Emergency Scrotal Exploration Research Articles

A national survey of practice for the emergency fixation of testis.

Scrotal exploration for suspected testicular torsion is a common emergency procedure in the United Kingdom (UK). There is no universally agreed practice for how the testis should be fixed, or whether a nontorted testis should receive fixation. This survey aims to describe the methods used for emergency scrotal exploration and testicular fixation in the UK. An online survey was distributed to urologists, general surgeons and specialist paediatric surgeons in approved NHS trusts, and via the email lists of collaborating organisations. The survey questioned surgeons on their operative management of a variety of common diagnoses encountered during scrotal exploration using multiple choice and free-text answers. A total of 340 responses were received from 83 institutions. Respondents included urologists (consultants, 33%; trainees, 24%), paediatric surgeons (consultants, 12%; trainees, 16%) and general surgeons. In cases of torsion, respondents predominantly perform sutured fixation (74%); however, sutureless dartos pouch fixation was used frequently (37%) by paediatric surgeons. The finding of 'bell-clapper' anatomy without torsion prompts 69% of respondents to undertake sutured fixation, but alternative nontorsion diagnoses frequently prompt use of sutureless methods (53-66%). This study is the largest survey of methods for emergency scrotal exploration and describes current UK practice. The majority of surgeons prefer sutured fixation in cases of torsion and/or bell-clapper anomalies, and sutureless methods in the absence of it.

Outcomes of Surgical Exploration of Acute Scrotal Pain Raising Suspicion of Testicular Torsion.

Background and objective Testicular torsion (TT) is a surgical emergency, affecting approximately one in every 4000 males under the age of 25 years annually in the United States. In this study, we aimed to determine the outcomes of emergency scrotal surgical exploration of cases that raised suspicion of TT presenting to Salmaniya Medical Complex (SMC), Bahrain's largest secondary and tertiary care center. Methods This was a retrospective cohort study. The data were collected from the hospital's electronic medical record software (I-SEHA). The data included patientage, Doppler ultrasound (DUS) findings prior to any surgical procedure, type of surgical procedure, and the surgical findings of that procedure. Results Of the 198 patients who underwent scrotal exploration, 141 had presented with signs and symptoms suggestive of TT. The mean age of the patients was 22.3 ±9.3years. Doppler imaging was performed preoperatively on 135 out of 141 (95.7%) patients. After scrotal exploration, 91.4% of the patients were found to have TT. The proportion of patients with salvageable testiswas 78.7%. Conclusions The study found that surgical exploration remains the definitive method in the management of acute scrotum in TT patients. Our findings are in line with those from other similar studies and meta-analyses.

Emergency scrotal exploration in children: Following a change in mindset in the UK

A survey of 200 emergency scrotal explorations done over four paediatric surgical centres in the UK revealed that the incidence of finding testicular torsion (TT) was 24% and the preoperative utilisation of Doppler ultrasound (DUS) was 10% [1]. We changed our practice to include better preoperative utilisation of a clinical risk score (TWIST) and DUS. This led to a significant increase in the incidence of finding TT from 18% to 53%. Obtaining a DUS did not lead to an increase in our orchidectomy rate. Adopting this change is possible in an NHS setting and it has significant clinical and economic benefits.

Does decentralisation of surgical management improve outcomes for paediatric testicular torsion?

