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Alghuyaythat WK, Alkhamees M, Alanazi AS, Alotaibi KF, Kaseb AM, Alanazi AM, Almutairi MM, Alhusini FK, Almutairi AN, Aldhafeeri BM, Aldahash AO, Aljameely SR, Alenazi MO. Hypothesis and Holistic Knowledge of Testicular Torsion Among the General Population of the Kingdom of Saudi Arabia. Cureus 2023; 15:e51194. [PMID: 38283529 PMCID: PMC10817825 DOI: 10.7759/cureus.51194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Background Testicular torsion is a serious condition that requires immediate medical attention. It occurs when the spermatic cord, which carries blood to the testicles, twists, reducing blood flow and oxygen to the testicle. This can lead to tissue death and loss of the testis if not treated promptly. It is important to seek medical attention immediately when symptoms of testicular torsion arise, as prompt treatment can help prevent permanent damage to the testicle. This study aimed to explore the level of knowledge about testicular torsion among the general population in the Kingdom of Saudi Arabia. Methodology A descriptive cross-sectional study was conducted using a convenience sample recruited from the general population who fulfilled the inclusion criteria. The data were collected from participants using an electronic pre-structured questionnaire. The researchers developed the questionnaire through expert consultation and after an intensive literature review. The questionnaire was reviewed by a panel of three experts for validation and applicability. After a pilot study, the reliability coefficient (Cronbach's alpha) was 0.74. The data were analyzed using SSPS version 25 (IBM Corp., Armonk, NY, USA) and presented as percentages and frequencies. Chi-square and logistic regression were conducted. P-values ≤0.05 were considered statistically significant. Results A total of 732 participants were recruited, most of whom were male (486, 66.4%), with ages ranging between 18 and 30 years (452, 61.7%). Regarding testicular torsion knowledge, more than half of the participants had good knowledge (406, 55.5%) and knew about the signs, symptoms, and risk factors of testicular torsion. There was a statistically significant relationship between age and knowledge (p < 0.001) and an insignificant relationship between sex and knowledge (p > 0.05). Conclusions The study participants were found to have good knowledge. Fortunately, most participants knew that testicular torsion is an emergency and they must immediately visit the hospital. With further awareness programs, the overall knowledge level can be improved.
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Affiliation(s)
| | - Mohammad Alkhamees
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, SAU
| | | | | | - Ahmed M Kaseb
- College of Medicine, Majmaah University, Al-Majmaah, SAU
| | | | | | | | | | | | | | - Saad R Aljameely
- Department of Family Medicine, King Khalid General Hospital, Hafr Al-Batin, SAU
| | - Mohammad O Alenazi
- Department of Ear, Nose, and Throat, Northern Border University, Arar, SAU
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Minas A, Mahmoudabadi S, Gamchi NS, Antoniassi MP, Alizadeh A, Bertolla RP. Testicular torsion in vivo models: Mechanisms and treatments. Andrology 2023; 11:1267-1285. [PMID: 36825607 DOI: 10.1111/andr.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Testicular torsion is a condition in which a testis rotates around its longitudinal axis and twists the spermatic cord. This in turn results in a significant decrease in blood flow and perfusion of testicular tissue. During Testicular torsion, the testicular tissue is affected by ischemia, heat stress, hypoxia, and oxidative and nitrosative stress. The testicular torsion should be considered an emergency condition and surgical intervention (testicular detorsion ) as the sole treatment option in viable cases involves counter-rotation on twisted testes associated, when possible, to orchipexy, in order to avoid recurrence. Possible testicular detorsion side-effects occur due to reperfusion and endothelial cells injury, microcirculation disturbances, and intense germ cells loss. OBJECTIVES To discuss testicular torsion surgery-based methods, different time frames for testicular torsion induction, and the associated pathophysiology by emphasizing cellular and molecular events as well as different therapeutic agent applications for testicular torsion. MATERIALS AND METHODS We reviewed all original research and epidemiological papers related to testicular torsion condition. RESULTS Testicular torsion causes germ cell necrosis, arrested spermatogenesis, and diminished testosterone levels, with consequent infertility. Among different involved pathophysiological impacts, testicular torsion/detorsion-induced ischemia seems to play the key role by leading the tissue toward other series of events in testis. Numerous studies have used adjuvant antioxidants, calcium channel blockers, anti-inflammatory agents, or vasodilating agents in order to decrease these effects. DISCUSSION AND CONCLUSION To the best of our knowledge, no previously conducted study examined therapeutical agents' beneficial effects post clinical I/R condition in humans. Different agents targeting different pathophysiological conditions were used to ameliorate the ischemia/reperfusion-induced condition in animal models, however, none of the administrated agents were tested in human cases. Although considering testicular detorsion surgery is still the golden method to reverse the testicular torsion condition and the surgical approach is undeniable, the evaluated agents with beneficial effects, need to be investigated furthermore in clinical conditions. Thus, furthermore clinical studies and case reports are required to approve the animal models proposed agents' beneficial impacts.
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Affiliation(s)
- Aram Minas
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | - Sina Mahmoudabadi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Naeimeh Shamsi Gamchi
- Division of Pharmacology and Toxicology, Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Mariana Pereira Antoniassi
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | - Arash Alizadeh
- Division of Pharmacology and Toxicology, Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Ricardo Pimenta Bertolla
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
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Ebrahim SH, Alaysreen AA, Yousif YF. Outcomes of Surgical Exploration of Acute Scrotal Pain Raising Suspicion of Testicular Torsion. Cureus 2023; 15:e40098. [PMID: 37425520 PMCID: PMC10328451 DOI: 10.7759/cureus.40098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Background and objective Testicular torsion (TT) is a surgical emergency, affecting approximately one in every 4000 males under the age of 25 years annually in the United States. In this study, we aimed to determine the outcomes of emergency scrotal surgical exploration of cases that raised suspicion of TT presenting to Salmaniya Medical Complex (SMC), Bahrain's largest secondary and tertiary care center. Methods This was a retrospective cohort study. The data were collected from the hospital's electronic medical record software (I-SEHA). The data included patient age, Doppler ultrasound (DUS) findings prior to any surgical procedure, type of surgical procedure, and the surgical findings of that procedure. Results Of the 198 patients who underwent scrotal exploration, 141 had presented with signs and symptoms suggestive of TT. The mean age of the patients was 22.3 ±9.3 years. Doppler imaging was performed preoperatively on 135 out of 141 (95.7%) patients. After scrotal exploration, 91.4% of the patients were found to have TT. The proportion of patients with salvageable testis was 78.7%. Conclusions The study found that surgical exploration remains the definitive method in the management of acute scrotum in TT patients. Our findings are in line with those from other similar studies and meta-analyses.
