Retrospective review of paediatric patients with acute scrotum

Abstract

BACKGROUND: The purpose of the present study was to evaluate the historical features and physical examination findings in boys presenting with acute scrotum and to determine the reliability of these modalities to make the correct clinical diagnosis. METHODS: A retrospective review of all boys presenting with acute scrotal/testicular pathology between January 1994 and December 1998 was performed. RESULTS: Two hundred and four boys were included in the study: 110 with torsion of the testicular appendage (TA), 40 with testicular torsion (TT), 29 with epididymo-orchitis (EO) and 25 with other diagnoses. Seventeen boys were managed conservatively. With the exception of symptom duration, there was no statistically significant difference between boys with TA, TT and EO. Boys with TT sought medical attention significantly earlier (median: 9.5 h) than those with TA (median: 48 h). Boys requiring an orchidectomy (n = 8) presented later than those who did not (median 30 vs 9 h; P < 0.05): seven (88%) were under 7 years of age. The testicular salvage rate was 88% and 36% with a pain duration of <12 h and >12 h, respectively. The preoperative clinical diagnosis was correct in 80% of those boys who underwent surgical exploration. Testicular torsion was misdiagnosed clinically in five boys. Late testicular atrophy was not observed in the present study. CONCLUSIONS: Most boys presenting with acute scrotum have TA. The history and physical examination can reliably identify those boys who can be managed conservatively. Routine surgical exploration is no longer justified in all boys with acute scrotum.