The Diagnosis and Management of Acute Scrotal Conditions in Boys

Hemalatha, V.T.; Rickwood, A. M. K.

doi:10.1111/j.1464-410x.1981.tb03230.x

Cited by 19 publications

(9 citation statements)

References 8 publications

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“…Kadish and Bolte did not find such symptoms helpful, 5 but noted that boys with testicular torsion tend to present after a shorter duration of symptoms 5 . This finding has been reported by other investigators 3,8–10 and is also seen in the present review, as is the observation that the average age of boys with testicular torsion is greater than that of boys with torsion of a testicular appendage (14.4 years, 7 14 years 5 and 11–17 years 6 compared to 9.4 years, 7 10 years 5 and 8–12 years 6 ). Despite such observations, the history and clinical features cannot be relied upon to differentiate testicular torsion from other diagnoses in the individual.…”

Section: Discussionsupporting

confidence: 87%

“…A high index of suspicion should not be discouraged however, as it prompts a request for surgical review. In some children surgical exploration is required to exclude testicular torsion, but the diagnosis can be excluded in more than 50% of cases from the history and examination when they are performed by an experienced examiner 3 3 and the findings of the present study would support this.…”

Section: Discussionsupporting

confidence: 51%

“…Pathognomic findings include abnormal elevation or axis of the testis, but these are seen infrequently 8 . Older boys with testicular torsion tend to have more constitutional upset and abdominal pain, 3 and Jefferson et al have found that nausea and vomiting had positive predictive values of 96% and 98%, respectively 7 5 but noted that boys with testicular torsion tend to present after a shorter duration of symptoms 5 .…”

Section: Discussionmentioning

confidence: 99%

“…Torsion of a testicular appendage has been reported as the cause of the acute scrotum in 55%, 3 46%, 1 42%, 10 35% 6,12 and 24% 8 of boys. In the present review it is the commonest cause of acute scrotal symptoms and this correlates well with several studies, 1,3,10 although in other reviews, torsion of the testis is reported to be more frequent 7,8,12,14 …”

Section: Discussionmentioning

confidence: 99%

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Management of the acute scrotum in children

Corbett

Simpson

2002

ANZ Journal of Surgery

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of the acute scrotum in children

Corbett

Simpson

2002

ANZ Journal of Surgery

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“…Salvageability largely depends on the duration of pain at presentation [1] , and in our series the average duration was 2.6 h when the testis was salvaged and 48 h when the testis had to be removed. Some degree of testicular atrophy is inevitable when pain is present for more than 8-12 h [20] and when pain is present for more than 24 h, testicular salvageability is very low [21] . Therefore, even in equivocal cases, early exploration is necessary to prevent testicular loss, and negative explorations are acceptable [14] .…”

Section: Discussionmentioning

confidence: 99%

The Acute Scrotum: A Review of 40 Cases

2005

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Objective: To determine the relative importance of clinical presentation, laboratory studies, and ultrasonography in the diagnosis of acute scrotum, and to suggest an effective method of management. Subjects and Methods: Forty patients who were hospitalized between January 2002 and December 2002 for acute scrotum were studied with respect to history, physical examination, blood tests, urine analysis including culture, and scrotal ultrasonography with color Doppler study. Results: Epididymitis (n = 24) was the commonest cause of acute scrotum followed by testicular torsion (n = 11), torsion of testicular appendages (n = 4), and idiopathic scrotal edema (n = 1). Both mean age (40.7 vs. 13.8 years), and average duration of pain at presentation (4.5 days vs. 19.1 h) were higher in patients with epididymitis than in torsion. Onset was usually insidious in epididymitis, sudden in testicular torsion, and variable in torsion of testicular appendages. The majority (87.5%) of patients with epididymitis were managed conservatively. The testis was salvaged in 81.8% of patients with testicular torsion. The accuracy of ultrasonography was only 72.7% in testicular torsion, but was good in epididymitis. Conclusion: Our results show that a careful clinical evaluation, by an experienced examiner, provides the correct diagnosis in acute scrotum rather than ultrasonography. It is of utmost importance to exclude testicular torsion in those who are younger than 16 years and whose pain duration is less than 24 h.

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Indications for conservative management of acute scrotal pain in children

Hastie

Charlton

1990

Journal of British Surgery

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Forty-three boys who presented with acute scrotal pain were studied retrospectively. Of these, 40 had torsion of scrotal contents. Torsion of testicular appendages, a self limiting condition, tended to present later than testicular torsion (P = 0.002). The testis was saved in all 11 cases of testicular torsion explored within 12h of the onset of pain but orchidectomy was required in four who presented later. In 11 cases, a torted testicular appendage diagnosed as a tender nodule was found on examining the upper pole of the testis. The remaining 14 cases of torted appendage were diagnosed at operation because testicular torsion could not be excluded due to scrotal swelling. Most (12) of this operated group were not seen until 3 days after the onset of pain. This study suggested that urgent operation was unnecessary in those in whom a tender nodule was found (pathognomonic of a torted appendage) and in those presenting after more than 24h of pain with scrotal erythema and oedema. The likely diagnosis in the latter case is a torted appendage and in cases of torsion of the testis there is no prospect of salvage at this stage. These guidelines were applied to a group of 20 boys studied prospectively. In eight, all with less than 24h of pain, immediate exploration was undertaken and testicular torsion was confirmed in six. The remaining 12 fulfilled the criteria for conservative management and were observed. All had normal testes at late review. Careful clinical assessment in boys with scrotal pain indicates which cases may be treated by non-operative management without fear of losing a salvageable testis.

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The Diagnosis and Management of Acute Scrotal Conditions in Boys

Cited by 19 publications

References 8 publications

Management of the acute scrotum in children

Management of the acute scrotum in children

The Acute Scrotum: A Review of 40 Cases

Indications for conservative management of acute scrotal pain in children

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