In testicular torsion (TT), delayed emergency scrotal exploration (ESE) increases the risk of orchidectomy. Transfer of a patient with suspected TT from a district general hospital (DGH) to a paediatric surgical centre (PSC) delays ESE and potentially puts them at increased risk of testicular loss. Prior to 1st January 2017, all boys under aged <16 years presenting to a DGH within the East Midlands Clinical Network (EMCN) would be referred to the PSC. From this date, it was agreed within the EMCN that boys aged ≥5 years with suspected TT presenting to a network DGH would be managed locally, barring exceptional circumstances. Boys aged <5 years would be referred to the PSC for management. This study aimed to assess the impact of decentralisation of ESE for suspected TT on orchidectomy rates in the EMCN. All patients who underwent ESE under the care of paediatric surgery in the PSC, and all patients <16 years old who underwent ESE in 4 EMCN DGHs between January 2017 and December 2019 were identified. Neonatal cases and inpatient referrals were excluded. Comparison was made with published data on ESE performed in the PSC over the 9 years 2008-2016 prior to decentralisation. In the 9 years prior to decentralisation, there were 110 cases of TT in the PSC. In the subsequent 3 years, there were 40 in the PSC and 37 in the DGHs. The orchidectomy rate of boys with TT presenting to DGHs and undergoing exploration locally (16%, 6/37) contrasts with the rate in those transferred from DGHs to the PSC for exploration (58%, 15/26). The difference is highly significant (p=0.00059, RR 0.28 [95% CI 0.13-0.63]) and indicates that in the EMCN, avoiding hospital transfer and performing ESE at the presenting DGH reduces the risk of orchidectomy by 72%. Decentralisation of the provision of ESE in boys with TT has resulted in a significantly lower orchidectomy rate in boys undergoing ESE in the presenting hospital than when transferred to the PSC. This study reinforces existing literature that demonstrates the effect of delayed ESE on orchidectomy rate, and supports the recommendations of national guidelines in the UK that transfer of boys to a PSC for ESE should only occur in exceptional circumstances.

Urological emergencies in a regional hospital in Senegal: a 20-month retrospective study

urological emergencies are diverse and varied, and are frequently encountered in urological practices. The purpose of this work was to study the epidemiological features and management of urological emergencies at the regional hospital of Kolda, Senegal. we conducted a retrospective and descriptive study collecting data from the medical records of all patients admitted as a urological emergency for 20 months (January 2020 and August 31, 2021). urological emergencies accounted for 3.6% of admissions to the Emergency Department and for 20.4% of urological consultations. The average age of patients was 51.9 ± 21.5 years, ranging from 1 to 98 years. Urinary retention was the most common urological emergency, observed in 249 cases (57.3%), followed by urogenital infections 89 (20.5%). Renal colic affected 48 (11%) of patients. Emergency management was based on urinary catheterization, which was performed in 193 patients (44.3%). The most common surgical procedures were suprapubic catheterization (42 patients; 51.9%) and emergency scrotal exploration (15 patients; 18.6%). in our context, urological emergencies are dominated by urinary retention due to prostatic disorders and urethral stenosis. Traumatic emergencies are uncommon.

Outcomes following emergency fixation of torted and non-torted testes

Scrotal exploration is a frequently performed emergency procedure in children. It is a subject of debate as to whether and how a non-torted testis should be fixed, with a wide variation in practice across the UK. This study aims to ascertain whether the method of testicular fixation (if any) impacts on patient outcomes. A review of all emergency scrotal explorations performed in children under the age of 18 between 2008 and 2018 in a tertiary Paediatric Surgery unit was undertaken. Patients were categorised by initial fixation method, chi squared analysis was used to compare complication and reoperation rates. 522 boys were taken to theatre, 424 had a unilateral procedure and 98 had bilateral; after 35 orchidectomies, 585 testes were left in situ. The most frequent diagnosis at operation was torted testicular appendage (n=278, 53%), followed by testicular torsion (n=79, 15%). The number of testes by category of fixation were: 72 no documented fixation, 130 dartos pouch only, 34 absorbable sutures, 346 non-absorbable sutures and 3 unspecified sutures. There was no difference in the reattendance rate between groups after outliers were removed (p=0.72). Thirty-seven patients experienced complications, most commonly ongoing pain. Nine patients required an ipsilateral reoperation, 25 underwent a contralateral operation at a later date. The complication rate appeared to be higher in the no fixation group compared to the dartos (p=0.02) and sutured groups (p=0.048). Testes in the no fixation group had a higher reoperation rate compared to the sutured group (p=0.002). The present study is a detailed analysis of a wide variety of emergency testicular fixation methods in a large cohort, including the routine fixation of non-torted testes. Whilst there appears to be a benefit to using sutured or dartos fixation, this merits cautious interpretation. It is likely that influences on complications and reoperations are multifactorial and cannot be attributed solely to the method of testicular fixation. Adoption of a standardised approach to emergency fixation of testes within or across institutions may be a potential avenue for future studies.

