Torsion Of Testicular Appendages Research Articles

Role of High-Resolution Ultrasonography With Colour and Duplex Doppler in the Evaluation of Acute Scrotal Diseases.

Introduction The term 'acute scrotum' denotes the sudden initiation of pain in the scrotal region. Acute scrotum is a frequent medical condition in children and adults. Ultrasound facilitates precise diagnosis and differentiation of numerous causes of acute scrotum. The objective of our research was to assess the utility of ultrasonography in the identification and prevalence determination of causes of acute scrotum. Materials and methods Patients with acute scrotal pain referred to the Department of Radiodiagnosis at Great Eastern Medical School & Hospital (GEMS), Srikakulam, India, were added in the research. This is a prospective observational study. High-frequency linear transducer (4-15 MHz) was used for imaging. Grey scale, colour and duplex Doppler were performed routinely. The ultimate diagnosis was established by considering the clinical results, follow-up observations, intraoperative observations and, when accessible, histopathological analysis. For the statistical analysis, IBM SPSS Statistics for Windows, version 22 (released 2013; IBM Corp., Armonk, New York, United States). was used. Descriptive analysis was conducted. The Kendall rank correlation coefficient was used to evaluate the non-parametric association between side and torsion. Results A total of 120 patients were included for statistical analysis. Inflammatory pathology was the most commoncause of acute scrotum, followed by testicular torsion and torsion of testicular appendage. Testicular torsion and side of pain did not show a significant association. Conclusion High-resolution ultrasonography with colour and duplex Doppler sonography is an excellent imaging modality exhibiting exceptional sensitivity and specificity for the accurate diagnosis of acute scrotal diseases. Inflammatory pathology was the most commoncause of acute scrotum, followed by testicular torsion and torsion of the testicular appendage.

Acute Scrotum in Children: A Retrospective Study of Cases With Review of Literature.

Testicular pain or swelling, often referred to as acute scrotum, can have a number of causes and presentations. Testicular torsion is an emergency condition requiring early diagnosis and surgery to salvage the involved testis in order to preserve testicular fertility. The study is aimed to know the incidence, aetiology, and management of acute scrotal conditions with a particular focus on testicular torsion. Epididymorchitis, trauma, and scrotal cellulitis are other causes of acute scrotum which are managed conservatively after proper investigations. The authors retrospectively reviewed 10-year epidemiological data of all children age under 14 years admitted to the tertiary care hospital with the diagnosis of acute scrotum. Data were collected about the clinical history, physical examination, biochemical investigations, Doppler ultrasound, and management done. 133 children aged between 0 days and 14 years (mean age, 7.5 years) were found to have acute scrotum out of which 67 (50.37%) patients had epididymitis, 54 (40.60%) patients presented with Torsion testis, three (2.25%) had torsion of testicular appendages, eight (6.01%) had scrotal cellulitis and one (0.75%) presented with a strangulated hernia. Due to late presentation, testis could be salvaged in only eight of the 54 patients with torsion testis. The testicular loss was seen more in bigger children and those with signs of infection in blood reports and colour Doppler showing no blood flow in the testis. The study results indicate that non-recognition of the severity of paediatric acute scrotum results in late presentation leading to testicular loss. Timely diagnosis will require sensitization of the parents, primary care providers, and paediatricians for this grave condition which leads to permanent testicular loss.

A Retrospective Review of Acute Scrotum in Pediatric Patients with Epididymo-Orchitis, Testicular Torsion, and Torsion of Testicular Appendages

A Retrospective Review of Acute Scrotum in Pediatric Patients with Epididymo-Orchitis, Testicular Torsion, and Torsion of Testicular Appendages

Çocuklarda akut skrotumun retrospektif değerlendirilmesi: tek merkezde onbir yıllık deneyim

Objective
 Incidence of underlying causes and outcomes in patients followed up and treated in the last 11 years by the Pediatric Surgery Clinic of our hospital with the diagnosis of acute scrotum in childhood were analyzed retrospectively.
 