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Zvizdic Z, Aganovic A, Milisic E, Jonuzi A, Zvizdic D, Vranic S. The Role of Demographic and Clinical Characteristics in Distinguishing Testicular Torsion from Torsion of the Appendix Testis: A Single-center Retrospective Study. Prague Med Rep 2023; 124:255-264. [PMID: 37736949 DOI: 10.14712/23362936.2023.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
The acute scrotum (AS) in the pediatric population is a medical emergency. AS is usually caused by testicular torsion (TT) and torsion of the appendix testis (TAT). The current study explored which demographic and clinical characteristics can help distinguish between TT and TAT. We analyzed all children ≤16 years who underwent surgical exploration for AS. The patients were divided into Group 1/TT and Group 2/TAT. Ninety patients were included in the study (24 with TT and 66 with TAT). The peak incidence of TT was significantly higher than in the TAT group (p<0.001). Scrotal pain was more prevalent in the TAT group (p=0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p=0.003 and p<0.001, respectively). The duration of symptoms was significantly longer in the TAT group (p<0.001). The duration of symptoms in the TT cohort significantly impacted the testicular salvage (p=0.008). Color Doppler ultrasound (CDUS) findings of absent/decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p<0.001). The older age, shorter duration of symptoms, systemic signs, and CDUS findings can help distinguish between the two most common acute scrotum causes.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Emir Milisic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Denisa Zvizdic
- Eye Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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5
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Comparison of demographic and clinical characteristics in distinguishing testicular torsion from torsion of the appendix testis: A single-center retrospective study. Asian J Urol 2022. [DOI: 10.1016/j.ajur.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kutsal C, Barhoom H, Halil Baloğlu İ, Tevfik Albayrak A, Tanık C, Dokucu Aİ. Histopathological effects of β-hCG and vitamin C on the detorsioned testicle in rats with unilateral testicular torsion. J Pediatr Urol 2022; 18:115.e1-115.e8. [PMID: 35144886 DOI: 10.1016/j.jpurol.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Testicular torsion is still an urgent surgical condition and without any treatment it can cause infertility. The main pathophysiology of testicular torsion ischaemic injury however; the main sequalae of detorsion is reperfusion injury. Furthermore; treatments to prevent ischemic reperfusion injury due to decreased blood flow are important to preserve testicular function. AIMS Human chorionic gonadotropin β (β-hCG) is an anabolic hormone that supports steroidogenesis and spermatogenesis. Vitamin C (Vit-C) is one of the water-soluble vitamins and is also a potent antioxidant in ischemic damage. Moreover, it has protective effects by increasing blood and lymph flow in the testicles. The aim of this study is to investigate the effects of β-hCG, Vit-C and their combination on ischemic reperfusion injury occurring after surgical treatment of testicular torsion. STUDY DESIGN Animal research studies. METHODS The study was performed on 25 male Wistar albino rats. The animals were divided equally into 5 groups. In the first group "Control Group," left orchiectomy was performed. In the second group "Sham Group," a 720° clockwise torsion was created and after 4 h of left testicular torsion it was detorsioned for 4 h and then left orchiectomy was performed. In the third group same procedure was applied with 30 mg vitamin C was administered via intraperitoneal route once a week for 3 weeks. In the fourth group after same surgical procedures 75 IU β-hCG was administered via intraperitoneal route once a week for 3 weeks. In the fifth group after 4 h left testicle torsion it was detorsioned for 4 h then, 75 IU β-hCG and vitamin C together were administered via intraperitoneal route once a week for 3 weeks. Left orchiectomy was performed after 3 weeks in the third, fourth and fifth groups. Specimens were evaluated histologically. RESULTS Testicular tissue histopathological evaluations were performed. A high histopathological stage indicates more testicular damage, and a low one was indicated less testicular damage. The average histopathological grade of vitamin C + β-hCG group was significantly higher than the average histopathological grade of the control, the sham group and vitamin C group. The average histopathological grade of the vitamin C group was significantly lower than the average histopathological grade of sham and β-hCG groups. The ratio of the testicular atrophy of the Vitamin C + β-hCG group (100%) was higher than sham (40%) and β-hCG (40%) groups with a significant difference. A significant statistical difference was found among all groups histopathological grades of testicular tissue. CONCLUSION In animals taking vitamin C, an improvement of histopathological findings and a significant decrease in histological stages has been provided. However, it was observed that the histological findings of β-hCG and β-hCG + vitamin C groups worsened. It was found that β-hCG increased oxidative damage in the testicles and this damage can be so severe that exceeding the capacity of potent antioxidants such as Vitamin C. We believe that β-hCG can be harmful to testicles exposed to oxidative damage.
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Affiliation(s)
- Cemil Kutsal
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Hüsam Barhoom
- Department of Pediatric Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | - İbrahim Halil Baloğlu
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Ahmet Tevfik Albayrak
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Canan Tanık
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Ali İhsan Dokucu
- Department of Urology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
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Takeshita H, Tachibana K, Sugiyama H, Kagawa M, Yano A, Okada Y, Morozumi M, Kawakami S. Nomogram predicting testicular torsion in Japanese patients with acute scrotal pain using physical examination findings and environmental conditions: Development and prospective external validation. Int J Urol 2021; 29:42-48. [PMID: 34599531 DOI: 10.1111/iju.14710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To develop a prediction tool based on physical findings and environmental conditions without utilizing color Doppler ultrasonography to guide non-urologists and patients' families in determining the testicular torsion possibility among patients with acute scrotal pain. METHODS Overall, 110 consecutive patients aged ≤30 years with acute scrotal pain at Saitama Medical Center between 2012 and 2014 were retrospectively evaluated. Physical examination results, including scrotal inspection, palpation and gait observation, and environmental conditions at pain onset (time range and ambient temperature) were collected. Multivariate analysis identified significant and independent risk factors for testicular torsion, and a nomogram predicting testicular torsion was constructed. The model underwent prospective validation in an independent set of 123 consecutive patients admitted with acute scrotal pain to our institution between 2015 and 2017. RESULTS Testicular torsion diagnosis rates were 27% (30/110) and 26% (32/123) in the training and validation cohorts, respectively. Logistic regression analysis showed four risk factors for developing testicular torsion: abnormal testicular position, walking difficulty, midnight to early morning onset and ambient temperature <15°C at pain onset. The constructed nomogram showed that the areas under the receiver operating characteristic curves were 0.92 and 0.84 for the training and validation cohorts, respectively. The calibration plot showed an acceptable fitness between the predicted probability and the observed rate of testicular torsion. CONCLUSIONS A novel nomogram was developed solely based on physical findings and environmental conditions to predict testicular torsion in Japanese patients with acute scrotal pain.
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Affiliation(s)
- Hideki Takeshita
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kojiro Tachibana
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Hironori Sugiyama
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Makoto Kagawa
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Akihiro Yano
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Yohei Okada
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Makoto Morozumi
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Satoru Kawakami
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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Alawamlh OAH, Flannigan R, Hayden R, Goldstein M, Li PS, Lee RK. Testicular Torsion and Spermatogenesis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1288:287-306. [PMID: 34453742 DOI: 10.1007/978-3-030-77779-1_14] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Testicular torsion (TT) is a common urologic emergency that can occur at any age. It is most common in newborns and during puberty. Prompt evaluation and management is required to salvage the testis following an episode of torsion. TT brings about damage to testicular tissue and spermatogenesis through various hypothesized mechanisms; however there is a consensus that the effects of ischemia, ischemia-reperfusion injury, and oxidative stress account for the most destructive effects. Numerous studies have examined the effects of various agents and therapies in limiting the effects of TT on the testis.
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Affiliation(s)
- Omar Al Hussein Alawamlh
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Ryan Flannigan
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Russell Hayden
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Marc Goldstein
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Philip S Li
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Richard K Lee
- James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA.
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Nene RV, Subramony R, Macias M, Campbell C, Aminlari A. Real-time Point-of-care Ultrasound for the Diagnosis and Treatment of Testicular Torsion. POCUS JOURNAL 2021; 6:70-72. [PMID: 36895665 PMCID: PMC9979951 DOI: 10.24908/pocus.v6i2.15186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Testicular torsion is a surgical emergency that needs prompt diagnosis and treatment. Point-of-Care ultrasound (POCUS) can not only establish the diagnosis but also guide the Emergency Physician in evaluating the response to manual detorsion. Case Report: We describe the case of a 13-year-old male who presented with acute scrotal pain. We demonstrate how bedside ultrasound was used to make the diagnosis of testicular torsion, guide the technique for manual detorsion, and confirm adequate return of blood flow. Our case illustrates the ease with which POCUS can be used in real time to diagnose and treat organ-threatening pathology, but more importantly, it shows how real-time POCUS was used to detorse a testicle that was refractory to the standard detorsion technique. Conclusion: The acute scrotum is a time-sensitive presentation and if testicular torsion is present, the diagnosis should be made as soon as possible. Many Emergency Departments do not have 24-hour coverage of ultrasound technicians, which would delay the diagnosis and treatment. Moreover, when manual detorsion is attempted, it often does not work because the testicle may need more than the standard 180 degree medial to lateral rotation. POCUS provides real-time analysis of return of blood flow and can thus guide further rotation, or opposite direction rotation, as needed.
