Scrotal Symptoms Research Articles

Unnecessary antibiotic use in men who have sex with men (MSM) with anogenital symptoms attending a sexual health clinic: a retrospective analysis

ObjectivesTo quantify the amount of unnecessary antibiotics, in particular ceftriaxone, given to men who have sex with men (MSM) with anogenital symptoms as part of presumptive management in an urban...

Acute genital diseases

Acute genital diseases can occur at any age and are characterized by complaints of various kinds of the external genitalia. Pain, swelling, and redness of the scrotum, adjacent groin region, and immediate surroundings are the leading symptoms, the severity of which may vary. In addition, peritonitic symptoms such as nausea, vomiting, and circulatory sensations may be present and are comparable to symptoms of an acute abdomen. The term "acute scrotum" encompasses various clinical entities, where scrotal symptoms are predominant and represent aurological emergency situation. Immediate and comprehensive diagnostics are necessary to ensure timely management in case of necessary surgical intervention.

Symptomatic Intraparenchymal Epididymal Cysts: Description of 11 cases.

Epididymal cysts are benign cystic formations of the epididymis that usually appear in adolescence or early adulthood. Their frequency doubles after the age of 14-15. Obstruction in the epididymal efferent ductules with subsequent prostenotic dilatation of them, as well as dysgenesis due to hormonal disorders during fetal or postnatal life, are possible. At the 1st Department of Pediatric Surgery of A.U.Th. we treated 11 cases of boys at the age of 11-16 who presented with acute scrotum because of an epididymal cyst. The diagnosis was confirmed by ultrasound scanning . Due to persistent symptomatology, patients underwent surgical exploration and removal of the cyst. The postoperative care of the patients was uncomplicated with immediate remission of symptoms. In one case, ipsilateral acute epididymitis occurred after 10 days, which was successfully treated with antibiotic therapy. It is reported that approximately 50% of epididymal cysts involute within an average of 17 months. In conclusion, using the data obtained from the review, of the small in number of international bibliography studies, it is proposed conservative treatment of asymptomatic cysts with diameter smaller than 1 cm and surgical excision [1] of large asymptomatic cysts with diameter greater than 1 cm, which do not regress after a follow-up of 24-48 months, cysts, regardless of their diameter, responsible for persistent symptoms and in the manifestation of acute scrotal symptoms due to inflammation, intravesical bleeding or secondarily torsion of the epididymis.

Comprehensive evaluation of hematospermia in patients with acute epididymitis compared to patients with isolated hematospermia.

Among the most commonly known causes of hematospermia are infections in the genitourinary tract, but no study exists that has comprehensively investigated hematospermia in patients with acute epididymitis. To assess the impact of hematospermia in patients with acute epididymitis and its association with clinical, microbiological, and semen parameters. Since May 2007, a total of 324 sexually active patients with acute epididymitis were recruited in a prospective cohort study. Patients received a comprehensive medical and sexual history, and clinical, sonographic, laboratory, and microbiological diagnostics. Antibiotic therapy was given according to European Association of Urology guidelines. Semen analysis was offered 14 days after the first presentation and initiation of therapy. Since 2013, a separate control group of 56 patients presenting with isolated hematospermia (=no other urogenital symptoms) was prospectively recruited, and differences between the groups were statistically evaluated. Of 324 patients with acute epididymitis, 50 patients (15%) had self-reported hematospermia. This occurred with a median of 24h before the onset of scrotal symptoms and was associated with significantly elevated prostate-specific antigen levels compared to 274 patients without hematospermia (3.1vs. 1.8ng/ml, p<0.01). The two most common etiological pathogens were Escherichia coli and Chlamydia trachomatis, and the bacterial spectrum was comparable in both epididymitis subgroups (p=0.859). Semen analysis at 14 days still showed hematospermia in 24% of patients associated with massive leukocytospermia. Compared to the hematospermia control group, the two epididymitis subgroups showed significantly increased inflammation markers (pH, leukocytes, and elastase), reduced sperm concentration, and reduced levels of alpha-glucosidase and zinc (always p<0.01). In sexually active patients who develop acute epididymitis, self-reported hematospermia is evident in 15% of patients as early as one day before the onset of scrotal symptoms. Conversely, none of the 56 patients presenting with isolated hematospermia developed epididymitis within the next 4 weeks.

MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY

You have accessJournal of UrologyCME1 Apr 2023MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY Piotr Sluzar, Alex Murray, Anna Daunt, Aatish Patel, Achyuta Nori, Geraldine O'Hara, and Tet Yap Piotr SluzarPiotr Sluzar More articles by this author , Alex MurrayAlex Murray More articles by this author , Anna DauntAnna Daunt More articles by this author , Aatish PatelAatish Patel More articles by this author , Achyuta NoriAchyuta Nori More articles by this author , Geraldine O'HaraGeraldine O'Hara More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monkeypox is a viral illness affecting predominantly gay, bisexual and other men having sex with men. The rapid progression of the recent outbreak meant genital manifestations preceded any guidelines for cases with urological symptoms. This study aims to develop an empirical care pathway for patients presenting with penile and scrotal symptoms secondary to monkeypox. METHODS: From May to September 2022, 198 patients with monkeypox who presented to a tertiary referral hospital were assessed for genital involvement by the infectious disease team, with the involvement of a urologist. Of these, 19 patients (10%) were admitted with genital lesions and were treated in an isolation ward with full personal protection equipment (PPE) in use. Symptoms requiring urological input were present in 8 individuals (4%). The mean time from the onset of symptoms to resolution was 25.3 (range 9-63) days. Based on the management of these patients, an empirical care pathway for genital monkeypox was developed. RESULTS: Four stages of genital monkeypox were observed (Figure 1). Limited penile oedema and discrete lesions should be managed conservatively with analgesia, cold compresses and elevation for swelling control. Patients with moderate oedema, paraphimosis and large coalescing ulcers should be considered for a topical 1% hydrocortisone cream to reduce the inflammation. In severe oedema with necrotic ulcers glyceryl trinitrate (GTN) patches are crucial to improve the vascularization of the necrotic ulcers on the penis. Cases of widespread necrosis and oedema may require imaging to assess the need for surgical debridement. GTN patches require daily changes for tissue salvage. Catheterization should be guided by the extent of oedema, the presence of paraphimosis and lesions close to the external urethral orifice. CONCLUSIONS: Monkeypox cases presenting through lesions on the penis and scrotum often require urological management to reduce penile oedema and prevent catheterisation. All admitted patients require isolation with full PPE. The initial stages of the infection should be managed conservatively with cold compresses, elevation and analgesia. Patients with advanced genital symptoms can benefit from the early use of topical steroid creams and GTN patches applied over the necrotic areas to reduce swelling and aid perfusion. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e192 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Piotr Sluzar More articles by this author Alex Murray More articles by this author Anna Daunt More articles by this author Aatish Patel More articles by this author Achyuta Nori More articles by this author Geraldine O'Hara More articles by this author Tet Yap More articles by this author Expand All Advertisement PDF downloadLoading ...

Epididymitis, orchitis, and epididymo-orchitis associated with SARS-CoV-2 infection in pediatric patients: A systematic review

IntroductionEpididymitis, orchitis, and epididymo-orchitis (EO) are common disorders in pediatric patients which may be caused by infection, trauma, or inflammation. SARS-CoV-2 associated EO has been previously described, particularly in adults. However, no systematic reviews of these manifestations in pediatric patients yet exist. We present a systematic literature review of epididymitis, orchitis, and EO associated with SARS-CoV-2 in pediatric patients to shed light on these relatively rare, yet potentially severe, conditions to understand presentation, course of illness, management options, and outcomes.Materials and MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed using specified key terms to search PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Embase. Articles were independently screened by two reviewers. Manuscripts with detailed descriptions of SARS-CoV-2 associated epididymitis, orchitis, or EO in pediatric patients were included. Exclusion criteria included: no clear diagnosis of the target diseases and no detailed clinical course described. Quality and bias were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.Results60 records were initially identified, with 6 case reports included in the systematic review. All 6 patients included presented with fever and genitourinary symptoms. Four patients were also diagnosed with multisystem inflammatory syndrome in children (MIS-C). One patient underwent surgical exploration for presumed testicular torsion, though intraoperatively there was no evidence of torsion. All patients recovered without documented long-term sequelae.DiscussionWhile observational studies are prone to bias, this systematic review suggests that epididymitis, orchitis, and EO are significant manifestations of SARS-CoV-2 that may mimic urologic emergencies (i.e., testicular torsion). Providers should suspect these conditions in pediatric COVID-19 patients with scrotal symptoms, particularly with associated MIS-C. The long-term genitourinary sequelae of SARS-CoV-2 should be investigated, including the effects on pediatric patients undergoing reproductive development.

