<p>Assessing the Utility of Ultrasound and Urinalysis for Patients with Possible Epididymo-Orchitis – A Retrospective Study</p>

Abstract

Purpose: Many experts recommend ordering an ultrasound and a urinalysis on all patients with scrotal pain. While the ultrasound may help diagnose a number of potential causes of scrotal pain, the urinalysis primarily has value in assessing for epididymo-orchitis. This study sought to evaluate the utility of these diagnostic tests for patients who presented to the emergency department (ED) with acute scrotal pain and possible epididymo-orchitis. Patients and Methods: This was a single-center chart review of patients presenting to the ED with scrotal pain. Trained research assistants reviewed charts to obtain urinalysis and ultrasound results as well as diagnoses and treatments provided. Using the final diagnosis as a gold standard, the sensitivity and specificity of ultrasound and urinalysis were calculated for the diagnosis of epididymo-orchitis. Also, through a prespecified definition of "changed management," we estimated the percentage of cases in which a urinalysis changed management of patients with acute scrotal pain. Results: We identified 663 adult and pediatric patients who presented with scrotal pain during 2016. All patients had an ultrasound performed, and 458 (69.1%) had a urinalysis done. The sensitivity of urinalysis for epididymo-orchitis was 58.2% (95% CI 48.9% to 67.1%), and the specificity was 85.1% (95% CI 80.8% to 88.7%). For ultrasound, the sensitivity was 78.8% (95% CI 71.4% to 85.0%) and the specificity was 98.1% (95% CI 96.4% to 99.1%). In 24 of 458 cases (5.2% [95% CI 3.4% to 7.7%]) where a urinalysis was obtained, its results may have changed management of the patient. Conclusion: The diagnosis of patients who present to the ED with scrotal pain is primarily driven by the ultrasound results. While the urinalysis may occasionally provide some benefit in the evaluation of patients with suspected epididymo-orchitis, the reflexive ordering of a urinalysis in patients with scrotal pain may be unnecessary.

Frequency of Urinary Tract Infections, Gonorrhea, and Chlamydia in Emergency Department Patients With Acute Scrotal Pain

“…A similar prior study evaluated the utility of the UA in pediatric and adult patients with epididymo-orchitis [6]. It was reported that of the 69.1% of patients with an acute scrotum that had UA done, and 26.7% were positive.…”

“…A cross-sectional study showed that utilization of US, UA, and GC in pediatric males presenting with scrotal pain varies dramatically [5]. In patients with suspected epididymo-orchitis, UA may have a degree of utility, although US is more sensitive and specific for the diagnosis [6]. However, one study found that if US is considered the gold standard for the diagnosis of epididymo-orchitis, the sensitivity of UA is 48.0%, and the specificity is 81.4% [4].…”

“…However, one study found that if US is considered the gold standard for the diagnosis of epididymo-orchitis, the sensitivity of UA is 48.0%, and the specificity is 81.4% [4]. Given the narrow role of UA in the evaluations of scrotal pain, UA may not be necessary for all patients presenting with scrotal pathology [6]. According to the Center for Disease Control, suspected epididymo-orchitis is the only scrotal pathology in which GC testing is indicated in, as it guides treatment [7].…”

Testicular Abscess and Ischemia Secondary to Epididymo-orchitis

“…The contrast agent used for CEUS is not nephrotoxic, minimizing impact on those with underlying kidney dysfunction. It can be performed quickly at the patient bedside, making it ideal for emergent evaluation of acute scrotal pain [6][7][8]. Additionally, in a study of segmental testicular infarction, CEUS was 100% sensitive in detecting infarction [9].…”