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Affiliation(s)
- Rahul V Nene
- Department of Emergency Medicine, University of California San Diego, CA
| | - Rachna Subramony
- Department of Emergency Medicine, University of California San Diego, CA
| | - Michael Macias
- Department of Emergency Medicine, University of California San Diego, CA
| | - Colleen Campbell
- Department of Emergency Medicine, University of California San Diego, CA
| | - Amir Aminlari
- Department of Emergency Medicine, University of California San Diego, CA
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Dias AC, Maroccolo MVO, Ribeiro HDP, Riccetto CLZ. Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil. Int Braz J Urol 2020; 46:972-981. [PMID: 32758303 PMCID: PMC7527113 DOI: 10.1590/s1677-5538.ibju.2019.0660] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. PATIENTS AND METHODS Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. RESULTS 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). CONCLUSION Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing population-wide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.
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Affiliation(s)
- Aderivaldo Cabral Dias
- Unidade de Urologia do Hospital de Base do Distrito Federal, Brasília, DF, Brasil
- Disciplina de Urologia, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Marcus Vinicius Osorio Maroccolo
- Unidade de Urologia do Hospital de Base do Distrito Federal, Brasília, DF, Brasil
- Departamento de Cirurgia, Hospital da Criança José de Alencar, Brasília, DF, Brasil
| | | | - Cassio Luis Zanettini Riccetto
- Disciplina de Urologia, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
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11
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Syed MK, Al Faqeeh AA, Othman A, Hussein AA, Hussain S, Almas T, Alsufyani R, Alaeddin H, Syed S, Syed SK. The Spectrum of Testicular Pathologies Upon Scrotal Exploration for Acute Scrotum: A Retrospective Analysis. Cureus 2020; 12:e10984. [PMID: 33209540 PMCID: PMC7667721 DOI: 10.7759/cureus.10984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The term acute scrotum encompasses a plethora of testicular pathologies that are detrimental to the survival and sustenance of testes. The aim of the present study is to determine the spectrum of these testicular pathologies upon scrotal exploration performed in the aftermath of acute scrotal pain in the pediatric population. Methods This multicenter retrospective cross-sectional study was conducted at the department of pediatric surgery at two hospitals. During the study period, the clinical characteristics of the 76 patients that underwent scrotal exploration for acute scrotum were assessed. These included age, duration of symptoms on presentation, and identification of the etiology underlying scrotal pain. The data obtained was eventually analyzed using the Statistical Package for the Social Sciences (SPSS) 23.0 software (IBM Corp., Armonk, NY). Results A total of 76 scrotal exploration procedures were performed. The involvement of the left side of the scrotum was more common than the right side. Most of the patients who presented were older than five years of age. A majority of the patients presented after 24 hours of the commencement of their symptoms. Of the included participants, 36 patients (47.47%) were found to have an underlying torsion of appendix testes that was appropriately managed. Testicular torsion was observed in 15 patients, out of which eight viable testes were salvaged with a subsequent orchidopexy while seven torsions required orchiectomy owing to their non-viability. Other findings included epididymo-orchitis and infected hydrocele. A total of 19 testes appeared completely normal upon scrotal exploration. Conclusion Scrotal exploration should be considered as part of the medical and surgical workup and in the management of acute scrotum, as it divulges the specific underlying testicular pathology. Prompt scrotal exploration can aid in ascertaining the underlying etiology and is, therefore, pivotal in the apt management of the underlying pathology.
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Affiliation(s)
| | | | - Alsayed Othman
- Pediatric Surgery, Al-Azhar University - Assuit Branch, Assuit, EGY
| | | | - Salman Hussain
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Reema Alsufyani
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Hasan Alaeddin
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Saifullah Syed
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Sabahat K Syed
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
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12
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Validation of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score in the Diagnosis of Testicular Torsion in Children With Acute Scrotum. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1992-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Zitek T, Ahmed O, Lim C, Carodine R, Martin K. Assessing the Utility of Ultrasound and Urinalysis for Patients with Possible Epididymo-Orchitis - A Retrospective Study. Open Access Emerg Med 2020; 12:47-51. [PMID: 32214857 PMCID: PMC7081061 DOI: 10.2147/oaem.s234413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/18/2020] [Indexed: 01/13/2023] Open
Abstract
Purpose Many experts recommend ordering an ultrasound and a urinalysis on all patients with scrotal pain. While the ultrasound may help diagnose a number of potential causes of scrotal pain, the urinalysis primarily has value in assessing for epididymo-orchitis. This study sought to evaluate the utility of these diagnostic tests for patients who presented to the emergency department (ED) with acute scrotal pain and possible epididymo-orchitis. Patients and Methods This was a single-center chart review of patients presenting to the ED with scrotal pain. Trained research assistants reviewed charts to obtain urinalysis and ultrasound results as well as diagnoses and treatments provided. Using the final diagnosis as a gold standard, the sensitivity and specificity of ultrasound and urinalysis were calculated for the diagnosis of epididymo-orchitis. Also, through a prespecified definition of “changed management,” we estimated the percentage of cases in which a urinalysis changed management of patients with acute scrotal pain. Results We identified 663 adult and pediatric patients who presented with scrotal pain during 2016. All patients had an ultrasound performed, and 458 (69.1%) had a urinalysis done. The sensitivity of urinalysis for epididymo-orchitis was 58.2% (95% CI 48.9% to 67.1%), and the specificity was 85.1% (95% CI 80.8% to 88.7%). For ultrasound, the sensitivity was 78.8% (95% CI 71.4% to 85.0%) and the specificity was 98.1% (95% CI 96.4% to 99.1%). In 24 of 458 cases (5.2% [95% CI 3.4% to 7.7%]) where a urinalysis was obtained, its results may have changed management of the patient. Conclusion The diagnosis of patients who present to the ED with scrotal pain is primarily driven by the ultrasound results. While the urinalysis may occasionally provide some benefit in the evaluation of patients with suspected epididymo-orchitis, the reflexive ordering of a urinalysis in patients with scrotal pain may be unnecessary.
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Affiliation(s)
- Tony Zitek
- Department of Emergency Medicine, University Medical Center of Southern Nevada, Las Vegas, NV, USA.,Department of Emergency Medicine, Kendall Regional Medical Center, Miami, FL, USA.,Department of Emergency Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Omar Ahmed
- Department of Emergency Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Chee Lim
- Touro University Nevada College of Osteopathic Medicine, Henderson, NV, USA
| | - Rianda Carodine
- Department of Emergency Medicine, University Medical Center of Southern Nevada, Las Vegas, NV, USA.,University of Nevada, Las Vegas, NV, USA
| | - Kent Martin
- Department of Emergency Medicine, Kendall Regional Medical Center, Miami, FL, USA
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Abbas TO, Abdelkareem M, Alhadi A, Kini V, Chandra P, Al-Ansari A, Ali M. Suspected testicular torsion in children: diagnostic dilemma and recommendation for a lower threshold for initiation of surgical exploration. Res Rep Urol 2018; 10:241-249. [PMID: 30584529 PMCID: PMC6287511 DOI: 10.2147/rru.s186112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Testicular torsion (TT) represents a clinical challenge that needs emergency surgical assessment. It is common to have negative scrotal exploration due to confounding symptoms and signs which makes it sometimes difficult to differentiate from similar surgical emergencies that do not warrant surgery. At the same time, several occasions of misdiagnoses or late interventions occur with devastating effects. We aim at delineating the significance of the different clinical, laboratory, and radiological variables in the detection of TT. Methods We retrospectively reviewed the charts of 52 patients who were surgically explored with a preoperative working diagnosis of suspected TT in our center over the period from 2011 to 2015. All the patients were examined by pediatric surgeons in the emergency room and had undergone ultrasound imaging of the testes. The ultrasound images were retrospectively reviewed by a pediatric radiologist who was blinded to the intraoperative findings. Univariate and multivariate and logistic regression analyses were performed. Results Of the studied group of patients, the majority (84.6%) had TT upon surgical exploration. The most frequently presented symptom was pain (80.8%), and only a minority (11.5%) presented with vomiting. Radiological findings with the highest sensitivity were heterogeneous echogenicity in favor of TT and enlarged epididymis indicating that TT is unlikely. However, the predictability of TT by any of the assessed clinical and imaging factors was statistically insignificant. Conclusion It is important to gather all relevant data from clinical, laboratory, and imaging sources when assessing pediatric patients with suspected TT given the inaccuracy of each single one of them if used alone. Keeping this in mind, Doppler ultrasound has a significant role to aid in the accuracy of the diagnosis and hence the appropriate decision-making thereafter. However, we found no single clinical or imaging sign that is sensitive enough to prove or rule out TT. Therefore, surgical exploration should take place in a timely manner. Moreover, further research is necessary to construct scoring systems where different predictors collectively have higher reliability.
