Scrotal Complaints Research Articles

Patient Query in Adolescent Testicular Torsion Cases: "Was it Necessary to Mention My Scrotal Pain?"

Objective This study investigates the reasons for the failure to diagnose testicular torsion (TT) in different healthcare facilities (HCFs) and by various physicians. Method We retrospectively analyzed all male patients who underwent TT surgery within the adolescent age group between 2015 and 2023. Healthy adolescent patients who initially presented or were referred to an HCF and were subsequently diagnosed at our hospital for TT surgery were analyzed, focusing on why they were not diagnosed earlier. Results A total of 11 patients aged 10 to 17 who were surgically confirmed to have TT at our hospital between 2015 and 2023 were analyzed retrospectively. These patients had been admitted to various public and private HCFs due to the sudden onset of symptoms such as abdominal pain, vomiting, fainting, sweating, and walking difficulties during and after working hours. Four patients had previously been admitted to one HCF, while seven had been admitted two to six times to an HCF. All patients were healthy, and all but one had received age-appropriate education. However, only two of them had reported experiencing scrotal pain. Laboratory tests and/or radiological examinations were conducted on eight patients, and nine patients received medical treatment and/or prescriptions. None of the patients were initially diagnosed with acute scrotum. Conclusion Despite having unrestricted and free access to well-equipped HCFs, the early diagnosis and treatment of TT are not ensured. Factors contributing to this delay include patients' concealment of, or failure to fully disclose, scrotal complaints, as well as physicians' incomplete history taking and genital examinations. The physician's male gender was not found to contribute to an earlier diagnosis of TT. A mandatory genital examination should be included in the emergency assessment protocol for male patients.

Robot-assisted laparoscopic varicocelectomy in a pediatric population

PurposeTo present our experience with robot-assisted laparoscopic varicocelectomy in a pediatric population.MethodsWe reviewed 49 consecutive cases performed by the same experienced surgeon. One-to-four veins were ligated at the internal ring of the inguinal canal, while the testicular artery and lymphatics were spared. Information on patient characteristics, surgical time, complications, and recurrences were collected.ResultsMedian patient age was 14 (range 10–17) years. Forty-eight had left-sided varicoceles and one had a bilateral varicocele. Forty-five were grade 3. All patients were referred due to discomfort/pain and 20 also had reduced testicular size. The median operating time from skin incision was 48 min (31–89 min) and the median console time was 18 min (7–55 min). Forty-seven patients were discharged the same day. Two patients experienced pain and problems urinating, respectively. These issues had resolved by the first post-operative day. There were no other complications, but at 6 months, eight recurrences were noted (16%). Scrotal complaints had subsided in all patients. Catch-up growth of the affected testicles was seen in 19/20 cases.ConclusionRobot-assisted laparoscopic varicocelectomy is feasible and safe in a pediatric population but with a relatively high recurrence rate.

Radiological patterns of incidental epididymitis in mild-to-moderate COVID-19 patients revealed by colour Doppler ultrasound.

The testis is a potential target organ for SARS‐CoV‐2 infection. Our study intended to investigate any testicular involvement in mild‐to‐moderate COVID‐19 men. We conduct a cross‐sectional study in 18 to 55‐year‐old men hospitalised for confirmed COVID‐19. A senior radiologist executed the ultrasound with multi‐frequency linear probe in all participants, regardless of any scrotal complaints. Exclusion criteria involved any situation that could impair testicular function. Statistical analysis compared independent groups, classified by any pathological change. Categorical and numerical outcome hypotheses were tested by Fisher's Exact and Mann–Whitney tests, using the Excel for Mac, version 16.29 (p < .05). The sample size was 26 men (mean 33.7 ± 6.2 years; range: 21–42 years), all without scrotal complaints. No orchitis was seen. Eleven men (32.6 ± 5.8 years) had epididymitis (42.3%), bilateral in 19.2%. More than half of men with epididymitis displayed epididymal head augmentation > 1.2 cm (p = .002). Two distinct epididymitis’ patterns were reported: (a) disseminated micro‐abscesses (n = 6) and (b) inhomogeneous echogenicity with reactional hydrocele (n = 5). Both patterns revealed increased epididymal head, augmented Doppler flow and scrotal skin thickening. The use of colour Doppler ultrasound in mild‐to‐moderate COVID‐19 men, even in the absence of testicular complaints, might be useful to diagnose epididymitis that could elicit fertility complications.