635 Can Virtual Clinics Streamline Urology Referrals from Primary to Secondary Care?

IntroductionThe COVID-19 pandemic caused the UK to enter lockdown from 23rd March to 8th May 2020, necessitating Urology clinics to be conducted virtually. Our study aimed to assess whether new Urology referrals could be triaged and have an outcome arranged virtually before being seen by a specialist in clinic, thereby reducing referral to investigation wait-times.MethodRetrospective data was collected from 23rd March to 8th May 2020 of new patient referrals consulted virtually in Urology outpatient clinics. Referrals were grouped into categories of presentation and outcome.Results642 new patients were consulted virtually during the study period. 181 (28.1%) had further imaging requested; of these, the presentations with the greatest proportion of patients with this outcome were those referred with imaging findings (50%), UTI/cystitis (43.1%) and scrotal symptoms (34.3%). 116 patients (18.1%) were added to the waiting list for procedures; 85 were for flexible cystoscopy, for which the commonest indications were UTI/cystitis (36; 55.4%) and haematuria (15; 55.5%).ConclusionsCertain urological presentations can be triaged straight to investigation by when directly referred from Primary Care, thus reducing referral to investigation wait-time and increasing outpatient protocol efficiency.

The Use of Doppler Ultrasound for Suspected Testicular Torsion: Lessons Learned from a 15-Year Multicentre Retrospective Study of 2922 Patients

BackgroundUse of Doppler ultrasonography (DUS) for patients with suspected testicular torsion (TT) is highly controversial and remains debated, as it can delay surgery and its performance may vary. ObjectiveTo assess the role, impact, safety, and performance of DUS in the management of patients with suspected TT before scrotal exploration. Design, setting, and participantsThe TORSAFUF cohort retrospectively included patients older than 12 yr who underwent surgery for suspected TT in 14 academic hospitals between 2005 and 2019. Perioperative data and surgical and DUS reports were collected. Outcome measurements and statistical analysisClinical factors influencing DUS utilisation were analysed using multivariate logistic regression. The orchidectomy rate and delay to surgery were compared by group with and without DUS receipt using one-to-one propensity score (PS) matching to assess imaging safety. For the group with preoperative imaging, DUS performance was evaluated using a contingency table. Results and limitationsOverall, 2922 patients were included, of whom 956 (32.7%) underwent DUS before surgery. DUS was more likely to be performed in older patients (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.1–1.2), those who experienced progressive onset of pain (OR 1.5, 95% CI 1.1–2), and patients who presented at the emergency department more than 6 h after their first scrotal symptoms (OR 2.3, 95% CI 1.9–2.8). After PS matching, DUS receipt was not significantly associated with orchidectomy but the delay to surgery was 1 h longer. DUS demonstrated strong sensitivity of 85.2% (95% CI 82.1–88.3%) and specificity of 52.7% (95% CI 48.8–56.6%). The performance was better for younger patients and for those with time since onset of pain of >6 h. ConclusionsIn this large retrospective study, DUS before surgery was safe, feasible, and useful in selected cases with suspected TT, but it should not delay or replace surgery in cases with a strong clinical suspicion. Patient summaryWe analysed the performance and safety of an ultrasound scan of the scrotum before surgery for patients with a suspected twisted testicle (TT). This scan before surgery was not associated with a higher risk of negative outcomes but was only moderate in accurately diagnosing TT. Surgery to correct TT should not be delayed.

Nonscrotal Causes of Acute Scrotum.

Acute scrotum is characterized by intense acute scrotal pain, which may be associated with other symptoms and signs such as abdominal pain, inflammation, and fever. Many pathologic conditions can present in this way, most which involve the scrotal contents. Nonscrotal conditions, however, can rarely present clinically only as acute scrotum: among them, renal colic, aneurysm rupture or other causes of retroperitoneal hemorrhage, primary abdominal or pelvic tumors and metastases, pancreatitis, pelvic inflammation, and muscle injuries. The pathophysiologic characteristics of the clinical presentation, clues for diagnosis, and imaging features of a series of nonscrotal lesions presenting clinically with acute scrotal pain are herein reported and illustrated. In patients presenting with acute scrotal symptoms and normal scrotal ultrasound findings, nonscrotal causes of acute scrotal pain should be considered in the differential diagnosis. Therefore, an ultrasound investigation of the abdomen, groin, and thighs is indicated.