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Affiliation(s)
- Tariq O Abbas
- Department of Pediatric Surgery, Hamad General Hospital, Doha, Qatar, .,College of Medicine, Qatar University, Doha, Qatar, .,Weill Cornell Medical College-Qatar, Doha, Qatar,
| | | | | | | | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Mansour Ali
- Department of Pediatric Surgery, Hamad General Hospital, Doha, Qatar,
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Yapanoglu T, Ozkaya F, Yilmaz AH, Mammadov R, Cimen FK, Hirik E, Altuner D. Effect of etoricoxib on experimental oxidative testicular ischemia-reperfusion damage in rats induced with torsion-detorsion. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2017; 21:457-464. [PMID: 28883750 PMCID: PMC5587596 DOI: 10.4196/kjpp.2017.21.5.457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/30/2016] [Accepted: 09/09/2016] [Indexed: 12/11/2022]
Abstract
Etoricoxib features antioxidant and anti-inflammatory properties concomitantly, suggesting that it may be beneficial in testicular ischemia reperfusion (I/R) damage. Our aim is to investigate the effects of etoricoxib on testicular I/R damage induced with torsion-detorsion (TD). The etoricoxib + torsion-detorsion (ETD) groups of animals were given etoricoxib in 50 and 100 mg/kg of body weight (ETD-50 and ETD-100), while the testes torsion-detorsion (TTD) and sham operation rat group (SOG) animals were given single oral doses of distilled water as a solvent. TTD, ETD-50 and ETD-100 groups were subjected to 720° degrees torsion for four hours, and detorsion for four hours. The SOG group was not subjected to this procedure. Biochemical, gene expression and histopathological analyses were carried out on the testicular tissues. The levels of malondialdehyde (MDA), myeloperoxidase (MPO), interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) were significantly higher, and the levels of total glutathione (tGSH) and glutathione reductase (GSHRd) were significantly lower in the TTD group, compared to the ETD-50, ETD-100 and SOG groups. Etoricoxib at a dose of 100 mg/kg better prevented I/R damage than the 50 mg/kg dose. Etoricoxib may be useful in clinical practice in the reduction of I/R damage on testes caused by torsion-detorsion.
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Affiliation(s)
- Turgut Yapanoglu
- Department of Urology, Faculty of Medicine, Ataturk University, Erzurum 25240, Turkey
| | - Fatih Ozkaya
- Department of Urology, Bayburt State Hospital, Bayburt 69010, Turkey
| | - Ali Haydar Yilmaz
- Department of Urology, Bilecik State Hospital, Bilecik 11100, Turkey
| | - Renad Mammadov
- Department of Pharmacology, Faculty of Medicine, Erzincan University, Erzincan 24100, Turkey
| | - Ferda Keskin Cimen
- Department of Pathology, Mengucek Gazi Education and Research Hospital, Erzincan 24100, Turkey
| | - Erkan Hirik
- Department of Urology, Faculty of Medicine, Erzincan University, Erzincan 24100, Turkey
| | - Durdu Altuner
- Department of Pharmacology, Faculty of Medicine, Erzincan University, Erzincan 24100, Turkey
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Afsarlar CE, Elizondo R, Yilmaz E, Cakmakci E, Ballow DJ, Demir E, Guney G, Koh CJ. Ultrasonographic findings in the epididymis of pediatric patients with testicular torsion. J Pediatr Urol 2017; 13:393.e1-393.e6. [PMID: 28713006 DOI: 10.1016/j.jpurol.2017.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although grayscale ultrasound and color Doppler ultrasound characteristics of the torsed testis are well established in the literature, less is known about its anatomic partner: the epididymis. OBJECTIVE The purpose of this study was to describe the ultrasound characteristics of the epididymis in pediatric patients with testicular torsion, and to describe their potential role as prognostic criteria for testicular salvage outcomes. STUDY DESIGN During a retrospective review of 217 pediatric patients with acute testicular torsion during 2009-2016, morphological features of the epididymis from scrotal ultrasounds (size, parenchymal characteristics, and vascular flow of both epididymis heads), as well as patient demographics, time duration, surgical outcomes, histopathology results, and follow-up periods were analyzed. RESULTS Mean epididymis size and twisting degree were significantly higher in the torsed testes than in the contralateral epididymis (P < 0.001) (Summary table). Cystic structures in the epididymis were identified: a higher number of cysts was associated with testicular non-viability (P = 0.025) and higher twisting degree (P = 0.017). Histopathologic examination showed that these spaces were infiltrated connective tissue most likely formed by venous congestion and vessel rupture. DISCUSSION Scrotal ultrasound can provide information on testicular morphology and viability, as well as morphological changes in the epididymis over time in pediatric patients with testicular torsion. These findings may provide potential prognostic information regarding testicular viability, as a higher number of cystic spaces in the epididymis was associated with a higher rate of testicular non-viability and a higher twisting degree. In addition, the epididymis size (volume) can change during the time course of the ischemic state. CONCLUSIONS This was the first study to describe and analyze epididymis ultrasound findings in pediatric patients with testicular torsion and to correlate them with testicular salvage outcomes. Further prospective studies are needed to determine the role of epididymis ultrasound findings as a potential pre-operative prognostic tool.
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Affiliation(s)
- C E Afsarlar
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatric Surgery, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - R Elizondo
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - E Yilmaz
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatric Surgery, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - E Cakmakci
- Department of Radiology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - D J Ballow
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - E Demir
- Department of Biostatistics, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - G Guney
- Department of Pathology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - C J Koh
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Schlomer BJ, Keays MA, Grimsby GM, Granberg CF, DaJusta DG, Menon VS, Ostrov L, Sheth KR, Hill M, Sanchez EJ, Harrison CB, Jacobs MA, Huang R, Burgu B, Hennes H, Baker LA. Transscrotal Near Infrared Spectroscopy as a Diagnostic Test for Testis Torsion in Pediatric Acute Scrotum: A Prospective Comparison to Gold Standard Diagnostic Test Study. J Urol 2017; 198:694-701. [PMID: 28392394 DOI: 10.1016/j.juro.2017.03.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE A rapid test for testicular torsion in children may obviate the delay for testicular ultrasound. In this study we assessed testicular tissue percent oxygen saturation (%StO2) measured by transscrotal near infrared spectroscopy as a diagnostic test for pediatric testicular torsion. MATERIALS AND METHODS This was a prospective comparison to a gold standard diagnostic test study that evaluated near infrared spectroscopy %StO2 readings to diagnose testicular torsion. The gold standard for torsion diagnosis was standard clinical care. From 2013 to 2015 males with acute scrotum for more than 1 month and who were less than 18 years old were recruited. Near infrared spectroscopy %StO2 readings were obtained for affected and unaffected testes. Near infrared spectroscopy Δ%StO2 was calculated as unaffected minus affected reading. The utility of near infrared spectroscopy Δ%StO2 to diagnose testis torsion was described with ROC curves. RESULTS Of 154 eligible patients 121 had near infrared spectroscopy readings. Median near infrared spectroscopy Δ%StO2 in the 36 patients with torsion was 2.0 (IQR -4.2 to 9.8) vs -1.7 (IQR -8.7 to 2.0) in the 85 without torsion (p=0.004). AUC for near infrared spectroscopy as a diagnostic test was 0.66 (95% CI 0.55-0.78). Near infrared spectroscopy Δ%StO2 of 20 or greater had a positive predictive value of 100% and a sensitivity of 22.2%. Tanner stage 3-5 cases without scrotal edema or with pain for 12 hours or less had an AUC of 0.91 (95% CI 0.86-1.0) and 0.80 (95% CI 0.62-0.99), respectively. CONCLUSIONS In all children near infrared spectroscopy readings had limited utility in diagnosing torsion. However, in Tanner 3-5 cases without scrotal edema or with pain 12 hours or less, near infrared spectroscopy discriminated well between torsion and nontorsion.