P40 Cross-specialty collaboration in the development of a national survey of practice for emergency scrotal exploration

IntroductionEmergency scrotal exploration for suspected testicular torsion is a common procedure, performed by Paediatric surgeons, Urologists and General Surgeons. It is expected that there is variation in practice in the way that testes are fixed after torsion and other pathologies, both within departments and across specialties. We aim to survey UK practice, and describe the impact of patient age, surgical specialty and grade of surgeon for this procedure.MethodsThe Paediatric Surgery Trainee Research Network (PSTRN) and the British Urology Researchers in Surgical Training (BURST) groups are developing an electronic national survey of practice. This will be distributed to every UK hospital; Paediatric, General and Urology Surgeons of Consultant and Middle Grade will be asked to participate if they offer this procedure as part of their current practice.ResultsAfter a discussion of some initial survey drafts, the PSTRN-BURST collaboration met over teleconference. The scope of the questions were broadened from looking only at fixation methods to include the initial surgical approach, methods of skin closure and a comparison between paediatric and adult practice and how the procedure changes based on the stage of puberty. The questions were refined and made more granular, and to facilitate this, the platform was changed from Google forms®, to REDCap® and finally, to Microsoft Forms®.ConclusionsAs a result of inter-specialty collaborative working, the quality of the survey questions has greatly improved. The survey is now structured in a manner that will yield the most scientifically valid conclusions and aims to benefit all clinicians that undertake emergency scrotal exploration.

An isolated torsion of epididymis in a 17-year-old boy: A rare cause of acute scrotum

Acute scrotum is a common clinical problem in children and torsion event superimposed on complete dissociation of the testicle and epididymis can be difficult to diagnose and often requires scrotal exploration. To the best of our knowledge, four cases of isolated torsion of the epididymis have been reported in the literature. We report a 17-year-old male patient with epididymal torsion who presented with testicular pain and hemi-scrotum swelling. Due to painful symptoms, emergency scrotal surgery exploration of the patient revealed a complete epididymis infarction due to isolated epididymal torsion with dissociation of the testis and epididymis.

Emergency scrotal exploration in children: Is it time for a change in mindset in the UK?

Acute scrotal pain is a common problem in children. Amongst the various causes, only testicular torsion (TT) needs urgent, and arguably any, surgical intervention. However TT accounts for only approximately 25% of cases. The diagnosis of TT is currently based mainly on history and clinical examination in the UK. We sought to find the incidence of finding TT during emergency scrotal exploration in four paediatric surgical centres in the UK. We also assessed the preoperative utilisation of clinical risk scores and Doppler ultrasound (DUS) to aid in the diagnosis. A retrospective review of 50 consecutive scrotal explorations done for acute scrotal pain at four tertiary pediatric surgical centres in 2019, including the preoperative utilisation of DUS, was analysed. Additionally an online survey was also sent out to consultant members of the British Association of Paediatric Urology to gauge their threshold for exploration, use of preoperative investigations and incidence of finding TT in their practice. In the four UK centres reviewed, TT was found in 24.5% (SD=8.54) of explorations. The overall utilisation of preoperative DUS was 10%. The online survey revealed a low threshold for exploration. However 72% of respondents recalled finding TT in <50% of explorations, with just over a third reporting finding TT in only 10% of explorations. There was low utilisation of preoperative DUS and clinical risk scores. The incidence of finding TT during exploration in this cohort is the same as the incidence of TT in a population of children presenting with acute scrotal pain. We hypothesise that this is due to low accuracy of clinical assessment, low utilisation of preoperative clinical and radiological aids and the practice of exploring torted testicular appendages. Improving awareness and training in these modalities will increase diagnostic accuracy, limiting emergency scrotal explorations to those children with a higher risk of testicular torsion. A care pathway for children presenting with acute scrotal pain is suggested () CONCLUSIONS: There is a low incidence of finding testicular torsion during paediatric scrotal explorations in the UK. There is low preoperative utilisation of clinical risk scores and Doppler ultrasound, which if utilised, could improve diagnostic accuracy.

