Abstract
Testicular pain is a common reason for seeking urgent urological advice and many patients with uncertain diagnosis undergo scrotal exploration. The role of ultrasound in triage of these patients is well recognised, but limited availability out-of-hours and inherent delays often make its use impractical. The aim of this study was to review local practices in relation to scrotal explorations and preoperative ultrasound and to highlight ways for improvement. We completed a retrospective study of 117 emergency scrotal explorations for suspected testicular torsion performed at our hospital in a four year period (2006-2010). Eleven patients (9.40%) had preoperative ultrasound. Analysis indicated that 32 patients (27%) had testicular torsion, 40 (34%) torsion of hydatid of Morgagni, 20 (17%) epididymo-orchitis, 1 (1%) testicular trauma and no cause for pain was found in 24 (21%) of cases. There were seven reported complications (5.98% rate). A significant proportion of patients undergoing scrotal exploration had pathology not requiring surgery. In cases where pain is of long duration (e.g. >12 hours) and clinical picture not suggestive of testicular torsion, ultrasound may be able to prevent unnecessary surgery by ruling out testicular torsion.
Highlights
Testicular pain is a common reason for seeking urgent urological advice and many patients with uncertain diagnosis undergo scrotal exploration
Around 25-35% of patients who present at the emergency department with acute scrotal pain will have a testicular torsion [1,2]
We completed a retrospective study of all 117 emergency scrotal explorations for suspected testicular torsion performed at our institution in a four year period (2006-2010)
Summary
Testicular pain is a common reason for seeking urgent urological advice and many patients with uncertain diagnosis undergo scrotal exploration. Around 25-35% of patients who present at the emergency department with acute scrotal pain will have a testicular torsion (twisting of the spermatic cord and causing testicular ischaemia) [1,2]. It has been shown that modern CDUS is highly sensitive and specific test for testicular torsion and may predict likelihood of requiring orchidectomy on exploration [3,4,5,6]. This evidence has not changed the prevailing view based on early studies, that diagnostic performance of CDUS in cases of acute scrotum is questionable. There is a significant resistance to wider availability of CDUS for out-ofhours service, which in turn makes its use impractical
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