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Patterson K, Hennessey DB, O'Kelly F. A scoping review of historical and contemporary management strategies for paediatric scrotal trauma. Ir J Med Sci 2025:10.1007/s11845-025-03929-0. [PMID: 40088254 DOI: 10.1007/s11845-025-03929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 02/28/2025] [Indexed: 03/17/2025]
Abstract
OBJECTIVE To perform a scoping review of the literature pertaining to paediatric scrotal trauma and to contrast operative with conservative management in this cohort of patients using available data. METHODS A search of Cochrane, SCOPUS, and EMBASE databases was performed using methods pre-published on PROSPERO. Reporting followed Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible studies were articles or abstracts published in English describing the management of paediatric scrotal trauma, which reported at least one secondary outcome. The intended primary analysis is to report the management of paediatric scrotal trauma and the outcome based on management. RESULTS Thirty-six studies were identified, totaling 253 patients. Then, 91.7% of cases presented with unilateral testicular injury and 94.5% of cases resulted from blunt trauma. Then, 86% of patients presenting with scrotal trauma underwent ultrasound imaging of the scrotum. One hundred twenty-three cases underwent conservative management, 116 cases underwent acute surgical management, and 14 underwent delayed surgical management, with a mean time to an intervention of 3 days. Thirty patients were found to have testicular atrophy, with a mean follow-up of 14 months, of these 30 patients, 63% (n = 19) were conservatively managed, 20% (n = 6) were managed with acute surgical repair, and 17% (n = 5) were managed with delayed surgical repair. CONCLUSION Paediatric testicular trauma is a rare presentation. A high level of suspicion is mandatory when testicular rupture is suspected. Early exploration is warranted in the setting of high risk and provides an excellent chance of testicular salvage.
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Affiliation(s)
- Kenneth Patterson
- Department of Urology, Tallaght University Hospital, Dublin, Ireland.
| | | | - Fardod O'Kelly
- Department of Paediatric Urology, Beacon Hospital, Dublin, Ireland
- Department of Surgery, University College Dublin, Dublin, Ireland
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Sintim-Damoa A, Cohen HL. Pearls and Pitfalls of Pediatric Scrotal Imaging. Semin Ultrasound CT MR 2022; 43:115-129. [PMID: 35164905 DOI: 10.1053/j.sult.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Akosua Sintim-Damoa
- Department of Radiology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Harris L Cohen
- Department of Radiology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
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Crocetto F, Arcaniolo D, Napolitano L, Barone B, La Rocca R, Capece M, Caputo VF, Imbimbo C, De Sio M, Calace FP, Manfredi C. Impact of Sexual Activity on the Risk of Male Genital Tumors: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168500. [PMID: 34444249 PMCID: PMC8392571 DOI: 10.3390/ijerph18168500] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 12/26/2022]
Abstract
Most cancers are related to lifestyle and environmental risk factors, including smoking, alcohol consumption, dietary habits, and environment (occupational exposures). A growing interest in the association between sexual activity (SA) and the development of different types of tumors in both men and women has been recorded in recent years. The aim of the present systematic review is to describe and critically discuss the current evidence regarding the association between SA and male genital cancers (prostatic, penile, and testicular), and to analyze the different theories and biological mechanisms reported in the literature. A comprehensive bibliographic search in the MEDLINE, Scopus, and Web of Science databases was performed in July 2021. Papers in the English language without chronological restrictions were selected. Retrospective and prospective primary clinical studies, in addition to previous systematic reviews and meta-analyses, were included. A total of 19 studies, including 953,704 patients were selected. Case reports, conference abstracts, and editorial comments were excluded. Men with more than 20 sexual partners in their lifetime, and those reporting more than 21 ejaculations per month, reported a decreased risk of overall and less aggressive prostate cancer (PCa). About 40% of penile cancers (PCs) were HPV-associated, with HPV 16 being the dominant genotype. Data regarding the risk of HPV in circumcised patients are conflicting, although circumcision appears to have a protective role against PC. Viral infections and epididymo-orchitis are among the main sex-related risk factors studied for testicular cancer (TC); however, data in the literature are limited. Testicular trauma can allow the identification of pre-existing TC. SA is closely associated with the development of PC through high-risk HPV transmission; in this context, phimosis appears to be a favoring factor. Sexual behaviors appear to play a significant role in PCa pathogenesis, probably through inflammatory mechanisms; however, protective sexual habits have also been described. A direct correlation between SA and TC has not yet been proven, although infections remain the most studied sex-related factor.
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Affiliation(s)
- Felice Crocetto
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Davide Arcaniolo
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (D.A.); (M.D.S.)
| | - Luigi Napolitano
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
- Correspondence:
| | - Biagio Barone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Roberto La Rocca
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Marco Capece
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Vincenzo Francesco Caputo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Ciro Imbimbo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
| | - Marco De Sio
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (D.A.); (M.D.S.)
| | - Francesco Paolo Calace
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (D.A.); (M.D.S.)
| | - Celeste Manfredi
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80121 Naples, Italy; (F.C.); (B.B.); (R.L.R.); (M.C.); (V.F.C.); (C.I.); (F.P.C.); (C.M.)
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (D.A.); (M.D.S.)
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Wu WJ, Gitlin JS. The Male Genital System. Pediatr Rev 2020; 41:101-111. [PMID: 32123021 DOI: 10.1542/pir.2017-0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Wayland J Wu
- Smith Institute for Urology, Zucker School of Medicine, Lake Success, NY
| | - Jordan S Gitlin
- Cohen Children's Medical Center, Division of Pediatric Urology, Zucker School of Medicine, New Hyde Park, NY
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