An overview of acute scrotal pain

Acute scrotal pain requires immediate medical attention to determine the underlying cause and to treat accordingly. The diagnosis may not be straightforward and in some patients, immediate surgery may be necessary in order to treat torsion of the testes early to achieve good results. The aim of this retrospective study is to evaluate the underlying causes and the outcome of acute scrotal pain. It includes a total of 116 patients over a period of 18 months who were admitted to the general urology ward. Seventy-six percent of the patients complained of pain only, 13% complained of pain with fever, 7% complained of urinary symptoms and 4% a combination of the three. After evaluation, 44 patients were diagnosed to have torsion of the testes and all of these patients were below 20 years old. Thirty-eight of the patients complained of pain only and 2 had pain with fever. Two patients were thought to have torsion and exploration was performed. They were found to have infection. The rest had orchidopexy done and only 2 had orchidectomy due to infarction. Fifty-two patients had acute epididymo-orchitis, 50 of these were above 20 years old and half (n = 25) of this group of patients admitted to having had exposure to sexually transmitted diseases, 11 patients had a history of instrumentation and 14 had no known causes. From this study, age appeared to be the main differentiating point between torsion and epididymo-orchitis. for equivocal cases, new technology such as the Doppler ultrasound and testicular scan may be useful in future to improve the diagnosis of this urogenital emergency.