Acute Scrotal Pain Research Articles

The role of ultrasound imaging in adult patients with testicular torsion: a systematic review and meta-analysis.

Our aim was to determine the accuracy of ultrasound (US) examination-based testicular torsion diagnosis in adult patients with acute scrotal pain. A comprehensive electronic search was performed using internet retrieval systems up to 5 August 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The quality of eligible studies was assessed using Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2). The diagnostic value of ultrasound in patients with testicular torsion was evaluated using pooled estimates of sensitivity, specificity, likelihood ratio, and diagnostic odds ratio, as well as the summary receiver operating characteristics curve. Twenty-six studies with 2116 patients were included in the study. Overall diagnostic sensitivity was 0.86 [95% confidence interval (CI) 0.79-0.91] and specificity was 0.95 (95% CI: 0.92-0.97). Subgroup analysis of prospective studies showed pooled sensitivity of ultrasound for testicular torsion was 0.94 (95% CI 0.83-0.98), and pooled specificity was 0.98 (95% CI 0.94-1.00). Recent studies after 2010 showed diagnostic sensitivity of 0.95 (95% CI 0.84-0.99) and specificity of 0.98 (95% CI 0.93-0.99). This meta-analysis demonstrated that ultrasound represents an effective imaging modality for diagnosing testicular torsion in adult patients with acute scrotal pain.

A rare complication after inguinal hernia repair: testicular torsion

Testicular torsion is the most common urological emergency characterized by reduced blood flow of the testis, often due to spermatic cord torsion occurring in adolescence. A 68-year-old male patient admitted our hospital emergency service with the complaint of acute scrotal pain for a week. On history, he had undergone right inguinal hernia repair with synthetic mesh one week ago. Due to reduced blood flow of right testicular artery on colored doppler ultrasonography, emergent surgery was performed. On intraoperative examination, 360 degree torsion of spermatic cord from distal to the mesh, thrombosis of right testicular artery and necrosis of testicular tissue was observed. After detorsion of right testis, absence of blood supply to the right testis was observed. According to these findings, right inguinal orchiectomy was performed. It should be kept in mind that persistent pain may be a sign of testicular torsion which may develop early after inguinal hernia repair with synthetic polypropylene mesh. In suspicious of testicular torsion because of persistent scrotal pain after inguinal surgery, scrotal colored doppler ultrasonography must be performed immediately and consulted to the urologist. Succeed results may be provided by multidisciplinary approach and early treatment.

“My testicles hurt!” Scrotal ultrasonography in the evaluation of adult acute scrotal pain.

Introduction Acute scrotal pain in adult is classified as a medical emergency, necessitating accurate assessment. Common causes include inflammation, trauma and testicular torsion[1]. In cases of testicular torsion, the viability of the testis is dependent on the interval between onset of pain and surgical intervention[2]. A 90% salvage rate is possible for patients who are treated within 4-6 hours, while the salvage rate can drop to 45% with delayed interventions[3]. While clinical and physical examination are essential, B-mode and colour Doppler ultrasound are indispensable because of their moderate-high sensitivity (69-90%) and high specificity (98-100%)[4]. Ultrasound is also cost-effective, swift and non-invasive, leading to timely diagnosis and appropriate treatment plan. Colour Doppler imaging with B-mode ultrasound, allows dynamic assessment of the scrotal structure, reveals testicular perfusion status and possible extent of ischemic injury. Ultrasound strain elastography (SE) shows potential in distinguishing between pathologies and improving clinical diagnosis[3]. Learning Objectives This exhibit aims to: 1. Review the role of ultrasound in diagnosing and distinguishing various acute testicular pathologies. 2. Describe and discuss the sonographic appearances of commonly encountered pathologies utilising various ultrasound imaging techniques (Greyscale, colour Doppler and SE). 3. Evaluate the potentials, pitfalls and limitations of these techniques in diagnosing acute scrotal pain. Imaging Findings In this review, we present a spectrum of cases to demonstrate the sonographic findings of various pathologies commonly encountered in adult acute scrotal pain during the course of our daily practice. The pathologies discussed included testicular torsion, rupture, epididymitis, orchitis and epididymo-orchitis. Both testicular and extra-testicular components are assessed with B-mode and colour Doppler. SE was applied in some cases, and further correlation with other available imaging modalities and/or histopathology were also included wherever available. Insights on recognizing and strategies in overcoming the pitfalls are discussed. Conclusion The ability to identify the sonographic appearances of various scrotal pathologies allows for improving the diagnostic confidence and accuracy. This non-invasive examination of the scrotum improves patient outcomes by decreasing morbidity and avoiding unnecessary and risky surgical exploration.