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Affiliation(s)
- Bruce J Schlomer
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas.
| | | | | | | | | | - Vani S Menon
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | | | - Kunj R Sheth
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Clanton B Harrison
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | - Micah A Jacobs
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | | | - Berk Burgu
- Ankara Üniversitesi Tıp Fakültesi, Ankara, Turkey
| | - Halim Hennes
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | - Linda A Baker
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
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The paediatric acute scrotum. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000511422.16408.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Street EJ, Justice ED, Kopa Z, Portman MD, Ross JD, Skerlev M, Wilson JD, Patel R. The 2016 European guideline on the management of epididymo-orchitis. Int J STD AIDS 2017. [PMID: 28632112 DOI: 10.1177/0956462417699356] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epididymo-orchitis is a commonly encountered condition with a reported incidence of 2.45 cases per 1000 men in the United Kingdom. This 2016 International Union against Sexually Transmitted Infections guideline provides up-to-date advice on the management of this condition. It describes the aetiology, clinical features and potential complications, as well as presenting diagnostic considerations and clear recommendations for management and follow-up. Early diagnosis and management are essential, as serious complications can include abscess formation, testicular infarction and infertility. Recent epidemiological evidence suggests that selection of fluoroquinolone antibiotics with anti-Chlamydial activity is more appropriate in the management of sexually active men in the over 35 years age group.
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Affiliation(s)
- Emma J Street
- 1 Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | | | - Zsolt Kopa
- 3 Semmelweis University, Budapest, Hungary
| | - Mags D Portman
- 4 Central and North West London NHS Foundation Trust, London, UK
| | - Jonathan D Ross
- 5 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mihael Skerlev
- 6 Department of Dermatology and Venereology, Zagreb University School of Medicine, Zagreb, Croatia
| | | | - Rajul Patel
- 8 Solent NHS Trust, University of Southampton, Southampton, UK
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Four-year retrospective look for acute scrotal pathologies. North Clin Istanb 2017; 2:182-188. [PMID: 28058365 PMCID: PMC5175104 DOI: 10.14744/nci.2016.16768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 01/03/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: A group of diseases in the scrotum setting forth by the sudden swelling and redness and pain consist of acute scrotal pathologies. The most common causes of acute scrotum in children are epididymitis, epididymo-orchitis, orchitis, testicular torsion, torsion of the appendix testis, incarcerated inguinal hernia and traumatic hydro/hematocele. In this study; we aim to evaulate patients with acute scrotal pathologies who were interned in our department. METHODS: All hospital data of cases who were interned at our deparment due to acute scrotum in between June 2010-June 2014 were evaluated retrospectively. Cases with incarcerated inguinal herni were excluded in this study. RESULTS: In a 4-year-period 114 cases were interned in our department with acute scrotum. Mean age of the patients was 7.6±4.577 years (min: 1m-max: 18yrs). Doppler US was performed in 112 patients to evaluate the blood flow while in 2 patients applied after normal office hours were evaluated without Doppler US and operated under emergency conditions. The patients had received diagnosis of epididymitis/epididymo-orchitis/orchitis (n=83 cases; 72.8%), testicular torsion (n=24; 21.1%), torsion of the appendix testis (n=2; 1.8%) with and traumatic hydrocele/ hematocele (n=5; 4.4%). While detorsion was performed in 18 (75%) cases with testicular torsion and orchiectomy in 6 (25%) cases. Histopathological evaluation of orchiectomy specimens revealed hemorrhagic necrosis and hemorrhagic infarction or ischemic changes. Normal testicular size and vascularity were detected in 11 (61.1%) cases with detorsioned testis as detected by follow-up Doppler US. Late orchiectomy was performed in 7 cases (38.9%) with complete atrophy due to lack of blood supply. CONCLUSION: Although Doppler US is very helpful for differential diagnosis of patients with acute scrotum who applied early period, if Doppler US will lead to a waste of time, direct surgery without delay will reduce the risk of testicular loss.
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Surgery of the Male Genital System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
In April 2013, the Centers for Disease Control and Prevention (CDC) convened an advisory group to assist in development of the 2015 CDC sexually transmitted diseases (STDs) treatment guidelines. The advisory group examined recent abstracts and published literature addressing the diagnosis and management of sexually transmitted infections. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of epididymitis that were considered in preparation of the 2015 CDC STD treatment guidelines.
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Affiliation(s)
- Stephanie N Taylor
- Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans
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25
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Yılmaz Ö, Yeşildal C, Malkoç E, Soydan H. Testicular torsion in a patient with Cohen syndrome. Turk J Urol 2015; 41:51-52. [PMID: 26328200 PMCID: PMC4548649 DOI: 10.5152/tud.2015.27136] [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: 03/27/2014] [Accepted: 07/03/2014] [Indexed: 06/04/2023]
Abstract
Cohen syndrome is an extremely rare autosomal recessive disorder. A 12-year-old boy with Cohen syndrome applied to a primary health care center because of severe pain in the left groin and was diagnosed with epididymo-orchitis. Despite the administered the antibiotic treatment, pain increased. Therefore, the family brought the patient to the emergency department 16 h after the first diagnosis. The patient had mild mental retardation, myopia, and craniofacial dysmorphism, which are components of Cohen syndrome. There was no blood flow on the left testicle at color Doppler ultrasonography. Further, scrotal exploration was performed because of a high risk of torsion. The left testicle was torsioned, and the color was dark blue. Revascularization could not be achieved by detorsion; left orchiectomy and right testicular fixation were then conducted. In conclusion, to the best of our knowledge, this is the first reported case of testicular torsion in Cohen syndrome. If a patient with this syndrome has acute groin pain, testicular torsion should be immediately ruled out with Doppler ultrasonography. These patients may not clearly and correctly express themselves because of mild mental retardation. Moreover, detailed genitourinary, particularly testicular examination may clarify the omitted pathologies and make them well known in future in this syndrome.
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Affiliation(s)
- Ömer Yılmaz
- Correspondence: Ömer Yılmaz, Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey, Phone: +90 530 322 68 34 E-mail:
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Latham JL. Surgery of the Male Genital System. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Testicular torsion is a urological emergency most commonly seen in adolescence, involving a decrease in blood flow in the testis resulting from torsion of the spermatic cord that can result in gonad injury or even loss if not treated in time. Testicular ischaemia-reperfusion injury represents the principle pathophysiology of testicular torsion, with ischaemia caused by twisting of the spermatic cord, and reperfusion on its subsequent release. Many cellular and molecular mechanisms are involved in ischaemia-reperfusion injury following testicular torsion. Studies have investigated the use of pharmacological agents as supportive therapy to surgical repair in order to prevent the adverse effects of testicular torsion. Numerous substances have been proposed as important in the prevention of post-ischaemia-reperfusion testicular injury. A range of chemicals and drugs has been successfully tested in animal models for the purpose of mitigating the dangerous effects of ischaemia-reperfusion in testis torsion.