 Materials and Methods
 A total of 216 patients diagnosed with acute scrotum by the Pediatric Surgery Clinic between November 2010 and October 2021 were included in this study. The age, presentation complaints, physical examination, laboratory and radiological results, additional anomalies, medical and surgical treatment results of the patients were analyzed.
 Results
 The patients were aged between 3 weeks to 17 years, with a mean age of 9.9 ± 4.4 years. Pain and swelling are most common in acute scrotum present on the right side in 119 patients (55.1%) and on the left side in 97 patients (44.9%). Causes of acute scrotum were orchitis /epididymoorchitis (O/EO) in 98 (45.4%), strangulated inguinal hernia (SIH) in 52 (24.1%), testicular torsion (TT) in 38 (17.6%), and torsion of testicular appendage (TTA) in 11 (5.1%), testicular rupture in 5 (2.3%), idiopathic scrotal edema 5 (2.3%), intravaginal abscess 3 (1.4%), testicular cancer 2 (0.9%), hydrocele 2 (0.9%). Vesicoureteral reflux was detected in 7 (7.1%) of the patients with O/EO. 
 Conclusion
 In this series, O/EO was found to be the most common cause of acute scrotal pain. The acute scrotum should be approached like the acute abdomen because only lower quadrant abdominal pain may be the cause of testicular torsion.

Testicular appendage torsion in children.

Testicular appendage torsion (TAT) is a medical emergency that presents as an acute scrotum, usually in children and preadolescents. In previous reports of TAT, most cases have been treated conservatively, but some necessitate surgical treatment. Our aim was to examine the incidence, clinical examination findings, etiology, and treatment of TAT. We retrospectively reviewed records of all patients with TAT (aged ≤15 years) treated at the Juntendo University Urayasu Hospital between January 2012 and September 2020. Surgical treatment was performed when a diagnosis of testicular torsion could not be completely ruled out or if pain recurred after conservative treatment. Patients with a hard scrotum or scrotal erythema were hospitalized for conservative treatment. Data regarding age, diagnosis, blood test results, and clinical findings were analyzed. Among 101 boys with TAT, the median age was 10 years. The incidence of TAT varied significantly according to age and was highest among patients aged 8-11 years. Sixty-seven boys (66.3%) underwent inpatient surgical treatment, 10 boys (9.9%) received inpatient conservative treatment, and 24 boys (23.8%) received outpatient conservative treatment. The median duration of hospitalization was significantly shorter among those who underwent surgery (2.0 days) than among those who received inpatient conservative treatment group (3.5 days). Operations were short, uncomplicated, and safe; they shortened the hospital stay; and they would certainly prevent recurrence of TAT and testicular torsion on one side. Furthermore, we recommended that TAT patients presenting with signs of severe inflammation, such as hard scrotum or scrotal erythema, receive early surgical treatment to minimize duration of hospitalization.

Testicular appendage torsion resulting in testicular ischemia and necrosis in a child

Torsion of intrascrotal appendages is the most common cause of acute scrotum in children, comprising 40 %–60% of the underlying cause of this entity. Torsion of the testicular appendages can be managed conservatively because it spontaneously necroses, disappears, and does not cause testicular dysfunction without blocking testicular blood flow. Our patient had a relatively large torsed testicular appendage, and we performed conservative treatment because there was no spermatic cord torsion. Clear blood flow to the testis was confirmed by ultrasonography examination, but the testicular blood flow was blocked and, as a result, there was testicular necrosis. The aim of this case report is to warn that testicular necrosis can occur even in torsed testicular appendage, which presents conventional ultrasonic findings and can rule out torsion of the spermatic cord. • Torsion of intrascrotal appendages is the most common cause of acute scrotum in children, and it generally can be managed conservatively because it does not cause testicular dysfunction without blocking the testicular blood flow. • Our case of torsed testicular appendage resulted in necrosis despite maintenance of spermatic cord blood flow on ultrasonography examination. • This is the first case report showing that a torsed appendage may have blocked testicular blood flow and caused testicular necrosis.