Persistent orchialgia after laparoscopic living-donor nephrectomy: an underestimated complication requiring information adjustment.

Laparoscopic living-donor nephrectomy (LLDN) is the gold-standard procedure for kidney procurement. Ipsilateral orchialgia has barely been described. Some authors reported that ligation of gonadal vein (GV) above iliac vessel bifurcation could prevent orchialgia. We aimed to assess incidence and duration of orchialgia after LLDN in male donors despite distal ligation of GV. Patients who underwent LLDN from 2014 to 2017 were included. Standard procedure consisted in distal ligation of GV, close to the renal vein confluence and proximal ureteral ligation. Patients' demographics, per-operative data, and post-operative consultation reports were retrospectively reviewed. Orchialgia and scrotal symptoms were assessed through a non-validated questionnaire by phone interview. Sixty-nine donors were included. Orchialgia incidence and testicular swelling were 31.9% (n = 22) and 15.9% (n = 11), respectively. Median symptom duration was 15.5months. Orchialgia led to medical consultation in 41.7% (n = 10) of cases. All patients declared having been informed, prior to donation, about possible residual pain but not specifically orchialgia. Orchialgia after LLDN affects more than 30% of donors, despite distal ligation of GV and led less than 50% of them to medical consultation, suggesting a large underestimation in clinical practice. Emphasis should be put on this complication during pre-donation information.

Imaging of the acute scrotum: keys to a rapid diagnosis of acute scrotal disorders.

Imaging of the scrotum in the setting of acute symptoms such as pain or swelling is commonly performed emergently to differentiate between patients who require immediate surgery and those that do not. Acute scrotal symptoms are generally caused by infectious, traumatic or vascular etiologies. Rapid diagnosis and initiation of treatment is vital for testicular salvage in cases of acute testicular torsion, testicular rupture, and Fournier gangrene. Epididymitis, epididymo-orchitis, torsed testicular appendage, segmental testicular infarction, scrotal hematomas, testicular neoplasms, and acute idiopathic scrotal edema can have similar clinical presentations, but these conditions do not require immediate surgery. Ultrasound is the well-established first-line imaging modality for the acute scrotum. Contrast-enhanced ultrasound and magnetic resonance imaging can be useful as problem-solving tools when ultrasound studies are inconclusive or equivocal. This review describes normal scrotal anatomy and a wide range acute scrotal disorders, with emphasis on the imaging and clinical features that can minimize the risk of misdiagnosis.

Ultrasound assessment of perinatal testicular torsion.

The goal of this study was to elucidate the different sonographic features of prenatal and postnatal testicular torsion (TT) using high-frequency colour Doppler ultrasound (HCDU) in an effort to increase diagnostic accuracy. 29 patients (average age, 7.5 days) with perinatal TT were divided into patients with postnatal (acute) TT vs patients with prenatal (chronic) TT and their clinical characteristics, imaging features on HCDU and surgical pathology results were retrospectively analyzed. Significant differences were observed between prenatal and postnatal TT cases with regard to testicular size (p = 0.01) and echogenicity (p = 0.007). All 17 prenatal cases had non-homogeneous testicular parenchymal echo patterns compared with only 9 (64.3%) postnatal TT cases. Five postnatal TT cases presented with homogeneous echo patterns compared with none of the prenatal TT cases. Testicular blood supply was absent in 25 (80.7%) of 31 testes on colour Doppler flow imaging, with the majority occurring in the prenatal TT cases [i.e. 16 (94.1%) cases]. 1 affected testis out of a total 17 testes from 16 patients with prenatal TT was salvaged, with a salvage rate of 1/17 or 0.06%. 7 affected testes out of a total 16 testes from 13 patients with postnatal neonatal TT were salvaged, with a salvage rate of 7/16 or 43.8%. In neonates with acute scrotal symptoms, the possibility of perinatal TT should be considered and HCDU examination should be performed in a timely manner. HCDU examination could aid in testicular salvage by prompting quick surgical intervention. This study underlined the clinical contribution of HCDU in evaluating postnatal (acute) vs prenatal (chronic) TT. The sonographic features of postnatal TT with salvageable testes were compared with prenatal torsion and the relative salvage rates in both cases were discussed.