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Moslemi MK, Kamalimotlagh S. Evaluation of acute scrotum in our consecutive operated cases: a one-center study. Int J Gen Med 2014; 7:75-8. [PMID: 24470769 PMCID: PMC3896279 DOI: 10.2147/ijgm.s52413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose The purpose of the present study was to evaluate the clinical history, demographic data, surgical exploration findings, and final diagnoses in all young males presenting with acute scrotum to our center. Materials and methods This was a descriptive–retrospective study in which all consecutive cases of acute scrotum treated in our department from March 2008 to March 2012 were evaluated. Results A total of 116 cases were included in the study. Out of these cases, 100 cases underwent surgical exploration, and the remaining 16 cases were managed conservatively. Our eligible cases were divided into three groups: the testicular torsion (TT) group (68%); the torsion of the appendix testis (AT) group (20%); and the epididymo-orchitis (EO) group (9%). Testicular preservation was achieved in 39 cases of the TT group, while due to delayed referral, orchiectomy was performed in 29 cases. Thus, our testicular salvage rate was 57.5% and missed testicular torsion rate was 42.5%. Conclusion It was observed that our testicular salvage rate was lower than the expected figures published in the literature. This is may be attributed to different causes, including delayed referral or presentation of acute scrotum cases, inadequate knowledge of the general practitioners working in emergency departments, or poor knowledge of parents.
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Affiliation(s)
- Mohammad Kazem Moslemi
- Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Sharifeh Kamalimotlagh
- Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran
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van Heurn LWE, Pakarinen MP, Wester T. Contemporary management of abdominal surgical emergencies in infants and children. Br J Surg 2013; 101:e24-33. [PMID: 24338775 DOI: 10.1002/bjs.9335] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute abdominal complaints in children are common presentations in the emergency department. The aetiology, presentation, diagnosis and management often differ from those in adults. METHODS This review was based on expert paediatric surgical experience confirmed by evidence from the literature obtained by searching PubMed and the Cochrane Library. Keywords used were the combinations of 'abdominal emergencies', 'acute abdomen' and the disorders 'acute appendicitis', 'intussusception', 'volvulus', 'Meckel's diverticulum', 'incarcerated inguinal hernia', 'testicular torsion' and 'ovarian torsion' with 'children'. Information was included from reviews, randomized clinical trials, meta-analyses, and prospective and retrospective cohort studies. RESULTS Presentation and symptoms of abdominal emergencies, especially in young children, vary widely, which renders recognition of the underlying disorder and treatment challenging. Critically targeted imaging techniques are becoming increasingly important in obtaining the correct diagnosis without unnecessary delay. Minimally invasive techniques have become the method of choice for the diagnosis and treatment of many abdominal emergencies in children. CONCLUSION Knowledge of abdominal disorders in childhood, their specific presentation, diagnosis and treatment facilitates management of children with acute abdomen in emergency departments. Imaging and minimally invasive techniques are becoming increasingly important in the diagnosis of acute abdomen in children. Urgent operation remains the cornerstone of therapy for most acute abdominal disorders.
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Affiliation(s)
- L W E van Heurn
- Departments of Paediatric Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Differentiation of Epididymitis and Appendix Testis Torsion by Clinical and Ultrasound Signs in Children. Urology 2013; 82:899-904. [DOI: 10.1016/j.urology.2013.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 03/26/2013] [Accepted: 04/01/2013] [Indexed: 11/30/2022]
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31
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Reiman MP, Mather RC, Hash TW, Cook CE. Examination of acetabular labral tear: a continued diagnostic challenge. Br J Sports Med 2013; 48:311-9. [DOI: 10.1136/bjsports-2012-091994] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Boettcher M, Krebs T, Bergholz R, Wenke K, Aronson D, Reinshagen K. Clinical and sonographic features predict testicular torsion in children: a prospective study. BJU Int 2013; 112:1201-6. [DOI: 10.1111/bju.12229] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Boettcher
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
| | - Thomas Krebs
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
| | - Robert Bergholz
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
| | - Katharina Wenke
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
| | - Daniel Aronson
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
| | - Konrad Reinshagen
- Department of Paediatric Surgery; UKE Medical School; Hamburg Germany
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Liao WS, Shen BY, Wu CC. Acute scrotal pain associated with urethral foreign bodies. FORMOSAN JOURNAL OF SURGERY 2013. [DOI: 10.1016/j.fjs.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Smith RP, Tracy CR, Kavoussi PK, Witmer MT, Costabile RA. The impact of color Doppler ultrasound on treatment patterns of epididymitis in a university-based healthcare system. Indian J Urol 2013; 29:22-6. [PMID: 23671360 PMCID: PMC3649595 DOI: 10.4103/0970-1591.109979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Evaluate the impact of scrotal color Doppler ultrasound (CDUS) on epididymitis treatment patterns in a university-based institution. MATERIALS AND METHODS From 1 January 1999 to 30 July 2005, 870 patients from a single institution were diagnosed with epididymitis. A total of 480 men met the inclusion criteria for acute epididymitis. Scrotal ultrasound was included as a part of the diagnostic evaluation in 42.7% of men. Ultrasound reports were available for review in 187 cases. Information regarding patient demographics, diagnostic evaluation, and treatment was reviewed. RESULTS Ultrasound findings consistent with epididymitis were identified in 69.3% of men. The four most commonly reported irregularities were scrotal wall thickening (84.2%), abnormal epididymal echotexture (74%), increased epididymal vascularity (72.9%), and an enlarged epididymis (71.5%). Scrotal ultrasound was performed in 67% men under age 20 compared to 36% men between ages 30 and 69. Patients presenting to the Emergency Department underwent sonographic evaluation 57% of the time versus 17.2% men presenting to primary care physicians (P < 0.001). Ninety-five per cent (194/204) of patients who underwent CDUS were treated with antibiotics compared to 96% (263/275) of those who did not receive an ultrasound (P = 0.78). CONCLUSIONS CDUS can be helpful in patients with a potential diagnosis of testicular torsion, however, the use of CDUS as a diagnostic adjunct in the evaluation of epididymitis is of limited value. Treatment patterns and antibiotic usage were not significantly altered by ultrasound findings at this institution.
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Affiliation(s)
- Ryan P Smith
- Department of Urology, University of Virginia Health System, Charlottesville, VA, USA
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Altinkilic B, Pilatz A, Weidner W. Detection of Normal Intratesticular Perfusion Using Color Coded Duplex Sonography Obviates Need for Scrotal Exploration in Patients with Suspected Testicular Torsion. J Urol 2013; 189:1853-8. [DOI: 10.1016/j.juro.2012.11.166] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Bora Altinkilic
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
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Retrospective Review of Diagnosis and Treatment in Children Presenting to the Pediatric Department With Acute Scrotum. AJR Am J Roentgenol 2013; 200:W444-9. [DOI: 10.2214/ajr.12.10036] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nason GJ, Tareen F, McLoughlin D, McDowell D, Cianci F, Mortell A. Scrotal exploration for acute scrotal pain: a 10-year experience in two tertiary referral paediatric units. Scand J Urol 2013; 47:418-22. [PMID: 23281617 DOI: 10.3109/00365599.2012.752403] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Acute scrotal pain is a common presentation to the paediatric emergency department. Testicular torsion is one of the most common causes of acute scrotal pain. Testicular torsion is a surgical emergency requiring immediate surgical exploration to prevent permanent testicular damage or loss. The aim of this study was to determine the surgical outcome of all scrotal explorations and to assess the use of colour Doppler ultrasound (CDUS) in the assessment of acute scrotal pain in two tertiary referral paediatric units. MATERIAL AND METHODS A retrospective review of a prospectively maintained database was carried out for all scrotal explorations between 1999 and 2010. RESULTS In total, 155 scrotal explorations were carried out for acute scrotal pain. The mean age was 9.1 years (range 0-15 years). The pathology in 46.5% (n = 72) was testicular torsion, 30.3% (n = 47) were torsion of a testicular appendage, 16.1% (n = 25) were epididymitis, 3.3% (n = 5) had no obvious pathology identified and other pathology accounted for 4%. There was a significant difference in age of presentation between those with testicular torsion and those with torsion of a testicular appendage (9 vs 10 years, p = 0.0074). CDUS was performed by a trained radiologist on 40 patients. Overall sensitivity, specificity, positive predictive value and negative predictive value for CDUS predicting testicular torsion were 96.9%, 88.9%, 96.9% and 89%, respectively. Overall, 36 patients (23%) with acute scrotal pain (50% of patients in the group with confirmed testicular torsion at exploration) required orchidectomy. CONCLUSION This study supports the practice of immediate surgical exploration with a clinical suspicion of testicular torsion in a paediatric population.
