Chronic orchalgia after surgical exploration for acute scrotal pain in children

Hart, Jodi; Pastore, Gianna; Jones, Matthew; Barker, Andrew; Khosa, Japinder; Samnakay, Naeem

doi:10.1016/j.jpurol.2015.11.014

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…This complication rate is similar to the previously described complication rate (5.6%e18%). 10,11 The higher rate of abscess and reexploration in the unmatched group of patients who did not undergo ICLO seems secondary to a higher number of patients with necrotic aspects of the twisted testicle. We also evidenced that ICLO reduced the absolute risk of subsequent TT of 0.4% (0.7% in the groups with no ICLO and 0.3% in the ICLO group).…”

Section: Discussionmentioning

confidence: 99%

Contralateral Orchiopexy at the Time of Urgent Scrotal Exploration—Is It Safe? A Propensity Score Matched Analysis from the TORSAFUF Cohort

et al. 2021

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Purpose:We evaluate the safety of immediate contralateral orchiopexy (ICLO) at the time of scrotal exploration for testicular torsion suspicion.Materials and Methods:Patient data were retrieved from the TORSAFUF cohort project, which is a multicenter national study conducted at 14 academic French hospitals between 2005 and 2019. Each patient who underwent surgical exploration for testicular torsion suspicion was included. The primary study outcome was the safety of ICLO compared to ipsilateral scrotal exploration alone. The primary outcome of interest was the complication rate within 90 days of surgery. The end point was planned before data collection.Results:Overall, 2,775 patients were included, of whom 1,554 (56%) underwent ICLO. After propensity score matching and multivariable analysis, ICLO was associated with a higher complication rate (OR 1.51, 95% CI 1.1–2.1, p=0.01), especially a higher rate of hematoma (OR 2.9, 95% CI 1.3–6.6, p=0.01), and delayed wound healing (OR 3.0, 95% CI 1.8–5.2, p <0.001).Conclusions:At the time of scrotal exploration for acute scrotum, ICLO was associated with an increased postoperative complication rate, with a particular increase in hematoma, and delayed wound healing. ICLO should not be performed systematically.

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Section: Discussionmentioning

confidence: 99%

Contralateral Orchiopexy at the Time of Urgent Scrotal Exploration—Is It Safe? A Propensity Score Matched Analysis from the TORSAFUF Cohort

et al. 2021

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“…3 A pediatric study of chronic orchialgia after surgical exploration for acute scrotal pain found that 1.4% of patients developed this issue. 4 Microsurgical denervation of the spermatic cord is an option for definitive pain control. [5][6][7] The typical patient pathway includes attempts at conservative medicationbased management, followed by diagnostic spermatic cord nerve block, which, if successful, is followed by microsurgical denervation of the neural structures of the spermatic cord.…”

Section: Re ´Sumementioning

confidence: 99%

Resolution of post-traumatic chronic testicular pain in a pediatric patient after microsurgical denervation of the spermatic cord: a case report

Zuercher

D’Alessandro

Brown

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Chronic scrotal content pain, chronic orchialgia, or testicular pain can present after trauma, vasectomy, and hernia repair, among other triggers. Microsurgical denervation of the spermatic cord is an option for definitive pain control. While this practice is established in adult urology, access to diagnostic intervention and definitive denervation surgery is limited in the pediatric population. Clinical features We report a case of definitive resolution of testicular pain with microsurgical denervation of the spermatic cord in a pediatric patient with post-traumatic chronic orchialgia that significantly reduced his daily activities and worsened his anxiety prior to this treatment. The patient underwent attempts at conservative medication-based management, followed by diagnostic spermatic cord nerve block before definitive denervation surgery. Conclusions The incidence of chronic pain in pediatrics is substantial and is estimated to be around 20%. Orchialgia remains difficult and problematic to treat. Mental health diagnoses such as anxiety and depression are also significantly associated with chronic pain. Following consideration and implementation of steps for all these concerns, a diagnostic block and microsurgical denervation led to successful resolution of chronic testicular pain in a pediatric patient.

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“…The most important differential diagnosis for AS is TT, which accounts for up to 25% of acute scrotal disease in the pediatric population [2]. In contrast, the most frequently detected pathology during scrotal exploration is TAT, representing 54-71% of the operative diagnosis of AS [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Comparison of demographic and clinical characteristics in distinguishing testicular torsion from torsion of the appendix testis

Zvizdić¹,

Aganovic²,

Milišić³

et al. 2021

Preprint

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Purpose The acute scrotum (AS) in the pediatric population is a medical emergency. The most common causes of AS include testicular torsion (TT) and torsion of the appendix testis (TAT). Their distinction may be clinically challenging. The purpose of our study was to compare demographic and clinical characteristics of the pediatric cases of TT and TAT and thus provide clinical evidence for distinguishing these two conditions. Methods We retrospectively analyzed all children ≤ 16 years who underwent surgical exploration for AS. The patients were divided into Group 1 or TT and Group 2 or TAT groups. Results Ninety patients were included in the study (24 with TT and 66 with TAT). Patients with TT were significantly older than those with TAT (p < 0.001). The peak incidence of TT was in the age of 12–16 years (p < 0.001), whereas the peak of TAT was in the age group of 7–11 years (p < 0.001). Scrotal pain was more prevalent in patients with TAT (p = 0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p = 0.003 and p < 0.001, respectively). The mean duration of symptoms was significantly longer in the TAT group than in the TT group (p < 0.001). Color-Doppler Ultrasound (CDUS) findings of absent or decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p < 0.001). Conclusion Our data indicate that the older age, shorter duration of symptoms, systemic signs (nausea/vomiting and abdominal pain), and characteristics CDUS findings can help distinguish between the two most common acute scrotum causes.

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Chronic orchalgia after surgical exploration for acute scrotal pain in children

Cited by 11 publications

References 12 publications

Contralateral Orchiopexy at the Time of Urgent Scrotal Exploration—Is It Safe? A Propensity Score Matched Analysis from the TORSAFUF Cohort

Contralateral Orchiopexy at the Time of Urgent Scrotal Exploration—Is It Safe? A Propensity Score Matched Analysis from the TORSAFUF Cohort

Resolution of post-traumatic chronic testicular pain in a pediatric patient after microsurgical denervation of the spermatic cord: a case report

Comparison of demographic and clinical characteristics in distinguishing testicular torsion from torsion of the appendix testis

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