English

BACKGROUND Twisting of the spermatic cord resulting in ischemia of the testicles known as testicular torsion is a surgical emergency. Delay in diagnosis or surgery results in loss of testicles. Doppler ultrasound of scrotum is used in evaluating acute scrotum to support or rule out a diagnosis of torsion testis. Our study compares Doppler results with findings at exploration to finding out the accuracy of Doppler diagnosis in this scenario. METHODS This was a record based observational cross-sectional study. Out of all cases of acute scrotum presented to a tertiary care hospital over 14 months time, those patients with Doppler evaluation done were identified (n = 52) and their surgical findings were compared to the Doppler findings. Diagnostic accuracy of Doppler in diagnosing torsion testis was measured using sensitivity, specificity, accuracy, and predictive values. RESULTS Out of these 52 cases, 44 (84.6 %) were testicular torsion on exploration while remaining cases were epididymo-orchitis four (7.7 %) and testicular appendage torsion four (7.7 %). Among 44 cases of torsion testis, 31 (70.5 %) patients underwent orchiectomy (70.45 %) and in remaining 13 (29.5 %) orchiopexy was done. Sensitivity of Doppler to diagnose testicular torsion was 86.4 %, specificity was 87.5 % and accuracy was 86.54 %. Positive predictive value (PPV) was 97.4 % and negative predictive value (NPV) was 53.8 %. CONCLUSIONS Doppler ultrasound can be used as an adjunct to clinical findings in acute scrotum. High positive predictive value suggest that all Doppler diagnosed torsion should undergo emergency exploration as it will be correct in 97.5 % cases. If performing a Doppler study delays the definitive management, and if clinical findings are highly suggestive of testicular torsion, treating doctor can proceed to surgery without Doppler evaluation. KEY WORDS Doppler, Torsion Testis, Scrotum

Pearls and Pitfalls of Pediatric Scrotal Imaging

Ultrasonography (US) is the primary imaging modality for the evaluation of pediatric scrotal disease. The ability to obtain exceptional anatomical detail and testicular perfusion information without ionizing radiation makes it the essential tool for evaluating scrotal pain and palpable masses. Challenges arise in both the performance and interpretation of scrotal US in the child. Optimizing imaging parameters and recognizing key differentiating US features help minimize misinterpretations that can lead to poor patient outcomes. Key pearls and pitfalls in pediatric scrotal ultrasound methods and diagnoses are reviewed. Knowledge of what is normal for the various ages of childhood from neonate through adolescence is necessary for accurate US analysis. Imaging evaluation of key causes of the acute painful scrotum including testicular appendage torsion, epididymitis, and testicular torsion are discussed. Sonographic features for the diagnosis of benign and malignant scrotal masses, microlithiasis, and cryptorchidism are reviewed.

Testicular Appendage Torsion—To Explore the Other Side or Not?

ObjectiveTo investigate and compare the risks vs benefits of synchronous contralateral scrotal compartment exploration when testicular appendage torsion is diagnosed intra-operatively. MethodsEmergency scrotal explorations performed at the Women's and Children's Hospital between 2002 and 2017 were retrospectively analysed to identify patients with testicular appendage torsion. Primary outcome measures were metachronous acute scrotum re-presentations and returns to theatre. Outcomes were compared between groups that underwent unilateral and bilateral scrotal compartment exploration. ResultsTesticular appendage torsion was diagnosed intra-operatively in 575 patients and 90.4% underwent unilateral scrotal exploration. Re-presentations with metachronous acute scrotum on the non-index side occurred in 8.5% of unexplored and 3.6% of previously explored sides (P = .29). Non-index side returns to theatre occurred in 5.4% of unexplored and 0% previously explored sides (P = .097). Future metachronous contralateral testicular appendage torsion was diagnosed in 4.2%. Post-operative complications were comparably low in both groups. The number needed to treat to prevent a return to theatre for metachronous contralateral testicular appendage torsion is 24. ConclusionThe low morbidity of exploring the contralateral side is justifiable, but confers only limited benefit of preventing low likelihood future metachronous contralateral pathology. In balancing these risks, we recommend contralateral exploration as advisable but not a necessity.

