Causes of delayed exploration of the acute scrotum in a regional tertiary centre

2020 ◽  
pp. 205141582098119
Author(s):  
Benjamin Storey ◽  
Nathan Shugg ◽  
Alison Blatt
Keyword(s):  
Retrospective Review ◽  
Testicular Torsion ◽  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
Acute Scrotum ◽  
Tertiary Institution ◽  
Level Of Evidence ◽  
Scrotal Pain ◽  
Surgical Exploration ◽  
Significant Difference

Background: Testicular torsion is an organ-threatening surgical emergency with a limited timeframe for intervention. Objective: To identify the delays to surgical exploration of patients with an acute scrotum in a tertiary hospital to prevent adverse outcomes associated with this time critical emergency. Methods: A retrospective review of medical records for all patients who underwent scrotal exploration for acute scrotal pain in a tertiary hospital in regional New South Wales between January 2008 to December 2018 was performed. Results: Retrospective review identified 242 patients, of whom 161 had testicular torsion and 56 resultant orchidectomies. No statistically significant difference in pre-hospital delays between paediatric or adult populations was found. The average time from presentation to theatre was 4 h 36 min. Patients who were delayed > 6 h from presentation to surgical exploration had significantly increased rates of orchidectomy. Delays that significantly affected rates of orchidectomy were transfer from peripheral sites, late presentation, misdiagnosis and representation after discharge. Conclusion: The most common reason for delay was diagnostic error with the patient later re-presenting to hospital. Patient transfer from the primary hospital to a tertiary institution and subsequent delayed surgical exploration also contributed to significantly higher rates of orchidectomy. Level of Evidence: 3

Approach to Male Urologic Emergencies

2019 ◽  
Author(s):  
Jonathan E. Davis ◽  
Jeffrey S. Dubin
Keyword(s):  
Emergency Department ◽  
Inguinal Hernia ◽  
Necrotizing Fasciitis ◽  
Testicular Torsion ◽  
Diagnosis And Treatment ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Penile Pain ◽  
Emergency Department Setting ◽  
Acute Scrotal Pain

This review details the evaluation and management of the acute scrotum in the emergency department setting and emergent penile complaints in adults, with an emphasis on the most serious and most common conditions. Other emergent conditions include necrotizing fasciitis of the perineum (Fournier disease), incarcerated or strangulated inguinal hernia, and genitourinary (GU) trauma. Emergency practitioners need to be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis. Basic anatomy and bedside evaluation are reviewed. Acute scrotal and penile pain and GU trauma are discussed in terms of assessment and stabilization, diagnosis, and treatment and disposition.  This review contains 5 figures, 19 tables, and 71 references. Keywords: Acute scrotal pain, testicular torsion, priapism, Peyronie disease, paraphimosis, phimosis, balanitis, posthitis, epididymitis

Clinical and Radiological Outcomes of Forefoot Offloading Versus Rigid Flat Shoes in Patients Undergoing Surgery of the First Ray

2019 ◽  
Vol 40 (10) ◽  
pp. 1189-1194 ◽  
Author(s):  
Paul M. C. Dearden ◽  
Robbie I. Ray ◽  
Peter W. Robinson ◽  
Caroline R. Varrall ◽  
Thomas J. Goff ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Score ◽  
Hallux Valgus ◽  
Controlled Trial ◽  
Adverse Outcomes ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Forefoot Surgery ◽  
Significant Difference

Background: It is common clinical practice to use either flat or reverse camber shoes to protect the foot for up to 6 weeks after surgery for hallux valgus or hallux rigidus. To date there is a paucity of evidence as to whether there is any difference between these 2 postoperative shoes, in either patient satisfaction or clinical outcomes. Methods: One hundred consecutive patients undergoing scarf/Akin osteotomies or first metatarsophalangeal joint (MTPJ) arthrodesis were recruited. Patients were randomized 50:50 to either flat or reverse camber postoperative shoes. Patients undergoing ancillary lesser toe procedures were not excluded. Patient satisfaction was assessed by visual analog scale (VAS) pain score and Likert satisfaction survey. Radiographic outcomes were reviewed at 1 year observing differences in fusion rates or deformity recurrence. There were 47 patients in the reverse cam and 43 in the flat shoe group. No difference in primary forefoot operation, additional operation, age at surgery, or preop VAS pain score was seen. Results: At 6 weeks, there was no significant difference in postop VAS pain score. The flat shoe group was significantly more likely to be satisfied with their general mobility (86.0% vs 61.7%; P = .01) and with their stability in the shoe (90.7% vs 69.6%; P = .03). No significant difference was seen between groups for nonunion or hallux valgus recurrence rates. Conclusion: Both forms of postoperative footwear were effective in enabling patients to mobilize and in preventing adverse outcomes. Patients were more likely to be satisfied with a flat postoperative shoe due to improved stability and ease of mobilizing. The results of this study aid surgeon decision making for postoperative footwear in forefoot surgery. Level of Evidence: Level II, prospective randomized controlled trial.