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Affiliation(s)
- Gregory J Nason
- Department of Paediatric Surgery and Urology, Our Lady's Children's Hospital, Crumlin , Dublin , Ireland
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Barbosa JA, Tiseo BC, Barayan GA, Rosman BM, Torricelli FCM, Passerotti CC, Srougi M, Retik AB, Nguyen HT. Development and initial validation of a scoring system to diagnose testicular torsion in children. J Urol 2012; 189:1859-64. [PMID: 23103800 DOI: 10.1016/j.juro.2012.10.056] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 10/16/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Testicular torsion is a surgical emergency requiring prompt intervention. Although clinical diagnosis is recommended, scrotal ultrasound is frequently ordered, delaying treatment. We created a scoring system to diagnose testicular torsion, decreasing the indication for ultrasound. MATERIALS AND METHODS We prospectively evaluated 338 patients with acute scrotum, of whom 51 had testicular torsion. Physical examination was performed by a urologist, and all patients underwent scrotal ultrasound. Univariate analysis and logistic regression were performed, and a scoring system for risk stratification of torsion was created. Retrospective validation was performed with 2 independent data sets. RESULTS The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1) and high riding testis (1). Cutoffs for low and high risk were 2 and 5 points, respectively. Ultrasound would be indicated only for the intermediate risk group. In the prospective data set 69% of patients had low, 19% intermediate and 11.5% high risk. Negative and positive predictive values were 100% for cutoffs of 2 and 5, respectively (specificity 81%, sensitivity 76%). Retrospective validation in 1 data set showed 66% of patients at low, 16% intermediate and 17% high risk. Negative and positive predictive values for cutoffs of 2 and 5 were 100% (specificity 97%, sensitivity 54%). The second retrospective data set included only torsion cases, none of which was misdiagnosed by the scoring system. CONCLUSIONS This scoring system can potentially diagnose or rule out testicular torsion in 80% of cases, with high positive and negative predictive values for selected cutoffs. Ultrasound orders would be decreased to 20% of acute scrotum cases. Prospective validation of this scoring system is necessary.
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Affiliation(s)
- João A Barbosa
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts 02115, USA.
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Koç ZP, Onur R, Balci TA. A novel false-positive cause in testis scintigraphy in the diagnosis of testis torsion. BMJ Case Rep 2012; 2012:bcr-2012-006742. [PMID: 22987904 DOI: 10.1136/bcr-2012-006742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Testis scintigraphy is the most reliable modality in the diagnosis of testis torsion since it directly reflects the vascularity of the testis. The 'rim sign' is considered as the pathognomonic sign of the missed torsion. However, there are some possible false-positive cases. In this case report, we would like to present an unexpected false-positive cause of the 'rim sign' in testis scintigraphy in an 18-year-old male patient.
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Affiliation(s)
- Zehra Pinar Koç
- Department of Nuclear Medicine, Fırat University Hospital, Elazig, Turkey.
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Günther P, Rübben I. The acute scrotum in childhood and adolescence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:449-57; quiz 458. [PMID: 22787516 DOI: 10.3238/arztebl.2012.0449] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 03/28/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The acute scrotum in childhood or adolescence is a medical emergency. Inadequate evaluation and delays in diagnosis and treatment can result in irreversible harm, up to and including loss of a testis. Various diseases can produce this clinical picture. The testis is ischemic in only about 20% of cases. METHODS This review is based on a selective literature search, the existing clinical guideline, and the authors' experience. RESULTS The clinical approach to the acute scrotum must begin with a standardized, rapidly performed diagnostic evaluation. Dopper ultrasonography currently plays a central role. Its main use is to demonstrate the central arterial blood supply and venous drainage of the testis. The resistance index of the testicular vessels should also be determined. CONCLUSION Physical examination and properly performed Doppler ultrasonography enable adequate evaluation of the acute scrotum in childhood and adolescence. In the rare cases of diagnostic uncertainty, immediate surgical exposure of the testis remains the treatment of choice.
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Affiliation(s)
- Patrick Günther
- Sektion Kinderchirurgie, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Clinical predictors of testicular torsion in children. Urology 2012; 79:670-4. [PMID: 22386422 DOI: 10.1016/j.urology.2011.10.041] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 10/21/2011] [Accepted: 10/21/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To distinguish the prognostic factors that decrease the probability of a negative exploration for "acute scrotum." In some institutes, patients with "acute scrotum" undergo immediate exploration after clinical evaluation. Because testicular torsion (TT) accounts only for a fraction of these cases, most infants can be treated conservatively. METHODS We performed a retrospective study of all patients treated at our institute from January 2008 to December 2009 for the diagnosis of "acute scrotum." Differences between groups were calculated using the chi-square test or analysis of variance and Mann-Whitney-Wilcoxon test for univariate or multivariate analysis, expressed as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The data from 138 patients were analyzed. The mean age was 9 years, 8 months. Of the 138 patients, 19 (13.8%) had TT. This group was compared with the boys without TT at exploration. The patients with TT were older on average (11 years, 1 month vs 9 years, 1 month, p = .035). Pain for <24 hours (OR 4.2, 95% CI 1.3-13.4), nausea and/or vomiting (OR 21.6, 95% CI 4.9-93.4), abnormal cremasteric reflex (OR 4.8 95% CI 0.7-35.2), and a high position of the testis (OR 18.0 95% CI 1.8-177.1) were associated with an increased likelihood of torsion. In the group of boys with ≥ 2 of these findings present, 100% had TT at exploration, with 0% false-positive results. CONCLUSION TT is uncommon among the group of boys treated for "acute scrotum." In particular, a pain duration <24 hours, nausea or vomiting, a high position of the testis, and an abnormal cremasteric reflex had a positive prognostic value for TT. A clinical score might help to avoid unnecessary explorations. In the future, we intend to test the diagnostic set described combined with ultrasonography.
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Dienye PO, Jebbin NJ. Acute appendicitis masquerading as acute scrotum: a case report. Am J Mens Health 2011; 5:524-7. [PMID: 21816859 DOI: 10.1177/1557988311415514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Acute appendicitis presents typically with periumbilical pain that in a few hours settles at the right lower quadrant of the abdomen. Atypical presentations are common but association with acute scrotum is an extreme rarity. A 30-year-old fisherman presented at a rural medical facility with a 2-day complaint of severe pain at the right hemiscrotum followed about 24 hours later with mild diffuse abdominal pain. There was associated mild fever and nausea but no vomiting. There were no urinary symptoms and no recent sexual exposure. Initial physical examination revealed mild generalized tenderness worse at the right lower quadrant but the scrotum was not remarkable, and cremasteric sign was negative. He was admitted as a case of acute abdomen for close observation. Abdominal and scrotal ultrasound scan were normal. By the second day of admission, pain became marked at the right lower abdomen with associated vomiting. There was also marked tenderness at the right lower quadrant with rebound. A diagnosis of acute appendicitis was thus made and appendicectomy done after proper workup. The abdominal and scrotal pain stopped after surgery and the patient was discharged on the seventh postoperative day. Patients with unusual abdominal and scrotal pain should be admitted and closely observed and evaluated to prevent unnecessary scrotal exploration or negative appendicectomy.
