Outcomes of scrotal exploration for acute scrotal pain suspicious of testicular torsion: a consecutive case series of 173 patients

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Acute scrotal pain is a urological emergency. Prompt assessment is required to diagnose the cause.Patients older than 11 years are unlikely to have torsion of a testicular appendage and assessment should focus on discriminating between testicular torsion and epididymo‐orchitis. Reasons for delay in presentation with acute scrotal pain need to be addressed. There is an association between testicular torsion and cold weather.OBJECTIVE• To determine the surgical outcome of all scrotal explorations performed on patients presenting with acute scrotal pain suspicious of testicular torsion.PATIENTS AND METHODS• Data was collected prospectively from a consecutive case series of patients of all ages who had scrotal exploration for acute testicular pain from 1998 to 2008.• The main outcome measures were pathology found during scrotal exploration, relationship between patient age and cause of scrotal pain, orchidectomy rate and the association between testicular torsion and cold weather.RESULTS• Data for 173 patients out of 179 was available for analysis.• The median age of the patients was 14 (0–92) years. 51% (n = 89) had testicular torsion, 24% (n = 42) had torsion of testicular appendages, 9% (n = 16) had epididymo‐orchitis, and other pathology made up 5%.• No obvious pathology was seen in 10% (n = 17).• Patients with Torsion of Appendages were significantly younger than other patients with scrotal pain (P < 0.0001).• Age was not useful in discriminating between patients with Testicular Torsion from other patients with scrotal pain. 9% (n = 16) of all patients required an orchidectomy.• Frequency of Testicular Torsion was higher during the colder half of the year (n = 0.02).CONCLUSIONS• Testicular torsion was the most common finding at surgical exploration, followed by torsion of testicular appendages.• Age had limited value in diagnosing the cause of acute scrotal pain.• Testicular torsion was associated with cold weather.• Our findings support the practice of surgical exploration for acute scrotal pain suspicious of testicular torsion in patients of any age.