Direk ve indirek inflamatuar belirteçler Brusella epididimo-orşiti non-Brusella epididimo-orşitten ayırabilir mi?

Giriş: Çalışmamızda inflamasyonu gösteren direk ve indirek belirteçlerin Brusella epididimo-orşit (BEO) tanısında ve Brusella dışı epididimo-orşit (NBEO) ayırıcı tanısındaki değerinin araştırılması amaçlanmıştır.

Pediatric Scrotal Pathology

The purpose of this article is to review the approach to pediatric patients with scrotal pathology and the associated causes including inguinal hernia, cryptorchidism, hydrocele, varicocele, testicular torsion, trauma, and tumors. The reader will understand the diagnostic and treatment options and need for urgent surgical referral. Research has demonstrated the safety and efficacy of laparoscopic hernia repair in pediatric patients. Studies have failed to clarify the optimal timing of neonatal hernia repair and indications for bilateral exploration. Current clinical practice guidelines for cryptorchidism recommend surgical referral by 6 months of age and discourage the use of ultrasound. Most scrotal complaints are managed with low morbidity and preservation of fertility. Scrotal complaints of pain, swelling, bulging, and masses are common in pediatric patients. Management should be done in conjunction with a pediatric surgeon or urologist. Research is required to facilitate practice guidelines for scrotal pathology and address the practice variation that still exists.

How should we monitor boys with testicular microlithiasis?

ABSTRACTTesticular microlithiasis (TM), a rare condition characterized by calcification within the seminiferous tubules, is associated with benign and malignant disorders of the testis. We review current practices of following up pediatric patients diagnosed TM incidentally on scrotal ultrasonography (US). We analyzed retrospectively patient characteristics, family history, indications for US, pathological features, US findings, outcome, and follow-up. At our institution, 2875 scrotal US examinations were performed on 2477 children with various scrotal complaints from 2008 to 2015. Testicular microlithiasis was detected in 81 patients (i.e., an incidence of 3.27%). Every 6 months, each patient underwent a clinical and ultrasonographic evaluation as well as serum tumor markers determination to detect a potential malignancy. Seventy-eight patients who had undergone scrotal US at least twice were included in this study. We evaluated the US studies for the type of TM (diffuse and focal) and change in follow-up studies. Testicular microlithiasis was typically diffuse (n = 56, 71.8%) and bilateral (n = 45, 57.7%), and it was detected the most frequently in the 9–11-year age group (27 patients, 34.6%). The most common comorbid conditions included undescended testes (31 patients, 39.7%) and hydrocele (11 patients, 14.1%). We found that serum tumor markers were within normal limits both at diagnosis and upon follow-up. No testicular tumors or new abnormal symptoms developed during the clinical follow-up. There is no convincing evidence that TM alone is premalignant in a pediatric population. In terms of follow-up, we advise regular self-examinations and annual US in the absence of risk factors.

Evaluating scrotal masses.

Scrotal complaints can be challenging to diagnose because of overlapping signs and symptoms among various presentations. Failure to properly identify and manage testicular malfunctions such as testicular torsion, testicular cancer, varicocele, and hydrocele may lead to patient infertility, testicle loss, or death. This article describes proper assessment of scrotal masses, recognition of potentially life-threatening testicular conditions, and appropriate diagnostic evaluations for each pathology.

Scrotal pathology evaluation among primary health care physicians

Introduction: Prompt evaluation of patients with scrotal complaint is recommended. Patients with testicular torsion need urgent medical attention. In contrast, neonate with congenital hydrocele has a benign course and needs reassessment within a year. Objectives: To determine scrotal pathology assessment pattern among primary health care providers (PHCPs) in Eastern Province, Saudi Arabia. Materials and methods: Cross-sectional study among 257 physicians using a questionnaire. The questionnaire consisted of two clinical scenarios, the first on acute scrotum and the second on congenital paediatric hydrocele. The chi-squared test was used to analyse categorical variable while the t -test was used for continuous variables. Logistic regression was used to assess factors affecting scrotal evaluation. Results: Out of 257 questionnaires that were distributed, 170 were completed by PHCPs and analysed. The mean age of PHCPs was 34.7 years [standard deviation (SD) ±9.8] and mean experience was 9.9 years (SD ±10.2). Only 16 PHCPs (9.4%) stated that they do scrotal examination on a regular basis. Most PHCPs referred patients with acute scrotum to other specialists (49%) rather than to emergency services (32.9%). Thirty-eight PHCPs (22.3%) reported that they prefer to investigate either by laboratory or imaging modality before treating patients with acute scrotum. When asked about neonates with congenital hydrocele, most of the PHCPs (51.2%) reported that they tend to assure the parent and then reassess the patient after 1 year. However, a significant number of PHCPs (22.9%) stated that they recommended referral for surgical correction. Using logistic regression analysis, it was found that Saudi PHCPs tend to have more appropriate management than other nationalities (P≤ 0.001). Conclusions: Patients with scrotal complaints should have prompt and appropriate care. PHCPs tend to have significant delays in the care of patients with acute scrotum problems.

