The acute scrotum in childhood

Abstract

The acute scrotum is the most urgent of urological emergencies. A torted testis may show signs of atrophy after six hours and viability is compromised after this time. Testicular torsion can occur at any age. Surgery can be avoided only if testicular torsion can be confidently and completely excluded from the differential diagnosis. Conditions where urgent surgical exploration is not indicated include torsion of an appendix testis, idiopathic scrotal oedema or epididymo-orchitis. Investigations (e.g. Doppler ultrasonography, isotope scintigraphy) should not delay exploration and are used to provide reassurance if testicular torsion has been excluded. The principles of surgical management are to explore the affected hemiscrotum for evidence of testicular torsion. If the testis appears viable, it must be manually detorted and secured in the scrotum in order to prevent recurrence. In post-pubertal boys where the testis is clearly non-viable, the testis should not be excised. In all cases of intravaginal testicular torsion, prophylactic fixation of the contralateral side is strongly recommended.