A case of acute scrotum with an extremely rare etiology - extravaginal testicular torsion in adult male

Extravaginal torsion (EVT) of the testis occurs almost exclusively in neonates, being the most common mechanism of torsion in the fetus and newborn. In this condition, the spermatic cord is twisted outside the sack of tunica vaginalis in the scrotum. Unlike the intravaginal torsion reported in older children and adults, this entity is considered to have a different surgical anatomy. The incidence of intravaginal testicular torsion in patients under 25 years of age is estimated at around 1 per 4000, however, extravaginal testicular torsion in adults is an extremely rare entity. We present the case of a healthy 22-year-old patient who was admitted to the emergency room with right hemi-scrotal pain, tenderness, and swelling with acute onset of 8 hours. His initial evaluation included color doppler ultrasound that revealed a twisted right cord with no intratesticular vascular flow. The patient underwent emergency scrotal exploration revealing a 360° counterclockwise extravaginal torsion of the right testis. Testicle regained normal aspect after detorsion, and 3 point orchidopexy was performed. Recovery was uneventful and color doppler ultrasound revealed normal vascular flow 15 days after surgery.

Timing and outcomes of testicular torsion during the COVID-19 crisis

BackgroundDuring the COVID-19 crisis, there has been widespread reporting that non-COVID-19-related medical care has been delayed, even for emergent conditions. Testicular torsion is an emergent condition with higher risk of testicular loss with longer ischemic times. We sought to investigate whether patients with testicular torsion had longer time from symptom onset to initial presentation, longer total ischemic time, and higher rate of orchiectomy during the pandemic.Materials and methodsUsing billing data, we identified all patients age >1yo seen in our hospital from 1/1/2018 through 5/31/2020 who underwent emergent scrotal exploration for confirmed testicular torsion, comparing the COVID-19 crisis (3/1/2020–5/31/20) to the pre-COVID-19 period (1/1/2018–2/29/20). The primary outcome was time from symptom onset to initial presentation and secondary outcomes were ischemic time (time from symptom onset to entry of the OR) and orchiectomy rate. Parameters were compared with Mann–Whitney U and Fisher's exact tests; Poisson regression compared rates of torsion.ResultsOf 94 total cases, 77 occurred during the pre-COVID-19 period and 17 during the COVID-19 crisis. Median time from symptom onset to initial presentation was not significantly different (2.4 h [IQR 1.1 h–38.9] during COVID-19 vs. 5.6 h [IQR 1.6–16.9] during pre-COVID-19 period, p = 0.476). Time to presentation was >12 h in 5/17 patients (29%) during COVID-19 and 24/77 patients (31%) during pre-COVID-19 period (p = 1.00). Median ischemic time during COVID-19 was 7.5 h (IQR 4.7 h–45.5 h) compared to 9.4 h (IQR 5.4 h–22.5 h) during pre-COVID-19 period (p = 0.694). Incidence of orchiectomy in our center was 29% (5/17) during COVID-19 and 17% (13/77) during pre-COVID-19 period (p = 0.397). About half of patients were seen initially at outside facilities prior to arrival (47% [8/17] during COVID-19 vs. 49% [38/77] during pre-COVID-19 period, p = 1.00). The number of torsion case presentations per week to our facility increased from 0.7 cases/week in the pre-COVID-19 period to 1.3 cases/week during COVID-19 (p = 0.015); when comparing only the March 1 to May 31 calendar period, there were 0.6 cases/week during the pre-COVID-19 period and 1.3 cases/week during COVID-19 (p = 0.021).ConclusionTime to presentation, ischemic times, and orchiectomy rates for testicular torsion at our center were not significantly different during the COVID-19 period compared to the preceding 2 year period. The number of torsion case per week presenting to our facility increased significantly.Summary Table 1Comparison of patients, timing, and testicular outcomes among patients with testicular torsion before and during COVID-19 crisis.Summary Table 1OverallPre-COVIDCOVIDp-valuen947717Age, years (median [IQR]{range})14.38 [12.70, 15.87] {1.3–19.7}14.22 [12.64, 15.83]{1.3–19.7}15.24 [14.21, 16.01]{4.2–17.4}0.2950Time from symptom onset to presentation, hours (median [IQR]{range})5.38 [1.49, 18.38]{0.7, 148.0}5.58 [1.60, 16.85]{0.7, 81.3}2.40 [1.12, 38.92]{0.9, 148.0}0.4760Time from symptom onset to presentation > 6 h, n (%)43 (45.7)35 (45.5)8 (47.1)1.0000Time from symptom onset to presentation > 12 h, n (%)29 (30.9)24 (31.2)5 (29.4)1.0000Ischemic time, hours (Time from symptom onset to OR) (median [IQR]{range})9.19 [5.32, 26.02]{2.7, 152.2}9.40 [5.42, 22.52]{2.7, 86.3}7.52 [4.67, 45.45]{2.7, 152.2}0.6940Orchiectomy, n (%)18 (19.1)13 (16.9)5 (29.4)0.3970Presentation at OSH, n (%)46 (48.9)38 (49.4)8 (47.1)1.0000