Acute scrotum in children and the role of Doppler sonography in differential diagnosis

Sixty-one patients aged from 2 months to 17 years who were hospitalized between 02.01.2017- 25.05.2019 in the Department of Pediatric Surgery for acute scrotum were investigated by Doppler sonography with S onoscape2 ultrasound equipped with a high-frequency 7-11 MHz linear transducer. Testicular appendage torsion was reported in 49 children, 6 patients were with testicular torsion and 4 were with orchiectomy. Five patients were diagnosed with orchiepididymitis and three patients were with acute scrotum because of different types of trauma. The present article describes the frequency of acute scrotum, its etiology and importance of Doppler investigation in the differential diagnosis of acute scrotum.

Acute Scrotum: Validating the role of Color Doppler Ultrasonography in children and young adults

Introduction: Acute scrotum is a surgical emergency and a rapid diagnosis is important to save testis from irreversible harm. Study was carried out to outline the etiology of acute scrotum in children and young adults to establish the role of Doppler Ultrasonography substantiating the role of clinical examination. Materials and Methods: In this study we examined reliability of color Doppler ultrasonography comparing operative finding and clinical course. 50 patients of less than 25 years of age with acute scrotum admitted or managed in OPD were included in the study. The patients were categorized into two groups. One group comprised of patients who needed immediate surgical exploration on the basis of history, physical examination and Doppler Ultrasonography (suggestive of testicular torsion).The second group, had patients who on the basis of history, physical examination and Doppler Ultrasonography (suggestive of epididymo-orchitis, etc) were managed conservatively. Results: Doppler ultrasonography in acute scrotum diagnosed the condition with torsion of testis, epididymo-orchitis and torsion of testicular appendages. Sensitivity and specificity of Color Doppler ultrasonography for testicular torsion was 86.93% and 92.6% respectively and for epididymo-orchitis was 95.3% and 100% respectively. Conclusion: Color Doppler Ultrasonography is highly sensitive, specific, very safe and a noninvasive method of evaluating acute scrotum in children and young adults. It is not only helpful in timely surgical intervention for testicular salvage but also helps in avoiding unnecessary surgical exploration.

Paternity, erectile function, and health-related quality of life in patients operated for pediatric testicular torsion

Spermatic cord torsion (SCT) may lead to organ loss and can potentially influence fertility. Long-term effects of SCT are not fully investigated. The purpose was to evaluate paternity rates in adults who have had SCT in childhood and to compare the results to those of a control population. The secondary purposes were to compare paternity rates after testis-preserving surgery with those after orchiectomyand to evaluate erectile function and health-related quality of life (HRQoL). Questionnaires concerning paternity, erectile function (International Index of Erectile Function [IIEF]-5 questionnaire), and HRQoL (15D questionnaire) were mailed to 74 men who had been treated for SCT and to 92 controls treated for testicular appendage torsion in 1977-1995 and who were currently older than 30 years. Thirty-five of the 74 (47%) patients with SCT and 58 of the 92 (63%) controls responded. A same-aged control was selected for each patient with SCT. The median age at investigation was 41 (interquatile range [IQR]: 36 to 46) years in the SCT group and 41 (IQR: 38 to 46) years in the control group (p=0.81). The paternity rate was 23 of 35 (66%) in the SCT group and 26 of 34 (76%) in the control group (p=0.43). Nine percent of patients and controls suffered from infertility. Of the 30- to 50-year-old patients with SCT, 9 of 16 (56%) had children after orchiectomy, and 13 of 16 (81%), after detorsion (p=0.25). Significant or moderate erectile dysfunction (IIEF-5 total score <12) was observed in 3 of 32 (9%) patients and in 1 of 35 (3%) controls (p=0.34). Erectile dysfunction was similarly rare in both the orchidopexy and orchiectomy group. Total HRQoL scores were similar in the SCT and control groups (p=0.69) as well as in patients with orchidopexy and orchiectomy (p=0.50). Paternity, erectile function, or HRQoL was not impaired in the general level in the patients with SCT in comparison with controls. Both the modes of treatment, orchiectomy or detorsion, had no significant impact on the results. However, the results cannot be generalized to the individual level. The limitations were a small sample size and inability to investigate maternal factors to the paternity. However, the results are encouraging for the patients and families. Paternity rate and HRQoL were similar in patients with SCT and controls. The type of surgery (orchiectomy vs. detorsion) did not affect paternity rates statistically. Moderate or significant erectile dysfunction was rare in both groups.