Emergency of acute scrotal trauma ultrasound

Objectives • To understand scrotal anatomy, physiology and pathology. • To become familiar with the ultrasound features of benign and malignant male scrotum conditions, diagnostic pitfalls and optimizing techniques. • To present a spectrum of scrotal pathologic cases. Methods Ultrasound is the first line modality to assess the acute and chronic disease of the scrotum especially in emergency trauma cases. High frequency linear transducers are easily used to obtain high resolution ultrasonography of the scrotum. Results We review the imaging and pathologic features of a spectrum of benign and malignant processes involving the scrotum in trauma cases. The most common clinical scenario is acute scrotal pain and swelling after trauma injury in emergency cases. The scrotal injuries are categorised into extratesticular injuries and intratesticular injuries. The extratesticular injuries includes scrotal wall hematoma, hydrococele, hematocele and epididymal injuries. The intratesicular injuries includes intratesicular hematoma, testicular fracture and testicular rupture. The extratesticular injuries are usually required conservative management and the extratesticular injuries are usually required surgical treatment. The benign palpable lumps such as epididymitis, epididymo-orchitis, epididymal cyst, epidermoid cyst, spermatocele, varicocele are also commonly seen in acute settings as well. Conclusions Ultrasound provides useful clinical information in ascertaining the type of the scrotal injuries, its vascular supply and the relationship with the surrounding structures. It is fast and reliable in evaluating various extratesticular and intratesticular injuries. The knowledge and experience of the operator is crucial in making the accurate diagnosis by overcoming the potential diagnostic pitfalls and optimising techniques. This enables the clinician in planning and optimising the appropriate therapy.

Role of sonography and color doppler in the evaluation of scrotal swellings

Background: Ultrasonography combined with color Doppler is the first modality for investigation of scrotal swellings. It is difficult for a clinician to differentiate a testicular pathology from an extratesticular one with presents as a scrotal swelling based on physical examination alone. Aims and Objectives: Early detection of pathology and establishing a surgical versus nonsurgical treatment for acute scrotal pain is important. Materials and Methods: This study included a total of 107 patients. Various scrotal pathologies were detected with ultrasound and Doppler with clinical correlation and found out that noninflammatory pathologies are more common than inflammatory pathologies. Conclusion: We concluded that high-resolution sonography and color Doppler can be used as a primary imaging modality in the diagnosis of scrotal pathologies.

Predictive value of hematological parameters in testicular torsion: retrospective investigation of data from a high-volume tertiary care center.

ObjectiveTo investigate the use of hematological parameters in the differential diagnosis of testis torsion and epididymo-orchitis, and to determine the predictive value of these parameters in the diagnosis of testis torsion.MethodsThis study retrospectively reviewed the medical data of patients who presented to our institute with the complaint of acute scrotal pain. Eighty-five patients who had undergone orchiectomy or surgical detorsion due to testis torsion and 72 patients with epididymo-orchitis were included in the study. The control group comprised 78 healthy males. The groups were compared with respect to age, hematological parameters, neutrophil to lymphocyte ratio (NLR), monocyte to eosinophil ratio (MER), and platelet to lymphocyte ratio (PLR).ResultsThe monocyte count significantly differed between testis torsion and epididymo-orchitis, and was useful in the differential diagnosis. The mean neutrophil, platelet, and white blood cell counts, and the NLR, MER, and PLR values in the control group were significantly lower than those in the torsion and epididymo-orchitis groups.ConclusionThe sensitivity and specificity of NLR in predicting testis torsion were as high as the sensitivity and specificity of doppler ultrasonography, suggesting the possible use of this parameter in the diagnosis of testis torsion.