The management of testicular torsion in the UK: How can we do better? A national quantitative and qualitative analysis of the factors affecting successful testicular salvage

Testicular torsion is a surgical emergency, requiring time-critical surgery to avoid potential organ loss. This study collates national data on paediatric testicular torsion, offering a comprehensive insight into the current standard of care in England for paediatric patients with suspected testicular torsion. National data collection using Freedom of Information requests. Of 134 acute secondary care NHS trusts in England that treat paediatric patients, responses were received from 121 trusts - representing 140 hospitals - providing a picture of the current standard of care in England. Less than two thirds of hospitals have a paediatric A&E department. One third of hospitals use inter-hospital transfer for paediatric patients with suspected torsion, with variable age restrictions. Mean transfer distance was 19·4 miles (range 2·2 to 61·6 miles). No statistically significant relationship between transfer arrangements and the number of non-viable testicle incidents was found (P=0·15, ns). There was no correlation demonstrated nationally between size of population served and number of scrotal explorations completed (Pearson's r=0·20 (CI -0·0·8-0·46), p=0·16, ns). Qualitative thematic content analysis of serious incident reports identified common themes leading to missed diagnosis and delayed time to theatre: Education and Training, Communication, Transfer Complications, On-site Resources and Cross-site Working. We found variability in resource provision across England, as well as the number of explorations, and the number of unviable testicles found at exploration nationally. We received variable and incomplete data on emergency scrotal explorations and subsequent orchidectomies, very low levels of local audit and limited disclosure of incident reports. A mandatory national audit would allow more comprehensive data collection to accurately identify trends and make informed recommendations. To improve outcomes, we recommend continued education of ED and surgical teams, with mandatory testicular examination for young males presenting with abdominal pain. Whilst streamlining inpatient services is important, the time lost between symptom onset and seeking medical attention is crucial, and raising awareness in the community for young boys and parents may be imperative to improve rates of testicular salvage.

Acute Scrotum Secondary to Torsion of a Tunica Vaginalis Cyst

This is a case of an 8-year-old boy with a chief complaint of left-lower-quadrate abdominal pain for 3 days. Examination revealed swollen left hemi-scrotum and scrotal ultrasound showed a para-testicular cystic mass, which was later proven to be a torsion of a benign scrotal tunica cyst during emergent scrotal exploration. Torsion of the tunica vaginalis cyst is a rare cause of acute scrotum, and we present this case to share our experience of diagnosis and management of this peculiar disease.

Assessment of Age and Duration of Symptoms on Outcomes of Emergency Scrotal Exploration for Acute Scrotal Pain.