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Affiliation(s)
- Paul O Dienye
- University of Port Harcourt Teaching Hospital, Nigeria.
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Srinivasan A, Cinman N, Feber KM, Gitlin J, Palmer LS. History and physical examination findings predictive of testicular torsion: an attempt to promote clinical diagnosis by house staff. J Pediatr Urol 2011; 7:470-4. [PMID: 21454130 DOI: 10.1016/j.jpurol.2010.12.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 12/11/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To standardize the history and physical examination of boys who present with acute scrotum and identify parameters that best predict testicular torsion. MATERIALS AND METHODS Over a 5-month period, a standardized history and physical examination form with 22 items was used for all boys presenting with scrotal pain. Management decisions for radiological evaluation and surgical intervention were based on the results. Data were statistically analyzed in correlation with the eventual diagnosis. RESULTS Of the 79 boys evaluated, 8 (10.1%) had testicular torsion. On univariate analysis, age, worsening pain, nausea/vomiting, severe pain at rest, absence of ipsilateral cremaster reflex, abnormal testicular position and scrotal skin changes were statistically predictive of torsion. After multivariate analysis and adjusting for confounding effect of other co-existing variables, absence of ipsilateral cremaster reflex (P < 0.001), nausea/vomiting (P < 0.05) and scrotal skin changes (P < 0.001) were the only consistent predictive factors of testicular torsion. CONCLUSION An accurate history and physical examination of boys with acute scrotum should be primary in deciding upon further radiographic or surgical evaluation. While several forces have led to less consistent overnight resident staffing, consistent and reliable clinical evaluation of the acute scrotum using a standardized approach should reduce error, improve patient care and potentially reduce health care costs.
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Affiliation(s)
- Arun Srinivasan
- Division of Pediatric Urology, Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, Long Island, Lake Success, NY 11042, USA
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Acute appendicitis presenting with a painful inguinal mass: complication related to patent processus vaginalis and testicular maldescent. Pediatr Emerg Care 2011; 27:414-6. [PMID: 21546805 DOI: 10.1097/pec.0b013e318218744d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Appendicitis with or without perforation is a common pediatric emergency department diagnosis, as are the findings of patent processus vaginalis and cryptorchidism. We describe the unique presentation of perforated appendicitis complicated by a tender inguinal mass resulting from the presence of purulence as well as a cryptorchid but viable testis within a patent processus vaginalis. We describe our diagnostic approach and review the literature relevant to inguinoscrotal presentations of appendicitis.
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46
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Graham SM, Gatti JM. Painful testicle in a young boy. CMAJ 2010; 182:1543-4. [PMID: 20501782 DOI: 10.1503/cmaj.090499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Stephen M Graham
- Department of Urology, University of Kansas Medical Center, Kansas City, USA
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Beni-Israel T, Goldman M, Bar Chaim S, Kozer E. Clinical predictors for testicular torsion as seen in the pediatric ED. Am J Emerg Med 2010; 28:786-9. [PMID: 20837255 DOI: 10.1016/j.ajem.2009.03.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 03/31/2009] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of the study was to identify clinical findings associated with increased likelihood of testicular torsion (TT) in children. DESIGN This study used a retrospective case series of children with acute scrotum presenting to a pediatric emergency department (ED). RESULTS Five hundred twenty-three ED visits were analyzed. Mean patient age was 10 years 9 months. Seventeen (3.25%) patients had TT. Pain duration of less than 24 hours (odds ratio [OR], 6.66; 95% confidence interval [CI], 1.54-33.33), nausea and/or vomiting (OR, 8.87; 95% CI, 2.6-30.1), abnormal cremasteric reflex (OR, 27.77; 95% CI, 7.5-100), abdominal pain (OR, 3.19; 95% CI, 1.15-8.89), and high position of the testis (OR, 58.8; 95% CI, 19.2-166.6) were associated with increased likelihood of torsion. CONCLUSIONS Testicular torsion is uncommon among pediatric patients presenting to the ED with acute scrotum. Pain duration of less than 24 hours, nausea or vomiting, high position of the testicle, and abnormal cremasteric reflex are associated with higher likelihood of torsion.
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Affiliation(s)
- Tali Beni-Israel
- Pediatric Emergency Unit, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Zerifin 70300, Israel
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Diagnosis and Management of Testicular Torsion, Torsion of the Appendix Testis, and Epididymitis. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2009. [DOI: 10.1016/j.cpem.2009.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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49
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Using color power Doppler ultrasound imaging to diagnose the acute scrotum. A pictorial essay. Emerg Radiol 2008; 15:289-94. [DOI: 10.1007/s10140-008-0710-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 01/31/2008] [Indexed: 12/01/2022]
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50
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Kaye JD, Shapiro EY, Levitt SB, Friedman SC, Gitlin J, Freyle J, Palmer LS. Parenchymal echo texture predicts testicular salvage after torsion: potential impact on the need for emergent exploration. J Urol 2008; 180:1733-6. [PMID: 18721947 DOI: 10.1016/j.juro.2008.03.104] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Indexed: 10/21/2022]
Abstract
PURPOSE In the setting of signs and symptoms of testicular torsion the absence of diastolic flow and/or color flow on Doppler ultrasound has traditionally prompted emergent scrotal exploration. This practice emanates largely from the difficulty on ultrasound of distinguishing salvageable torsed testes from those that are not salvageable. We identified ultrasound findings predictive of testicular viability or the lack thereof. MATERIALS AND METHODS We retrospectively reviewed the charts of all boys who underwent scrotal exploration for signs and symptoms of torsion during a 4-year period. In those who underwent preoperative Doppler ultrasound of the scrotum ultrasound findings were reviewed, as were the operative dictations. In patients who underwent orchiectomy the pathology reports were also reviewed. In patients in whom the torsed testis appeared viable and who underwent orchiopexy followup data were reviewed when available. Emergency room charts were also reviewed to ascertain, when documented, the duration of pain before presentation to the emergency room and the interval between ultrasound and operating room. RESULTS During this period 55 boys underwent exploration after preoperative scrotal Doppler ultrasound revealed absent diastolic flow and/or color flow Doppler in the symptomatic testis. Assessment of parenchymal echogenicity revealed heterogeneity in 37 testes (67%), of which none were deemed viable at exploration. Orchiectomy was performed in 34 of 37 cases. Pathological examination revealed necrosis in all 34 cases, a finding consistent with late torsion. The remaining 3 testes underwent orchiopexy by parental directive despite nonviability, as confirmed by biopsy and subsequent atrophy. Thus, heterogeneity on preoperative ultrasound was universally predictive of organ loss (chi-square p <0.001). Of the 18 symptomatic testes (33%) demonstrating homogeneity and isoechogenicity on ultrasound 16 (89%) were deemed viable at exploration. Boys in whom the torsed testicle was nonviable on exploration experienced an average of 27.5 hours of pain preoperatively (range 5 to 72), whereas boys in whom the torsed testis was salvaged experienced an average of 20.5 hours of pain (range 2 to 96) (p = 0.073). The nonviable group underwent surgery an average of 49 minutes after ultrasound, whereas the viable group underwent surgery 52 minutes after ultrasound (p = 0.92). None of the 55 patients experienced any surgical or anesthetic complications and no pathological condition was noted intraoperatively in the contralateral asymptomatic testis. CONCLUSIONS In the setting of Doppler proven testicular torsion heterogeneous parenchymal echo texture indicates late torsion and testicular nonviability. Therefore, the case may not require emergent scrotal exploration. On the other hand, homogeneous echo texture portends extremely well for testicular viability. Thus, such testes should be explored emergently.
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Affiliation(s)
- Jonathan D Kaye
- Division of Pediatric Urology, Schneider Children's Hospital, North Shore-Long Island Jewish Health System, Long Island, New York, USA
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