes of the acute scrotum, including epididymitis …”