Critical Analysis of the Clinical Presentation of Acute Scrotum: A 9-Year Experience at a Single Institution

No AccessJournal of UrologyTestis1 Sep 1997Critical Analysis of the Clinical Presentation of Acute Scrotum: A 9-Year Experience at a Single Institution Robert H. Jefferson, Luis M. Perez, and David B. Joseph Robert H. JeffersonRobert H. Jefferson , Luis M. PerezLuis M. Perez , and David B. JosephDavid B. Joseph View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64426-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed the significance of the clinical presentation of boys who underwent surgical exploration for acute scrotum. Materials and Methods: We retrospectively analyzed the records of 115 consecutive boys who underwent surgical exploration for acute scrotum between October 1986 and January 1996. We divided the children into group 1 – 83 with spermatic cord torsion a mean of 14.4 years old, group 2 – 27 with torsion of a testicular appendage a mean of 9.4 years old and group 3 – 5 with epididymo-orchitis a mean of 14.1 years old. Particular attention was given to nausea and vomiting, patient age and duration of pain. Results: Nausea and vomiting occurred in 69 and 60% of the boys in group 1, 8 and 4% in group 2 and none in group 3. Nausea and vomiting had positive predictive values of 96 and 98%, respectively, for spermatic cord torsion. Only 6 of the 83 boys (7%) with spermatic cord torsion were younger than 11 years, whereas 15 of the 27 (56%) with torsion of a testicular appendage were younger than 11 years. Of the 83 boys with spermatic cord torsion the testes were salvaged in 51 (61%) and the duration of pain was 40 minutes to 12 hours (mean 4 hours). The testes were not salvaged in any patient with greater than 12 hours of pain. Conclusions: We believe that any boy 11 years old or older with scrotal pain less than 12 hours in duration that is associated with nausea or vomiting should be considered to have torsion of the spermatic cord. In this day of cost-effective medical management it is not necessary to perform imaging in this subset of boys before surgical exploration. References 1 : Immediate exploration of the unilateral acute scrotum in young male subjects.. J. Urol.1980; 124: 829. Abstract, Google Scholar 2 : Torsion of the testis.. J. Urol.1974; 111: 521. Abstract, Google Scholar 3 : Acute scrotal swelling.. Urol. Clin. N. Amer.1995; 22: 101. Google Scholar 4 : Acute scrotal pain and swelling in children: a surgical emergency.. Urology1981; 17: 51. Google Scholar 5 : Torsion of the spermatic cord: a review of the literature and an analysis of 70 new cases.. J. Urol.1970; 104: 604. Abstract, Google Scholar 6 : Etiology of acute scrotum at surgical exploration in children, adolescents and adults.. Eur. 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Google Scholar From the Division of Urology, Department of Surgery, University of Alabama at Birmingham, Children's Hospital, Birmingham, Alabama.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byBurgu B, Aydogdu O, Huang R, Soygur T, Yaman O and Baker L (2013) Pilot Feasibility Study of Transscrotal Near Infrared Spectroscopy in the Evaluation of Adult Acute ScrotumJournal of Urology, VOL. 190, NO. 1, (124-129), Online publication date: 1-Jul-2013.Aydogdu O, Burgu B, Gocun P, Ozden E, Yaman O, Soygur T, Dursun A and Aydos K (2011) Near Infrared Spectroscopy to Diagnose Experimental Testicular Torsion: Comparison With Doppler Ultrasound and Immunohistochemical Correlation of Tissue Oxygenation and ViabilityJournal of Urology, VOL. 187, NO. 2, (744-750), Online publication date: 1-Feb-2012.Bayne A, Madden-Fuentes R, Jones E, Cisek L, Gonzales E, Reavis K, Roth D and Hsieh M (2010) Factors Associated With Delayed Treatment of Acute Testicular Torsion—Do Demographics or Interhospital Transfer Matter?Journal of Urology, VOL. 184, NO. 4S, (1743-1747), Online publication date: 1-Oct-2010.Capraro G, Coughlin B, Mader T and Smithline H (2008) Testicular Cooling Associated With Testicular Torsion and its Detection by Infrared Thermography: An Experimental Study in SheepJournal of Urology, VOL. 180, NO. 6, (2688-2693), Online publication date: 1-Dec-2008.SESSIONS A, RABINOWITZ R, HULBERT W, GOLDSTEIN M and MEVORACH R (2018) Testicular Torsion: Direction, Degree, Duration and DisinformationJournal of Urology, VOL. 169, NO. 2, (663-665), Online publication date: 1-Feb-2003. Volume 158Issue 3September 1997Page: 1198-1200 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Robert H. Jefferson More articles by this author Luis M. Perez More articles by this author David B. Joseph More articles by this author Expand All Advertisement PDF downloadLoading ...