Management and particular ultrasonographic finding in childhood acute scrotal swelling and pain associated with Henoch-Schönlein purpura: A case report and review of the literature

Management and particular ultrasonographic finding in childhood acute scrotal swelling and pain associated with Henoch-Schönlein purpura: A case report and review of the literature

Management and particular ultrasonographic finding in childhood acute scrotal swelling and pain associated with Henoch-Schönlein purpura: A case report and review of the literature

Henoch–Schonlein purpura (HSP), also known as immunoglobulin A (IgA) vasculitis, is a systemic vasculitis of unknown cause, mostly affecting children, in which complexes of IgA and components of complement are deposited on arterioles, capillaries, and venules. It is characterized by nonthrombocytopenic palpable purpura, abdominal pain, and arthritis. While renal involvement is well-known and frequent, scrotal involvement is uncommon and, therefore, not easy to be interpreted. Here, we report a case of a 3-year-old boy hospitalized for HSP, presenting with bilateral acute scrotum, and discuss diagnosis and treatment.

Thrombosed varicocele - a rare cause for acute scrotal pain: a case report

BackgroundAcute scrotal pain has various causes. Testicular torsion, torsion of appendages and Epididymo-orchitis are common causes, while varicocele thromboses are a rare cause. Varicocele thromboses can occur post operatively or spontaneously. Five cases of post-operative and five cases of spontaneous thromboses have been described till date. The traditional advice in the management of thrombosed varicocele has been to manage it conservatively in all patients by drugs and scrotal support with little description of the surgical treatment. Herein, we present an unusual sixth case of spontaneous thromboses of varicocele and discuss its presentation and surgical management. We would also like to highlight the differentiating points between spontaneous thrombosis and post operative in vitro clot formation in the varicoceles, as these two entities can often be confused for each other.Case presentationA 68 year-old man presented with excruciating scrotal pain of one week duration. Doppler study of scrotum revealed left varicocele with no evidence of Epididymo-orchitis. He was treated with intravenous antibiotics, analgesics and scrotal elevation. He had no relief and continued to have severe pain. Clinical examination was normal. Patient underwent exploratory surgery on a semi- emergent basis. Exploration revealed normal testis with thrombosed varicoceles. Patient underwent Varicocelectomy. Postoperatively patient had immediate pain relief. Histopathology revealed prominent thrombosed varicocele. A varicocelectomy specimen (done for primary infertility) was used for comparison. The differentiating points between the two entities were noted.ConclusionSpontaneous thrombosis of varicocele is a rare cause of acute scrotal pain. Pain out of proportion to clinical features is characteristic. Patients not responding to medical therapy may need varicocelectomy. Varicocelectomy may give immediate relief. Histopathology is useful in this disorder.

The utility of scrotal ultrasonography in the emergent setting: beyond epididymitis versus torsion

Scrotal pain is a common acute presentation for medical care. Testicular torsion and epididymo-orchitis are two diagnoses for which early detection is critical and their sonographic imaging features have been thoroughly described in the radiologic literature. Other important conditions for which radiologists must be aware have received less attention. This article will highlight key traumatic and non-traumatic causes of acute scrotal pain other than testicular torsion and epididymo-orchitis that may present in the emergency department setting.

Parental awareness of testicular torsion amongst Irish parents.

Testicular torsion is the most concerning underlying cause of acute scrotal pain that can lead to loss of the affected testicle. Whether a torted testicle can be salvaged surgically is directly affected by prompt presentation and diagnosis. This study aims to evaluate the awareness of testicular torsion amongst Irish parents and evaluate their response to a potential torsion. An anonymous questionnaire was distributed to parents attending general paediatric clinics and an acute paediatric unit in two paediatric tertiary referral centres. SPSS statistical analysis software was used to perform multivariant analysis of the data. There were 242 completed surveys. Fifty-six percent of responders had an awareness of torsion. In the event of an episode of severe testicular pain parents who were aware of testicular torsion were 4 times more likely to present immediately than those who had no awareness of torsion (OR 4.2, 95% CI1.4-12.2, P < 0.01), and those who identified correctly the critical timeframe were 3 times more likely to present immediately than those who did not (OR 3.0, 95% CI 0.85-10.8, P = 0.08). Of those parents with boys only 11% had discussed what to do in the event of acute scrotal pain. Education of this topic to the general Irish population and in particular to parents and young males is not established. Both knowledge of testicular torsion and awareness of the urgency in presentation are factors that determine parents promptness in seeking medical attention for their child in the setting of acute scrotal pain.

