Acute scrotum - Etiology and management

Area of Science:

• Pediatric Urology
• Surgical Emergencies
• Adolescent Health

Background:

• Acute scrotal pain is a frequent urological emergency in boys.
• Prompt diagnosis and management are essential to prevent testicular loss.
• Distinguishing testicular torsion from other causes of scrotal pain can be challenging.

Purpose of the Study:

• To review the outcomes of emergency scrotal exploration in boys presenting with acute scrotal pain.
• To analyze the incidence and characteristics of different scrotal pathologies in pediatric patients.
• To evaluate the testicular salvage rate in cases of suspected testicular torsion.

Main Methods:

• A retrospective review of 195 boys who underwent emergency scrotal exploration between 1983 and 2003.
• Patients were categorized into three groups: epididymo-orchitis, torsion of testicular appendages, and spermatic cord torsion.
• Demographic data, clinical presentation, and surgical outcomes were analyzed.

Main Results:

• Epididymo-orchitis (37%) was the most common diagnosis, followed by torsion of appendages (32%) and testicular torsion (29%).
• Testicular torsion salvage rate was only 37% due to delayed presentation (mean duration of pain 2.11 days).
• Spermatic cord torsion was more common in neonates, while appendage torsion predominated in prepubertal boys.

Conclusions:

• Routine surgical exploration is recommended for any boy presenting with acute scrotal pain and suspicion of testicular torsion.
• Early surgical intervention is critical for improving testicular salvage rates in cases of testicular torsion.
• No perioperative morbidity or mortality was observed in the study groups.