To study the effects of age and duration of symptoms on the outcomes of scrotal explorations for acute scrotal pain at our institution. Case series. Bradford Teaching Hospital NHS Trust, from January 2006 to December 2017. Retrospective data was collected from electronic case records of the patients who required scrotal exploration for suspected torsion of the testis. Group difference between continuous variables (age and duration of symptoms) were assessed by Kruskal Wallis and independent samples Mann-Whitney U-tests. The Fisher Exact and Chisquare tests were used to analyse relationships between categorical data. In total, 502 patients required scrotal exploration. The median age (years) and duration of symptoms (hours) were 16.4 years (1.3 - 77) and 4 hours (1 - 336), respectively. Torsion of the testis was found in 231 (46%), torsion of the testicular appendix in 126 (25%), epididymal inflammation in 46 (9.2%), and no cause identified in 99 (19.7%). Immediate orchidectomy for non-viable testis performed in 34 (14.7% of TT group and 6.8% of the overall cohort). Duration of symptoms was significantly associated with risk of orchidectomy in torsion patients 4 vs. 27 hours (p <0.0001). Overall 47 (9.3%) patients presented after 12 hours, 22 (46.8%) had TT. There were 13 (2.6%) patients older than 40 years and 8 (61.5%) of these had torsion. The most commonest diagnosis for patients presenting with acute scrotal pain was torsion of the testis followed by torsion of appendix testis. Testicular salvage was inversely related to the duration of symptoms. Patient's age did not predict the need for orchidectomy. This data supports the practice of urgent scrotal exploration for acute scrotal pain with a clinical suspicion of torsion regardless of age and duration of symptoms.

Does the source of referral affect the outcomes of testicular torsion?

Introduction: This single-center study retrospectively analyzed the intra-operative findings relative to the source of referral of patients with testicular torsion by the urologist in a tertiary teaching hospital. Methods: All patients who underwent emergency scrotal exploration under the care of the urologist in the Urology Division, Department of Surgery, and University of Abuja Teaching Hospital between January 2014 and January 2019 were identified. Clinical data were obtained from hospital records. Results: Over the five years of study, 33 patients had scrotal exploration for testicular torsion. The mean age was 25-years, and the mean duration of the presentation was 50.38 h (1–240 h). None of the patients who presented after 24 h had a viable testis, and there was a strong negative correlation between duration of presentation and intra-operative findings (r = −0.889, P

Does the source of referral affect outcomes for paediatric testicular torsion?

This single centre study retrospectively analysed the intraoperative findings relative to source of referral for emergency scrotal explorations performed in a tertiary level paediatric surgery department. All patients who underwent emergency scrotal exploration under the care of paediatric surgeons in our unit between April 2008 and April 2016 were identified. Clinical data were obtained from contemporaneous records. Over the 8-year study period, 662 boys underwent emergency scrotal exploration: 6 (1%) were internal referrals, 294 (44%) attended our emergency department (ED) directly, 271 (41%) were referred from primary care and 91 (14%) were transferred from other hospitals. Excluding procedures in neonates, testicular torsion was present in 100 cases (15%). Testicular detorsion with bilateral 3-point testicular fixation was performed in 66 (66%) and orchidectomy with contralateral fixation in 34 (34%) where the torted testis was non-viable intraoperatively. The orchidectomy rate in the presence of torsion was 23% in ED referrals (12/52), 43% in primary care referrals (12/28) and 50% for transfers (10/20). The difference in rates between ED referrals and patients transferred from other hospitals was significant (p=0.026). There was no significant difference in median age between any of the groups (p=0.10). Boys undergoing emergency scrotal exploration had a higher orchidectomy rate when transferred from other hospitals to our unit. This difference was statistically significant when compared with boys presenting directly to our ED. This supports advice from The Royal College of Surgeons of England for undertaking paediatric scrotal explorations in the presenting hospital when safe to do so rather than delaying the care of these patients by transferring them to a tertiary paediatric surgical unit.