Pattern of scrotal examination by physicians in the Eastern Province of Saudi Arabia

Introduction: A wide variety of pathological lesions affect the scrotal contents. They include both benign and malignant lesions. Missed or delayed diagnosis of such lesions can lead to compromised fertility, cosmetic deformities, testicular loss or even death. Early diagnosis of scrotal lesions can prevent the possible development of such complications. Objectives: The pattern of scrotal examination by physicians in the Eastern Province of Saudi Arabia was evaluated in this study to assess the extent of efficacy for early diagnosis. Materials and methods: In this cross-sectional study of scrotal pathology, self-administered questionnaires regarding scrotal evaluation were answered by physicians of different disciplines, including emergency care, internal medicine, paediatric surgery, family medicine and general practitioners. The questionnaires included direct questions on clinical examination of the scrotum as well as clinical scenario quizzes. Collected data were analysed with SPSS (Statistical Product and Service Solutions) version 17 (SPSS Inc., Chicago, IL, USA). The chi-squared test was used to analysis categorical variables, while the t -test was used for continuous variables. Factors affecting scrotal evaluation were assessed by logistic regression. Results: 257 questionnaires were analysed. Routine evaluation of the scrotum was performed by only 14% of respondents. Among the physicians who did not perform routine scrotal examination, 64.2% restricted it to cases with scrotal complaints and 16% considered the conservative cultural nature of their patients a hindering factor. Forty-five per cent did not perform scrotal examination in the standing position. Only 27.8% advised patients with high risk of testicular cancer to perform routine self-examination of their testicles. Conclusions: This study revealed a significant deficiency of early detection of scrotal disease by physicians in the Eastern Province of Saudi Arabia with a high probability of development of complications. We recommend that all physicians be advised to follow a well-structured protocol for scrotal examination during routine practice.

Perfusion CT evaluation in experimentally induced testicular torsion: proceed with caution

As imaging evolves and an accurate preoperative diagnosis is made, less surgery will need to be performed. However, in the testicular torsion scenario the stakes are high, and there is the need for a 100% sensitive test. Ovali and colleagues1 use advanced technology to discriminate testicular torsion from non-torsion. The animal model used is a valid animal model, but there are many variables to take into account. Although an advanced diagnostic modality may be useful in indeterminate cases of testicular torsion, there are some issues that need to be resolved prior to incorporating this modality into daily practice. Firstly, in clinical practice, we have yet to define what the indeterminate cases with testicular torsion are: Are these patients experiencing minimal pain with findings suggestive of torsion but not clinically confirmed torsion, or are they patients presenting to the emergency room with vague scrotal complaints and discomfort? Secondly, prior to adopting a new technology, we need to be vigorous in understanding its utility in comparison to the available diagnostic modalities and surgical findings. Ultrasound (US), Doppler and nuclear scans are not yet routine tests done in most tertiary care centres. They are ancillary tests that may help rule out torsion, but they are not found to be clinically useful in emergency room settings. The authors provide an elaborate list of different measurements when performing computed tomography (CT) scans in this experimental study, but does this list entail higher radiation doses and possibly longer times in the radiology suite (time is a known factor to be detrimental to testicles in children with presumptive diagnosis of torsion)? Since the introduction of ALARA (As Low as Reasonably Achievable), in 2001 by the Society for Pediatric Radiology, physicians and radiologists have been collaborating to lower radiation exposure by avoiding unnecessary CT examinations. Radiologists at our institution actively screen CT requests, stating that the risks outweigh the benefits for CT scans compared to other radiologic examinations (US, magnetic resonance imaging and others). Furthermore, children are known to be 10 times more sensitive to radiation than middle-aged adults; therefore. the authors need to be cognizant about the dose of the CT scan in this setting and the duration of the test. Finally, and most importantly, in an era of economic crisis, the cost-effectiveness of an advanced technology needs to be thoroughly investigated. The authors touched briefly on these two issues, but more accurate data needs to be investigated in future studies should CT become a diagnostic tool for testicular torsion in children.