Pitfalls in Imaging for Acute Scrotal Pathology

Introduction Differentiation among the many clinical situations that can present with acute scrotal pain is a significant diagnostic problem in clinical practice. A firm diagnosis is often difficult based on clinical history and physical examinations alone, and imaging is usually requested for this purpose. However, imagingfindings alonemaynot clarify the diagnosis as imaging studies have to be interpreted in close correlation with clinical information and with knowledge of the possible pathologic situations underlying the clinical presentation of the specific patient. In this article we describe and discuss the most common problems encountered when performing diagnostic studies for acute scrotal symptoms and the solutions for, possibly, avoiding them.

Asymmetric spermatic cord vessel enhancement on CT: a sign of epididymitis or testicular neoplasm

To determine whether asymmetric spermatic cord vessel enhancement (ASE) on contrast-enhanced computed tomography (CECT) indicates scrotal pathology. Sixty-one male patients with scrotal symptoms who underwent both scrotal ultrasound (US) and CECT within 24h were identified through a radiology information system. Twenty-eight emergency department patients who underwent CECT only for unrelated symptoms were included for comparison. Two blinded radiologists independently reviewed each CECT scan for qualitative ASE. These data were compared with US diagnoses, when present. A third blinded radiologist reviewed each CECT scan for quantitative ASE by measuring Hounsfield unit (HU) density ratios. McNemar, Kappa, Student's t test, and ANOVA were used for analysis. Eighty-nine total patients included 28 with CECT only and 61 with CECT and US, of which 41 had abnormal US: 15 acute epididymitis and/or orchitis, 7 testicular neoplasms, 11 varicoceles, and 8 with other pathologies. Twenty patients with normal US and 28 patients with CECT only served as control groups. Identification of ASE agreed with US diagnosis of epididymitis (and/or orchitis) or testicular neoplasm (reader 1: κ=0.79, reader 2: κ=0.75) with average 95.5% sensitivity and 88.8% specificity, and no significant difference between readers (p=0.58). For epididymitis (and/or orchitis) or testicular neoplasm patients, the average ratio of spermatic cord HU density (ipsilateral:contralateral) was significantly different from other patients (4.01 vs. 1.26, p=0.0025). ASE on CECT shows stronger correlation with epididymitis (and/or orchitis) and testicular neoplasm compared with other scrotal pathologies. If discovered on CECT, this should prompt further clinical and/or imaging workup.

Evaluated of Testicular Tumors using Doppler Sonography

This study aimed to determine the gray scale and color Doppler sonographic features of the most common and some of the least common scrotal lesions. Between October 2012 to May 2013, 100 patients the age range of new born to 85 years old the mean 30.95, with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analyzed. The presentation symptoms including scrotal pain, painless scrotal mass or swelling, and trauma. Sonographic features that were reviewed included the size and echogenicity of the tumors, presence of cystic areas or calcifications,and distribution pattern of detectable blood flow on color or power Doppler

Unusual Testicular Ultrasound Findings in a Child with Henoch-Schönlein Purpura

Henoch-Schonlein purpura (HSP) is a systemic vasculitis characterized by the deposition of immune complexes containing immunoglobulin A antibodies. In cases of HSP, scrotal symptoms may precede other manifestations. Gray-scale and color Doppler ultrasound (US) is the primary imaging modality used to study scrotal diseases in children. In this report, we discuss a case of HSP in a 12-year-old boy with bilateral acute scrotal pain. Unusual features were sonographically observed in the isolated affected testes. In systemic vasculitis such as HSP, the scrotal involvement is uncommon and isolated affected testes with unusual sonographic features are unique in this case. Gray-scale and color Doppler US showed bilateral scrotal enlargement with subcutaneous scrotal edema and heterogeneous echogenicity of both testes. However, they maintained their normal vascularity and normal size for the patient's age. There was no sonographic evidence of hydrocele, epididymal involvement, or torsion. A follow-up examination 10 days after the initiation of steroid therapy showed significant symptom improvement. US demonstrated that both testes had normal echogenicity and normal vascularity. Scrotal skin thickening resolved. Radiologist awareness of such sonographic findings supported by proper clinical presentation is vital to distinguish HSP from other scrotal diseases, resulting in its safe management and the avoidance of unnecessary surgical exploration.