Management and Outcome of Testicular Torsion

Background : Testicular torsion is a common cause of acute scrotum and is complicated by loss of testes. Local data on testicular torsion is limited. This study therefore aimed at determining the incidence and clinical presentation of patients with testicular torsion in our setup. Methods : This retrospective study reviewed files of 90 patients admitted to our hospital with diagnosis of testicular torsion from January 2011 to December 2015. Results : The mean age of presentation was 19± 6 years. Fifty-nine (66%) of the patients presented with right sided torsion while 5 (6 %) had bilateral torsion. Acute, intermittent and missed types of torsion were seen in 59 (66%), 19 (21%) and 12 (13%) respectively. The duration of symptoms from onset tosurgery was 17± 4 hours. The testis salvage rates for acute and intermittent torsion were 18% and 21% respectively. Conclusion : Testis salvage rates were lower in our setup compared to other studies. This could be due to delays in presentation and in diagnosis. Therefore, a high index of suspicion should always be maintained in all cases of acute scrotal pain. Key words : Testicular, Torsion, Acute scrotum, Intermittent, Missed

Role of ultrasound and color Doppler in the evaluation of acute scrotal pain

Background: Traditionally acute scrotal pain is evaluated by gray scale ultrasound, which dissipated only the morphological changes of the lesion. But pattern of vascularity either normal, increased or absent of affected structure help to definitive diagnosis of the lesion and help to proceed the type of management either medical therapy or surgical treatment.Objectives: To determine the relative importance of color Doppler in the evaluation of acute scrotal pain by ultrasound.Methods: From June 2013 to June 2017 a total 150 patients with acute scrotal pain were selected. A thorough history taking and physical examination were done. Then patient were scanned with gray scale ultrasound followed by color Doppler study. Color Doppler diagnosis is compared with gray scale diagnosis.Results: In gray scale ultrasonography among the 150 cases, 54% were diagnosed as epididymitis, 16.66% were epididymo-orchitis and 16% patient diagnosed as normal. But in combined gray scale and colour Doppler study 58% were diagnosed as epididymitis, 22% were epididymo-orchitis and 6% of patient diagnosed as normal. In gray scale 10% patient were diagnosed as normal but become epididymitis and epididymo-orchitis in colour Doppler. Four percent were diagnosed as epididymitis in gay scale but became epididymo-orchitis in colour Doppler. Four percent patient was diagnosed as epididymitis orchitis but became testicular torsion in Doppler study. Total 14.66% of gray scale diagnosis became another diagnosis in the Doppler study.Conclusion: Combined gray scale and color Doppler study is superior than gray scale ultrasound in differentiating various cause of acute scrotal pain.Bang Med J (Khulna) 2017; 50 : 26-30

Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis

Testicular sonography has contributed greatly to the preoperative diagnosis of testicular torsion in the pediatric patient and is the mainstay for evaluation of acute scrotal pain. Despite its high sensitivity and specificity, both false-negative and false-positive findings occur. Presence of documented Doppler flow within the testis might be a dissuading factor for surgical exploration with resultant testicular loss in the false-negative cases. Our goal is to illustrate key sonographic features in the spectrum of testicular torsion with preserved testicular flow, and to describe how to differentiate testicular torsion from epididymitis in order to avoid the under-diagnosis of testicular torsion. We simplify the anatomy of the bell clapper testis. We also describe our sonographic protocol for testicular torsion and share valuable tips from our approach to challenging cases.