Ruptured Appendicitis Presenting as Acute Scrotal Swelling in a 23-Month-Old Toddler

BackgroundAcute appendicitis is a common disease process in which timely diagnosis minimizes the risk of complications. ObjectivesThis case illustrates one example of the range of clinical presentations of young children with acute appendicitis. Case ReportWe describe a case in a young child presenting with an inguinal and scrotal mass that was ultimately due to perforated appendicitis with abscess formation. ConclusionsIn the emergency department evaluation of these children with inguinal or scrotal complaints, we maintain that intra-abdominal processes should be included in the differential.

Scrotal Pathology in the Outpatient Setting in Operation Iraqi Freedom

The purpose of this study was to describe the incidence and pathology of scrotal pain among military men deployed in Operation Iraqi Freedom. It is a retrospective review of patients seen by the urology service at a U.S. Army combat support hospital (CSH) in Iraq from March 29, 2007 to August 12, 2007. Of the 222 outpatient visits to the urology service 81 (36%) had 1 or more scrotal complaints for a total of 90 scrotal-related problems. The vast majority (86%) were found to have epididymitis. Scrotal sonograms on these patients found only 1 patient with a testicular neoplasm. Varicocele (6.2%), spermatocele (4.9%), and hydrocele (2.5%) accounted for the remaining scrotal findings. Urologic referrals for scrotal problems are common in the deployed environment. We feel the best treatment for chronic scrotal pain in theater is conservative with urologic referral in patients who fail their initial course of therapy.

Testicular Microlithiasis in Patients with Scrotal Symptoms and Its Relationship to Testicular Tumors

To evaluate in a prospective study the coexistence of testicular microlithiasis with various scrotal pathologies and the relationship with testicular tumors in symptomatic patients presenting with various scrotal complaints. A total of 197 male patients of reproductive age who applied to our clinic between December 2004 and June 2005 with various scrotal complaints were included in the study. Patient complaints were of pain, swelling, smallness of the testes, and infertility. Patients were evaluated according to their medical history, scrotal ultrasonograms, tumor markers, and hormone profiles after physical examination. Independent t test and Fisher's exact test were used for statistical analysis. The mean (+/-SD) age of the 197 patients was 28.3 +/- 8.5 years. Pathologic findings were testicular tumors (1.8%), cryptorchidism (3.5%), varicoceles (75%), hydroceles (9.8%), epididymal cysts (9%), and atrophic testes (0.9%). Testicular tumors were found in 4 patients, and testicular microlithiasis was observed in 3 (75%) of these patients. Testicular microlithiasis ratios were determined as 25% in cryptorchidism, 6.5% in varicocele, 23% in hydrocele, 10% in epididymal cyst, and 50% in atrophic testes. The rate of testicular microlithiasis was significantly higher in patients with testicular tumors. The mean follow-up of patients was 19.5 months (range, 16 to 23 months), during which no new cancer case was detected. Testicular microlithiasis was more frequently observed in patients presenting with mass lesions and testicular tumors. Our findings suggest that symptomatic patients should be warned and kept aware of this issue, particularly if they have risk factors for testicular cancer.

A novel parameter by EFOV US for the quantification and the distinction of physiological amount of scrotal fluid and hydrocele: Ratio of testis volume/scrotum volume

Objective To determine the limits for the amount of tunical fluid enough to be termed as hydrocele by using extended-field of view US technology and to define hydrocele for the first time with standard numerical criteria. Methods A total of 60 patients were evaluated in this prospective study. Group 1 consisted of 20 patients with unilateral clinical hydrocele. Group 2 included 20 patients referred for scrotal US for reasons other than hydrocele. Group 3 comprised 20 male controls with no scrotal complaints. Testis volume ( V t), scrotum volume ( V s) and V t/ V s ratio were calculated for each subject by dimensions measured in longitudinal and tranverse planes. Results Mean V t/ V s ratio was 0.28 ± 0.17 (range, 0.07–0.57), 0.69 ± 0.08 (range, 0.53–0.80) and 0.71 ± 0.07 (range, 0.61–0.85) for groups 1, 2 and 3, respectively. Mean V t/ V s for group 1 was significantly lower than those for groups 2 and 3, respectively ( p < 0.001 for each). Based on the ROC curve analysis, 0.55 for V t/ V s ratio was determined as the optimal cut-off point below which the US diagnosis of hydrocele could be made (sensitivity 95.0% and specificity 97.5%). Conclusions We propose a novel US parameter of V t/ V s ratio below 0.55 for a standard distinction between hydrocele and physiological amount of scrotal fluid.