Clinical state of the paediatric acute scrotum in south‐eastern Victoria

Acute scrotal pain is a common paediatric surgical presentation. Delays in treatment can result in testicular loss from torsion. It is unclear where delays occur. We aimed to investigate presentations with an acute scrotum to identify any potential areas of delay. We conducted a prospective study (April 2017-November 2018) of paediatric patients (<18 years) presenting with acute scrotal pain. Data collected included: patient demographics, history/examination findings, mode of presentation, clinical timeline details and outcomes. A total of 107 acute scrotum presentations were identified: 58 (54.2%) testicular appendage torsion, 23 (21.5%) testicular torsion, 6 (5.6%) epididymo-orchidits and 20 (18.7%) other diagnoses. Median age at presentation was 11 years (4 months-16 years). Fifty-seven (53.3%) underwent emergency surgery, of whom 23 (40.4%) had testicular torsion, with 2 requiring orchidectomy. Median time from onset of symptoms to seeking medical opinion was 5.5 (0-135) h. Once assessed by a medical professional, the route to paediatric surgical review via general practitioner (GP) and local emergency department (ED) to paediatric ED was 4.84 (1.67-24.5) h; via GP to paediatric ED was 2.58 (0.75-25.5) h; via local ED to paediatric ED was 2.25 (1-7.75) h; and directly to paediatric ED was 0.45 (0-1.42) h. Delays in assessment and treatment of acute scrotal pain occur from the time parents are aware of symptoms to seeking medical opinion. Education to increase awareness may reduce time delays. GPs should refer patients directly to a paediatric ED. Local EDs should manage paediatric cases as per the local surgeons' skill base.

Mean Platelet Volume and Testicular Torsion: New Findings.

Testicular torsion is an emergency at any age; the aim of this study is to evaluate the role of mean platelet volume to assess the viability of the testes before surgeryMaterials and methods: We retrospectively analysed the medical records of consecutive patients who underwent surgical exploration for acute scrotal pathology between January 2014 and December 2016 in our institution. were divided into two groups (detorsion of testes and orchyectomy); a third group was created as control group. All patients underwent blood exam before surgery; inclusion and exclusion criteria were created. We also evaluated the association between mean platelets volume and the testicular recovery during surgeryResult: After reviewing medical charts following the inclusion and exclusion criteria, 8 patients were enrolled inGroup 1 and 11 patients in Group 2. 33 healthy controls were enrolled in Group 3. MPV value in Group 1 resultedsignificantly different (p < 0.01) from the value in Group 2 and 3. The duration of symptoms was shorter than6 hours in 4/8 (50%) patients in Group 1; this early referral to hospital allowed prompt detorsion and testicularrecovery. In these "early-presenting" patients, MPV value was significantly lower than in patients with torsion oftesticular appendage (p = 0.01) and in controls (p = 0.001). MPV could be a useful adjunct in diagnosing TT, aiding its differential diagnosis with Torsion of thetesticular appendage. The lower MPV value in "early-presenting" patients with TT suggests a role in predicting thetestis viability, and therefore the appropriate treatment.

Testicular appendage torsion managed non-operatively

Background: Acute testicular pain is one of the commonest reasons of testicular exploration. Testicular appendage torsion is one of conditions presenting with testicular pain. If the diagnosis is certain this can be managed conservatively. Operative management is reserved for those patients in whom non-operative management fails. The objective of this study was to ascertain the success of conservative management.Methods: The medical records of thirty-four consecutive patients who were diagnosed with testicular appendage torsion, were managed non-operatively and satisfied the inclusion criteria were retrospectively analysed. Results: The average age of patients was 16.3 years. 94% of the patients were successfully managed non-operatively. Pain not controlled by analgesia was the main reason for representing to the emergency department. All patients were discharged from any further follow up by day 9.Conclusions: Where the diagnosis of testicular appendage torsion is confidently made, non-operative management is a viable option. Larger studies are required to confirm these findings.