Direction of Rotation in Testicular Torsion and Identification of Predictors of Testicular Salvage

To identify the rate at which testicular torsion occurs in a lateral direction and identify any predictors of direction of testicular rotation and orchiectomy. We performed a retrospective review of 104 cases of emergent scrotal exploration performed for testicular torsion by 3 pediatric urologists from 2003 to 2017. Patients with neonatal torsion, negative scrotal exploration, or exploration for presumed intermittent testicular torsion were excluded. Univariable logistic regression was performed to assess if any factors predicted direction of testicular rotation. Univariable and multivariable logistic regression was used to identify predictors of testicular salvage. Of 104 cases of acute testicular torsion, information regarding the direction of testicular rotation was available in 81 patients. Lateral testicular rotation occurred in 38 cases (46%). No factors were found to be predictive of direction of torsion. Orchiectomy for testicular nonviability was performed in 50 of 104 cases (48%). On univariable analysis, younger age (p = .002), absence of gastrointestinal symptoms (P = .02), time to exploration (P < .001), testicular size differential on ultrasound (p = .002), absence of hydrocele (P = .01), abnormal ultrasound echotexture (P < .001), and degree of torsion (P = .04) were associated with orchiectomy. With the exception of absence of gastrointestinal symptoms, all predictors of orchiectomy remained statistically significant on multivariable analysis. Testicular rotation occurs in a lateral direction in 46% of cases. Lateral manual detorsion should be performed only with awareness of the potential for increasing the degree of testicular rotation. New independent predictors of testicular salvage were identified.

Save The Testicle; A Retrospective Cohort Study of Emergency Scrotal Exploration in a Single Centre

Save The Testicle; A Retrospective Cohort Study of Emergency Scrotal Exploration in a Single Centre

Manual Detorsion of Testicular Torsion - A Primary Care Intervention Procedure. Case Reports.

Testicular torsion is one of the known acute urological emergencies that require prompt intervention. Salvage of the testis is only possible if derotation is performed within 6 hours of onset of symptoms. The objective of this paper is to report successful manual detorsion of the testes of patients with testicular torsion. Three cases with testicular torsion requiring emergency scrotal exploration underwent manual detorsion after sedation while waiting to be taken to theatre. Case 1, a 15 year old male diagnosed with right sided testicular torsion. Case 2, a 28 year old male with right testicular torsion. Case 3, a 15 year old male who presented with a 6 hour history of left testicular torsion. Attempting manual detortion in patients with acute testicular torsion can salvage the testis against loss. Key Words : testicular torsion, manual detorsion, testicular survival, orchidopexy.

Explorative surgery for acute scrotal pain: The importance of patient age, side affected, time to surgery and surgeon.

Testicular torsion must be diagnosed quickly and accurately. The delay of the diagnosis and the subsequent delay of surgery may lead to loss testicular viability and orchidectomy. Aim of our retrospective evaluation was to define which element should be considered as major support to the clinician in distinguishing spermatic cord torsion from the other diseases mimicking this clinical emergency requiring surgical exploration. We retrospectively reviewed all clinical and instrumental data of emergency scrotal exploration performed for acute scrotal pain at two different Urological Department in a 10 year period. Results of surgical exploration represented the four diagnostic categories in which patients were divided for statistical evaluation. We evaluated the relationship between diagnosis performed by testicular surgical exploration and the all clinical data available including surgeon involved in the procedures. A total of 220 explorative scrotal surgery were considered. We divided the cases in 4 categories according to the diagnostic results of each surgical procedure. Of all, spermatic cord torsion was diagnosed in 45% (99/220). The total testis salvage rate was of 78.8%. The patients with a diagnosis of spermatic cord torsion were older than patients with appendix torsion (15 vs 11 years in mean). When the affected side was the left, the probability to have a diagnosis of spermatic cord torsion was higher than the right side [χ2 (2, N = 218) = 11.77, p &lt; 0.01]. Time elapsing between onset of symptoms and testicular salvagewas significantly lower even than in case of appendix torsion/necrosis (p &lt; .0001), and of others pathologies diagnosed (p = .0383). In case of spermatic cord torsion, in addition to the clinical data, patient age and left side affected may represent an independent diagnostic predicting factor. The time elapsing between onset of symptoms and explorative surgery remain the only still prognostic factor for testicular viability.