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Fulltext Management of acute testicular pain in children: changing trends with improvements in scrotal ultrasonography over 18 years

Kyaw L, Choo CSC, Ong LY, Yap TL, Teo HJ, Nah SA

Singapore Med J, 2023 Apr;64(4):249-254.

PMID: 35196848 DOI: 10.11622/smedj.2022032

INTRODUCTION: Doppler scrotal ultrasonography (US) is the modality of choice in diagnosing testicular torsion. We aimed to evaluate the performance of scrotal US in diagnosing testicular torsion over the past 18 years in our institution and determine the factors contributing to the length of wait times for it.

METHODS: A retrospective review was conducted of boys who presented with acute scrotal pain from 2014 to 2015. US reports, operative findings, final diagnosis and key time points of the patients' journey (time to emergency department consultation, time to admission, time to US and time to operating theatre [OT]) were collected. US performance results were compared with those observed in a historical cohort from 1998 to 2004. Wait times were compared between operated and non-operated patients.

RESULTS: Data from 519 boys with a mean age of 9.15 years was collected. Of these, 438 (84.4%) boys had undergone initial scrotal US; of these scrotal US cases, 28 were surgically explored, with 23 confirmed to have torsion. Another five cases were explored without prior US, and all were confirmed to have torsion. Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (P < 0.0001, r = 0.96) and time to OT (P < 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery.

CONCLUSION: There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with acute scrotum should target time to US and time to OT.

Matched MeSH terms: Scrotum/surgery

Fulltext Fournier's gangrene and the use of preputial rotation graft

Krishnan MMS

Med J Malaysia, 1982 Jun;37(2):124-7.

PMID: 6752671

This paper presents four cases of Fournier's gangrene, including one involving a reconstructive procedure using a preputial rotation flap to cover the raw area, to reduce the period of wound healing. Since Fournier's description of Idiopathic scrotal gangrene in 1884, there have been a number of reports on this relatively rare disease but the problem of achieving early healing and epithelialisation remains.

Matched MeSH terms: Scrotum/surgery*

An unusual cause of a penetrating injury to the anterior urethra: a thorny situation

Tan GH, Ho CC, Bahadzor B, Praveen S, Goh EH, Afdzillah AR, et al.

Clin Ter, 2013;164(1):35-7.

PMID: 23455741 DOI: 10.7417/T.2013.1509

Concurrent penetrating injury to the male external genitalia and the anterior urethra is uncommon. This case illustrates an unusual cause of such an injury, and its subsequent management and outcome. A 69-year-old man had his scrotum and anterior urethra pierced by a long thorn when he fell in his farm. He presented with urine leakage from the scrotal wound each time he micturated. Cystoscopic examination confirmed the cause and extent of the injury, and also facilitated the extraction of the thorn. The injury was allowed time to heal by urinary diversion with a urinary catheter. There were no stricture or fistula formations and the patient remained symptom-free at 3 months follow-up. Careful cystoscopic examination was both diagnostic and therapeutic in this case. A conservative approach is a feasible option in the management of selected cases of penetrating anterior urethral injury.

Matched MeSH terms: Scrotum/surgery*

Fournier's gangrene: its aetiology and management

Thambi Dorai CR, Kandasami P

Aust N Z J Surg, 1991 May;61(5):370-2.

PMID: 2025192

The clinical features and management of 12 patients with Fournier's gangrene are described. The patients differed from the usual description of Fournier's gangrene in that they were older, the disease had a less abrupt onset and a definite predisposing factor was identified in 10 of the 12 patients. The importance of early diagnosis and excision of necrotic tissue is emphasized.

Matched MeSH terms: Scrotum/surgery

Managing traumatic testicular dislocations: what we know after two centuries

Subramaniam S, Ab Khalil MK, Zakaria J, Hayati F

BMJ Case Rep, 2020 Nov 03;13(11).

PMID: 33148579 DOI: 10.1136/bcr-2020-236801

Traumatic testicular dislocation (TTD) is a rare consequence of blunt scrotal trauma. A 21-year old gentleman presented with inguinal pain following a motorcycle accident and physical examination revealed absence of both testes within a well-formed scrotal sac with bilateral inguinal swellings. Ultrasonography confirmed viability and location of the testes at the superficial inguinal pouch. He underwent emergent surgical reduction with orchidopexy and was discharged the next day. No evidence of testicular dysfunction or atrophy was noted at follow-up. We reviewed reports of TTDs reported in English over the last two centuries and discuss its occurrence, evolution and management.

Matched MeSH terms: Scrotum/surgery

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