Chronic orchalgia after surgical exploration for acute scrotal pain in children

The aim was to review the pediatric cohort undergoing surgical exploration for acute scrotal pain at our institution and assess the entity of chronic orchalgia post exploration in this cohort. A retrospective review of all pediatric patients who underwent surgery for acute scrotal pain at a single institution between 1 January 2001 and 1 January 2012 was conducted. A total of 1084 patients underwent scrotal exploration for acute scrotal pain where the underlying cause could not be clinically ascertained. Causes found at exploratory surgery are shown in the table. Forty-four children (4.1%) re-presented with another episode of acute scrotal pain and underwent re-exploration. A hundred of the 772 children with testicular appendage torsion at initial exploration had unilateral exploration only. Seven (7%) of these re-presented with contralateral appendage torsion. The complication rate of initial scrotal exploration was 5.6% and that of re-exploration was 6.8%. All complications were managed conservatively except for a painful reactive hydrocele that underwent the Jaboulay procedure. Fifteen (1.4%) children in this cohort developed chronic orchalgia. Thirteen (87%) of these had definite pathology found at initial exploration. One of 61 (2%) with postoperative complications (a reactive hydrocele) developed chronic orchalgia. Pediatric chronic pain specialists were consulted for all patients. In 10 of the 15 (67%), significant comorbidities included constipation, anxiety, somatization, hydrocele, dysfunctional voiding, and multiple joint pain. The Jaboulay procedure for reactive hydrocele and re-exploration to pex the testes due to suspected intermittent testicular torsion resolved chronic orchalgia in one patient each. Pediatric chronic orchalgia post exploration is uncommon. It has a multifactorial etiology. Comorbidities are common. It is possible that some unexplored patients labeled as chronic orchalgia in the literature may have underlying correctable pathology. Surgically correctable pathology such as intermittent testicular torsion, metachronous testicular appendage torsion, and symptomatic hydrocele or varicocele should be excluded in children with chronic orchalgia. Chronic pain specialists should be consulted and associated comorbidities managed. Prior surgical exploration and testicular fixation in children with chronic orchalgia helped reassure patients and families that there was no underlying surgical cause for the pain and facilitated compliance with chronic pain management. Pediatric chronic orchalgia has a multifactorial etiology and is uncommon after scrotal exploration surgery. Comorbidities are common and must be managed. Surgical exploration helps reassure patients that there is no correctable cause for the pain and facilitates engagement with chronic pain management.

Scrotal Exploration for Testicular Torsion and Testicular Appendage Torsion: Emergency and Reality

Background:Scrotal exploration is considered the procedure of choice for acute scrotum.Objectives:We evaluated the importance of early diagnosis and testicular salvage on the therapeutic outcomes of patients with pediatric testicular torsion (TT) and testicular appendage torsion (TAT) in our geographic area. Patients and Methods:We performed a retrospective database analysis of patients who underwent emergency surgery for TT or TAT between January 1996 and June 2009. Patient history, physical examination findings, laboratory test results, color Doppler sonography (CDS) results, and surgical findings were reviewed.Results:A total of 65 cases were included in our analysis. Forty-two cases were followed up for at least 3 months. Testicular tenderness was identified as the major clinical manifestation of TT, while only a few patients with TAT presented with swelling. CDS was an important diagnostic modality. The orchiectomy rate was 71% in the TT group.Conclusions:Cases of acute scrotum require attention in our area. Early diagnosis and scrotal exploration could salvage the testis or preserve normal function without the need for surgery.

