MP59-07 UTILITY OF PREOPERATIVE ULTRASOUND FOR THE EVALUATION OF TESTICULAR RUPTURE IN THE SETTING OF PENETRATING SCROTAL TRAUMA

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma1 Apr 2016MP59-07 UTILITY OF PREOPERATIVE ULTRASOUND FOR THE EVALUATION OF TESTICULAR RUPTURE IN THE SETTING OF PENETRATING SCROTAL TRAUMA Stephen Hurley, Edward Park, Ryan Powers, Patricia Vidal, Sarah Psutka, and Courtney Hollowell Stephen HurleyStephen Hurley More articles by this author , Edward ParkEdward Park More articles by this author , Ryan PowersRyan Powers More articles by this author , Patricia VidalPatricia Vidal More articles by this author , Sarah PsutkaSarah Psutka More articles by this author , and Courtney HollowellCourtney Hollowell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.826AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penetrating trauma to the scrotum results in testicular injury in up to 60% of cases. Delayed repair of a ruptured testis will often result in complications; namely infection, atrophy, persistent pain, and delayed orchiectomy. At the time of initial presentation, physical examination is often limited by patient discomfort as well as the presence of a hematocele and/or hematoma. Ultrasonography (US) has been found to be highly sensitive and specific for testicular rupture in the setting of blunt scrotal trauma. The purpose of this study was to determine the accuracy of scrotal US to identify testicular rupture in patients who have sustained a scrotal gunshot wound (GSW). METHODS We performed a retrospective review of patients presenting with a penetrating scrotal GSW from 2003-14. Each patient had preoperative scrotal US to evaluate for evidence of testicular rupture. An US depicting a heterogeneous echo pattern of the testicular parenchyma with loss of contour definition of the testicle was considered a positive examination. Patients underwent scrotal exploration within 24 hours of presentation. The sensitivity and specificity of US were determined in comparison to operative findings. Area under the curve (AUC) was calculated from the graphed receiver operating characteristic curve. RESULTS In total, 75 patients sustained penetrating GSWs to the scrotum. 31 (41%) patients had positive US findings, while 44 (59%) patients had negative examinations. No US revealed bilateral testicular injuries. At surgery, we observed 42 testicular ruptures in 37 (49%) of the 75 patients (5 patients with bilateral injuries). 32 (76%) testicles were salvaged, while 10 (24%) orchiectomies were performed. The sensitivity and specificity of preoperative US were 58% and 89% respectively, with 16 missed diagnoses, and 4 false positives. US had a positive predictive value of 84.6% and negative predictive value of 67.4% for identifying testicular rupture. AUC was 0.74. In 5 of the 16 missed injuries, ultrasound revealed a hematocele or hematoma in the ipsilateral hemiscrotum. CONCLUSIONS The utility of scrotal US for the evaluation of testicular rupture in the setting of penetrating scrotal trauma is limited. Concurrent scrotal pathology such as hematomas and hematoceles may limit the sensitivity of scrotal ultrasonography leading to false-negative examinations. A negative US exam should not deter the clinician from performing a scrotal exploration if physical exam findings are concerning for a testicular injury. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e786-e787 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Stephen Hurley More articles by this author Edward Park More articles by this author Ryan Powers More articles by this author Patricia Vidal More articles by this author Sarah Psutka More articles by this author Courtney Hollowell More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...