A Rare Cause of Acute Scrotal Pain: Spontaneous Thrombosis of Testicular Vein

A Rare Cause of Acute Scrotal Pain: Spontaneous Thrombosis of Testicular Vein

Acute scrotal pain in childhood: legal pitfalls

Acute scrotal pain in childhood is an emergency.Sudden scrotal pain may be caused by a variety of diseases. Therefore, it is important to carefully consider the specific medical history and possible differential diagnoses in each case for fast and decisive action (e. g. in case of testicular torsion). As minors lack the capacity for consent, it is absolutely necessary to obtain consent from their legal guardian. However, obtaining consent in the available time frame can cause organisational challenges in an acute emergency, which may lead to situations in the daily routine where a therapeutic decision needs to be taken (including surgery) without legal security based on consent by the guardian. In some cases, the child's consent also needs to be taken into account, depending on its age and development.For the physician and surgeon in charge, the legal evaluation of the case at hand and therewith the obtainment of legal security are of great significance.

Incarcerated Inguinal Hernia: A Cause of Testicular Ischemia Without the ‘Twist’

Introduction: Acute scrotal pain is a common complaint encountered in the emergency room. Besides testicular torsion, incarcerated inguinal hernia is another important cause that requires urgent exclusion as it warrants emergency surgery.Case Report: Here we present a case of acute painful scrotal swelling in a young man owing to an incarcerated inguinal hernia that caused testicular ischemia. Ultrasound evaluation revealed the presence of bowel and omentum in the scrotum and normal echotexture of the testis. However, color Doppler revealed the absence of testicular blood flow. The patient underwent emergency surgery. The bowel and testis were salvaged by reducing the hernia.Conclusion: This case report illustrates the occurrence of testicular ischemia owing to compressed vascular supply by an incarcerated inguinal hernia. It also shows that testicular ischemia can occur in the absence of a twisted spermatic cord, thereby underscoring the requirement for evaluating the testis in the setting of an incarcerated inguinal hernia

Ultrasound Diagnosis of Clinically Unsuspected Ureteral Stone Presenting as Acute Scrotum

Ureteral colic is not generally included in the differential diagnoses of acute scrotal pain, although ureteral pathology is a recognized cause of pain referred to the scrotum. We report 3 patients presenting with acute scrotal pain who had normal scrotal color Doppler ultrasound scans; subsequent ultrasound of the ipsilateral kidney revealed hydronephrosis, which ultimately led to the clinically unsuspected diagnosis of ureteral colic. We conclude that ureteral colic should be included in the differential diagnosis of acute scrotal pain, and we further suggest that a survey ultrasound of the kidney on the side of the pain should be performed in patients presenting with acute scrotal pain and a normal color Doppler ultrasound examination of the scrotum.

Testicular torsion: A case report

Abstract Background The acute scrotum is an emergency. Testicular torsion represents approximately 25% of the causes. The annual incidence of testicular torsion is approximately 1/4000 persons under 25 years, with highest prevalence between 12 and 18 years old. It usually occurs without apparent cause, but it has been associated with anatomical, traumatic, and environmental factors, among others. Clinical case A male 15 year-old male, with no history of importance, was seen in the Emergency Department, presenting with a sudden and continuous pain in the left testicle. It was accompanied by a pain that radiated to the abdomen and left inguinal area, with nausea and vomiting of more than 12 h onset. Doppler ultrasound showed changes suggestive of testicular torsion. Surgery was performed that showed findings of a necrotic left testicle with rotation of the spermatic cord of 360°. A left orchiectomy was performed. Conclusions Testicular torsion should always be considered one of the leading causes of acute scrotal pain. Delays in diagnosis should be avoided as this is directly related to the percentage of testicular salvage or loss.

Thrombotic and Nonthrombotic Types of Intratesticular Varicoceles: Value of Sonography for the Diagnosis.

An intratesticular varicocele is an uncommon entity, and its clinical importance remains unclear. The diagnosis can be made in the case of an intratesticular tortuous vein that shows retrograde flow on color Doppler sonography. The anatomic location and course of the intratesticular varicocele within the testicular parenchyma and its association with the existence of an ipsilateral extratesticular varicocele may vary among patients. The pathophysiologic mechanisms remain unclear; however, it may be questioned whether there is an association between testicular atrophy and intratesticular varicocele development. Although the diagnosis is usually made incidentally, patients may rarely present with acute scrotal pain due to acute thrombosis of an intratesticular varicocele.