Role of Doppler ultrasonography in acute scrotum in children and young adults

Background: Objective: To evaluate the efficacy of Doppler ultrasound in correctly diagnosing acute scrotal conditions in children and young adults. Methods: Over a period of two years 50 patients with acute scrotum were admitted in general surgery department who underwent Doppler ultrasound scrotum and its efficacy in correctly diagnosing the pathology was analysed. Results: 50 patients with age group ≤25 years were included in study. Scrotal pain was the most frequent presenting symptom of acute scrotum (98%) followed by Swelling of the hemiscrotum on the involved side present in 88% of the patients. Doppler ultrasound showed torsion of testis in 22 patients. On Scrotal exploration, torsion of spermatic cord was confirmed in 20 patients, one patient had torsion of appendix of testis and the other had Epididymo-orchitis. Thus the sensitivity and specificity of Doppler ultrasonography for testicular torsion was 86.9% and 92.6% respectively. Three patients with equivocal Doppler findings, but strong clinical suspicion of testicular torsion were explored, and testis was found to be torsed in all the three patients. Doppler ultrasonography showed Epididymo-orchitis in 20 patients, torsion of testicular appendage in 2 patients, Idiopathic scrotal edema in one, Incarcerated inguinal hernia in one, and a large hematocele in one patient. All twenty patients of epididymo-orchitis, two patients of torsion of testicular appendage, and one patient of idiopathic scrotal edema were managed conservatively. At three weeks follow up, all the patients were free of symptoms. One patient of scrotal trauma with Doppler showing a large hematocele, and the other one with obstructed inguinal hernia were explored and Doppler findings were confirmed. The sensitivity and specificity of Doppler ultrasonography for epididymo-orchitis was 95% and 100% respectively. Conclusions: Doppler ultrasound scrotum is an important investigation in acute scrotum.

Treatment of acute scrotum in children: 5 years' experience

A retrospective review was carried out to determine the incidence of various causes and outcome of management in patients with acute scrotum. Fifty children had a diagnosis of acute scrotum between 1st January 2007 and 15th May 2012. Age, mode of presentation, associated anomalies, and results of treatment were studied. Diagnosis of acute scrotum was confirmed by physical examination, Doppler ultrasound and biochemical investigations. Clinical presentation consisted of sudden swelling and pain in the inguinoscrotal region. The average age was 7.5 years (2 months-14 years). Causes of acute scrotum were orchitis/epididymo-orchitis (O /EO) in 22, strangulated inguinal hernia (SIH) in 16, testicular torsion (TT) in 11, and torsion of testicular appendage (TTA) in 1. Associated urological anomalies were found in 5 patients with O /EO. Medical treatment was applied to patients with O /EO, and surgical treatment was performed in patients with SIH, TT and TTA. In this series, O /EO was found to rank first as the cause of acute scrotum. Immediate surgical treatment in acute scrotum patients, except those with O /EO, is necessary. Associated urological anomalies should be investigated in patients with O /EO.

Magnetic Resonance Imaging of Acute Scrotum

The aim of the pilot study was to evaluate the feasibility of dynamic contrast enhanced (CE)-magnetic resonance imaging (MRI) in the detection of testicular ischemia and its ability to differentiate testicle torsion from other causes of acute scrotum. Seventeen boys or young men with an acute scrotum were included in the prospective study during the time period from October 2001 to December 2005. The median age of the patients was 16,4 (7-44) years. The duration of the symptoms preceding the MRI study varied from six hours to 30 days. The study protocol included physical examination by a surgeon, laboratory tests and Doppler ultrasound (DUS) and finally testicles were imaged by using a 1,5 T MRI scanner; T1-weighted and diffusion weighted images were produced. The gadolinium uptake, reported as the region of interest (ROI) perfusion values and presented as curves, was compared between the affected and contralateral testicle. In testicles with normal blood circulation the ROI values increased during the imaging time. Nine patients were operated on, because the spermatic cord torsion could not be excluded by clinical or DUS findings. All the normal testicles gave increasing ROI values meanwhile all three testicles with torsion gave constantly low values referring to no perfusion. Other causes of acute scrotum, such as epididymitis and torsion of testicular appendage seemed to be related with normal perfusion. Dynamic CE-MRI seems to show reliably ischemia of testicle and thus it may be helpful in selecting patients with acute scrotum for urgent operation.