Critical Analysis of the Clinical Presentation of Acute Scrotum

Jefferson, Robert H.; Pérez, Luis Miguel Luengo; Joseph, David B.

doi:10.1097/00005392-199709000-00134

Cited by 27 publications

(6 citation statements)

References 12 publications

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“…Duration of symptoms before surgery is an important predictor of outcome in TT ( 14 ). Jefferson et al ( 15 ) reported that no testicle with a history longer than 12 hours could be salvaged. Other researchers ( 11 ) observed testicular necrosis, even atrophy after orchidopexy in patients with the history shorter than 10 hour.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Second Look Exploration in Testicular Torsion of Children

2015

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Background:Testicular torsion (TT), or twisting of the testicle resulting in a strangulation of the blood supply, occurs in men whose tissue surrounding the testicle is not well attached to the scrotum. It is important to emphasize that testicular torsion is a medical emergency.Objectives:The aim of this study is to evaluate the second look exploration and outcomes in TT.Patients and Methods:Seventy boys out of 124 patients underwent early exploration and 48 hours later second look exploration due to TT. All patients were checked with preoperative color-doppler ultrasonography (CDU) and intraoperative bleeding test. Data included age at admission, side of pathology, relation of TT with season of year, duration of preoperative history, degree of testicular torsion, CDU findings, and degree of bleeding; results of second look exploration, follow-up, and outcomes were analyzed.Results:Totally 70 patients were included in this study within five years, of which mean age was 28.6 ± 32.9 months (range 1 to 144), 48% of our patients had nausea and vomiting. Preoperative CDU showed absent/weak flow in 50 (71%) cases. Winter showed most frequently (44%) referred cases of testicular torsion. Orchidopexy was performed in 44 (63%) and orchidectomy in 26 (37%) cases after second look exploration. Mean follow-up duration was 3.1 ± 1.4 years. 4 (9%) cases in orchidopexy group developed testicular atrophy during follow-up, all four cases had a history of longer than 12 hours and grade II testicular bleeding test intra-operatively. Other orchidopexy patients salvaged. 26 patients, who were in grade III, underwent orchidectomy in second look exploration.Conclusions:TT requires emergency attention. The ischemia time of the testis is traditionally after 6 hours, and imaging or other diagnostic modality should not be a cause of delay. Early surgical exploration is modality of choice, and second look exploration after 48 hours can be more effective and salvageable in these patients.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Second Look Exploration in Testicular Torsion of Children

2015

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“…Testicular torsion instances that are clinically evident or those identified by colour duplex ultrasonography should always be handled urgently [ 16 ]. It is recommended to do scrotal exploration, bilateral testicular fixation, and detorsion of the affected side [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Testicular Torsion and Irreversible Loss in an Adolescent Male: A Harrowing Case Report With Emphasis on Timely Intervention and Literature Review

Reddy,

Ramteke,

Patel

et al. 2023

Cureus

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Testicular torsion is a condition characterized by the twisting of the testis and spermatic cord within the scrotum, resulting in the obstruction of venous return and subsequent swelling. If left untreated, the torsion can progress to block the arterial blood supply, leading to ischemia. Prolonged ischemia can result in testicular necrosis and decreased fertility. Recognizing the urgency of this condition, timely diagnosis and management are crucial. In this clinical case, a 16-year-old male presented with left-sided scrotal pain following a minor trauma. Despite prompt medical attention, the delay in seeking treatment resulted in irreversible testicular necrosis. The case emphasizes the urgency of diagnosing and managing testicular torsion to prevent serious consequences such as testicular loss and reduced fertility. It serves as a poignant reminder for healthcare professionals to remain vigilant in recognizing this urological emergency and advocating for timely intervention to optimize patient outcomes.

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“…and that study quoted a salvage rate of 61%. [ 24 ] Barada et al . from new York report a delay of 20 h for those below 18 years of age making them a target population for education regarding testicular health.…”

Section: Discussionmentioning

confidence: 99%

Testicular torsion - symptomatology and outcomes of 101 scrotal explorations

2022

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Objective: The objective was to study the symptomatology of testicular torsion of patients operated in our hospital and their operative results in relation to the duration of symptoms. Materials and Methods: Data of all patients operated for acute scrotum at all ages over a 14 months’ time were collected from hospital records. Symptomatology and operative results were studied. Results: Out of 101 consecutive scrotal explorations done in this time, 63.4% of all scrotal explorations were testicular torsion ( n = 64). 22.8% were appendage torsion ( n = 23) and 13.9% were epididymo-orchitis ( n = 14). The peak age of testicular torsion was in the 11–15 years range and the left side is more common (65.6%). Symptoms of scrotal pain (92.2%), abdominal pain (18.8%), nausea/vomiting (18.8%), fever (9.4%), and urinary symptoms (3.1%) were seen in decreasing order of frequency. Among acute scrotum patients who had symptoms of nausea/vomiting or abdominal pain, testicular torsion was found to be significantly higher compared to those who did not have these symptoms (χ 2 = 0.044, P < 0.05). In all cases presented within 6 h of symptom onset, testicles were saved and salvage rates reduced with delay in presentation. The testicular salvage rates were 28.1% (18 out of 64 torsions). Patients below 18 years had more chance of going for orchiectomy than others (75% vs 66.7%). Patients who presented after 24 h had a statistically significantly lower salvage rate of 7.7% compared to those who presented within 24 h duration, 52.2%(χ 2 = 0.001, P < 0.05). Those with orchiopexy had a median duration of symptom of 6.5 h and the same for orchiectomy patients were 72 h. Our median symptom duration for testicular torsion was 36 h and it is higher than many other countries. Conclusions: Delay in presentation to the health-care facility is the major cause of poor salvage rates in the state and its improvement requires public health interventions and health education.

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Critical Analysis of the Clinical Presentation of Acute Scrotum

Cited by 27 publications

References 12 publications

Outcomes of Second Look Exploration in Testicular Torsion of Children

Outcomes of Second Look Exploration in Testicular Torsion of Children

Testicular Torsion and Irreversible Loss in an Adolescent Male: A Harrowing Case Report With Emphasis on Timely Intervention and Literature Review

Testicular torsion - symptomatology and outcomes of 101 scrotal explorations

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