Acute scrotum in Kawasaki disease: Two case reports and a literature review

Acute scrotum is a rare complication of acute Kawasaki disease (KD), less well recognized than other disease manifestations. We describe the cases of two patients, aged 59 months and 19 months, with hydrocele testis in the acute phase of KD. Scrotal ultrasound and trans-illumination were used in the diagnosis of hydrocele testis. One patient underwent eventual surgical intervention. We reviewed the literature for a better understanding of the pathogenesis of scrotal symptoms in acute KD and investigated the clinical importance of hydrocele testis. Careful further clinical observation may elucidate the true incidence of this extracardiac symptoms, thereby clarifying the diagnostic value of this possible complication in acute KD.

US in the assessment of acute scrotum

BackgroundThe acute scrotum is a medical emergency . The acute scrotum is defined as scrotal pain, swelling, and redness of acute onset. Scrotal abnormalities can be divided into three groups , which are extra-testicular lesion, intra-testicular lesion and trauma. This is a retrospective analysis of 164 ultrasound examination performed in patient arriving in the emergency room for scrotal pain.The objective of this article is to familiarize the reader with the US features of the most common and some of the least common scrotal lesions.MethodsBetween January 2008 and January 2010, 164 patients aged few month and older with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analyzed. The presentation symptoms including scrotal pain, painless scrotal mass or swelling, and trauma.ResultsOf 164 patients, 125 (76%) presented with scrotal pain, 31 (19%) had painless scrotal mass or swelling and 8 (5%) had trauma. Of the 125 patients with scrotal pain, 72 had infection,10 had testicular torsion, 8 had testicular trauma, 18 had varicocele, 20 had hydrocele, 5 had cryptorchidism, 5 had scrotal sac and groin metastases, and 2 had unremarkable results. In the 8 patients who had history of scrotal trauma, US detected testicular rupture in 1 patients, scrotal haematomas in 2 patients .Of the 19 patients who presented with painless scrotal mass or swelling, 1 6 had extra-testicular lesions and 3 had intra-testicular lesions. All the extra-testicular lesions were benign. Of the 3 intra-testicular lesions, one was due to tuberculosis epididymo-orchitis, one was non-Hodgkin’s lymphoma, and one was metastasis from liposarcomaConclusionsUS provides excellent anatomic detail; when color Doppler and Power Doppler imaging are added, testicular perfusion can be assessed

Scrotal Pearls and Pitfalls

Scrotal symptoms including palpable mass or pain often bring men to medical attention. Ultrasound serves as an extension of the physical examination in these patients and, in most cases, allows definitive diagnosis. Although the diagnosis of malignancy is of greatest concern both to the patient and clinician, a number of benign scrotal pathologies exist and most have characteristic imaging features. Knowledge of these imaging findings can help the radiologist to confidently identify common benign scrotal conditions. Location and imaging characteristics of uncommon lesions help to establish a rational differential diagnosis and appropriate recommendations for patient management.

Diffusion‐weighted magnetic resonance imaging in the detection of testicular torsion: Feasibility study

To investigate the feasibility and usefulness of diffusion-weighted magnetic resonance imaging in the detection of testicular torsion. Institutional Review Board approval and informed consent from all participants were obtained. Consecutive 28 patients with acute scrotal symptoms were included in this study. Fat-suppressed T2-weighted, dynamic subtraction contrast-enhanced, and diffusion-weighted images were obtained in the coronal plane with a 1.5 T MR unit. An apparent diffusion coefficient (ADC) map was reconstructed from the diffusion-weighted images obtained with b-factor of 0 and 800 s/mm(2). Comparisons of ADC values between the affected and nonaffected testes were performed with Mann-Whitney's U-test. Diffusion-weighted and ADC images with diagnostic quality were obtained in 23 out of the 28 patients (82%). In testicular torsion (n = 9), the mean ADC value of the twisted testes was significantly lower than that of the nonaffected testes (0.750 ± 0.297 vs. 1.017 ± 0.165 × 10(-3) mm(2)/sec, P < 0.05). In other scrotal disorders (n = 14), there was no significant difference in the mean ADC value of the testes between the affected and nonaffected side (P = 0.655). The affected-to-nonaffected ratio of ADC value was significantly lower in testicular torsion than that in other scrotal disorders (P < 0.05). Diffusion-weighted imaging of the scrotum with testicular ADC measurement can allow for the detection of testicular torsion without any use of contrast media.