Cystic appendix epididymis: a sonomorphologic study

We aimed to describe the morphologic characteristics of the appendix epididymis that appears cystic on ultrasound (US) examinations. Two hundred and seventy-two patients (544 testes) were examined by US for various scrotal complaints. The patients were prospectively evaluated for the presence of testicular appendages. Cystic appendix epididymis on US examinations was classified according to the presence of the stalk and size of the cyst. Testicular appendages have been identified in 337 out of 544 testes (61.9%). Of them, 241 were appendix testis (44.3%) and 96 (17.6%) were appendix epididymis. Of the appendix epididymises, 35 were cystic in nature (36.4%). The most common morphology in our study was the stalked appendix epididymis with nonseptated unilocular cysts (31.4%). In conclusion, cystic appearance of the appendix epididymis on sonographic examinations is frequent and it should not be mistaken with a torsed testicular appendage.

Ruling out Testicular Torsion: Still No Fail Safe Test

Acute scrotal complaints in children are common, and diagnosing testicular torsion is critical. Color Doppler ultrasound is a rapid, noninvasive

Severe scrotal pain in boys with Henoch-Schönlein purpura: incidence and sonography

Henoch-Schönlein purpura (HSP) is a systemic vasculitis with multiorgan involvement. The scrotal involvement and its sonographic appearance are less well recognized than that of the kidneys and abdomen, and the reported incidence is varied. To review the incidence of significant scrotal involvement in boys with HSP and its sonographic characteristics. Thirteen boys (ages 4-11 years) out of 87 boys diagnosed with HSP, over a 15-year period had significant scrotal complaints. Seven underwent sonographic evaluation to define the extent of scrotal involvement and because testicular torsion was being considered. Scrotal involvement producing significant pain occurred in 15 % of boys with HSP. The majority of boys had the diagnosis of HSP established before developing scrotal complaints. Sonographic findings consistently included an enlarged, rounded epididymis, thickened scrotal skin, and a hydrocele. The testes themselves were usually sonographically normal. Scrotal involvement in boys with HSP is not uncommon. The sonographic findings in the scrotum are sufficiently characteristic to allow distinction from torsion in most cases.

Lipoma paratesticular

Among the neoplasias affecting the scrotum and other elements contained within, testicular tumours are the most common; paratesticular neoplasias account for about 2%. 70% of them are benign tumours, lipoma being one the most frequent types.We contribute a new case of paratesticular lipoma in a 45-year old patient, who presented with scrotal complaints. Physical examination found fibroelastic scrotal tumoration; diagnosis being aided with ultrasound and CAT that showed fat tissue radiographic patterns. Complete removal of tumoration and subsequent pathoanatomical study confirmed the diagnosis of paratesticular lipoma. A literature review on the subject is included with reflections on the clinical, diagnostic and therapeutical aspects.

B-mode and colour-flow duplex ultrasonography: a useful adjunct in diagnosing scrotal diseases?

To determine the value of ultrasonography (US) and colour-flow duplex ultrasonography (CFD) as routine investigations in the diagnosis of scrotal pathologies. The imaging techniques were applied to 215 consecutive patients with scrotal complaints. The diagnosis of a urologist (D1, made from the patient's history, physical examination and laboratory results) and that of the radiologist (D2, using US and CFD) were compared with the "gold standard' (D3, the operative findings and course of the disease). The sensitivity and specificity of the diagnostic pathways (D1, D2) were determined statistically and compared with D3. The final diagnoses (D3) were testicular torsion (13 patients), torsion of the appendix testis (5), epididymitis (42), inguinal hernia (7), tumour (11), trauma (9), hydrocele (46), epididymal cyst (37), orchitis (10), varicocele (46) and other diagnoses (8). Using D1, the urologist missed seven diagnoses, of which one was a patient with a testicular torsion combined with an inguinal hernia, and one a patient with a tumour. Using US and CFD (D2), the radiologist missed five diagnoses, including one patient with combined testicular torsion and inguinal hernia. For the diagnosis of scrotal disorders, the basic clinical evaluation usually provides the correct diagnosis. However, US and CFD are useful adjuncts which cause a minimal burden to the patient and that in most cases will lead to the correct diagnosis, especially with important diagnoses like testicular torsion, when US and CFD should be performed immediately. If this does not provide a clear diagnosis, the patient should be explored surgically.