scholarly journals Interobserver Variability of the Diagnosis of Scaphoid Proximal Pole Fractures

2018 ◽  
Vol 07 (04) ◽  
pp. 350-354
Author(s):  
Reinier Beks ◽  
Tessa Drijkoningen ◽  
Femke Claessen ◽  
Thierry Guitton ◽  
David Ring ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
Consecutive Series ◽  
Proximal Pole ◽  
Level Of Evidence ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Improve Reliability ◽  
Control Study

Purpose Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures from waist fractures is important for management but it is unclear if the distinction is reliable. Methods A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures. Fifty-seven members of the Science of Variation Group (SOVG) were randomized to diagnose fracture location and displacement by using radiographs alone or radiographs and a computed tomography (CT) scan. Results Observers reviewing radiographs alone and observers reviewing radiographs and CT scans both had substantial agreement on fracture location (κ = 0.82 and κ = 0.80, respectively; p = 0.54). Both groups had only fair agreement on fracture displacement (κ = 0.28 and κ = 0.35, respectively; p = 0.029). Conclusion Proximal pole fractures are sufficiently distinct from proximal waist fractures that CT does not improve reliability of diagnosis. Level of Evidence Level IV interobserver reliability case-control study.

scholarly journals Management of the Acute Scrotum in a District General Hospital: 10-Year Experience

2009 ◽  
Vol 9 ◽  
pp. 281-286 ◽  
Author(s):  
Lukas Tajchner ◽  
John O. Larkin ◽  
Michael G. Bourke ◽  
Ronan Waldron ◽  
Kevin Barry ◽  
...  
Keyword(s):  
Testicular Torsion ◽  
Surgical Intervention ◽  
False Negative ◽  
False Negative Rate ◽  
District General Hospital ◽  
Primary Objective ◽  
Common Finding ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Operative Exploration

The acutely painful scrotum is a common urologic emergency. The primary objective of management is to avoid testicular loss. This requires a high index of clinical suspicion and prompt surgical intervention. In our series conducted between January 1996 and December 2005, 119 patients (age range: 4–62 years) underwent emergency operative exploration for acute scrotal pain. The most common finding was torted cyst of Morgagni (63/119, 52.9%), followed by testicular torsion (41/119, 34.4%). The majority of testicular torsions occurred in the pubertal group (22/41, 53.6%). Only one patient in this group had an unsalvageable testis necessitating orchidectomy, a testicular loss rate in torsion of 2.4%. There were no postoperative wound infections or scrotal haematomas. Testicular salvage depends critically on early surgical intervention, so the delay incurred in diagnostic imaging may extend the period of ischaemia. Furthermore, all radiological investigations have a certain false-negative rate. We advocate immediate surgical exploration of the acute scrotum. We report a low orchidectomy rate (2.4%) in testicular torsion.

scholarly journals Testicular Torsion in Children: A 20-Year Retrospective Study in a Single Institution

2011 ◽  
Vol 11 ◽  
pp. 362-368 ◽  
Author(s):  
Chao Yang ◽  
Bin Song ◽  
Juan Tan ◽  
Xin Liu ◽  
Guang-hui Wei
Keyword(s):  
Median Duration ◽  
Testicular Torsion ◽  
Clinical Manifestations ◽  
Acute Scrotum ◽  
Duration Of Symptoms ◽  
Surgical Exploration ◽  
Early Surgical Intervention ◽  
Hormonal Levels

In this paper, we evaluated the historical features and physical examination findings, as well as laboratory tests and ultrasound examinations, in children with testicular torsion (TT), in order to improve diagnosis and treatment in this population. A retrospective review of patients with diagnosis of TT between January 1990 and January 2010 was performed. We included 118 cases in the study, accounting for 9.01% of all cases of acute scrotum. Mean patient age was 9.3 ± 5.6 years. The left side was predominantly affected. The median duration of symptoms up to surgical exploration was 64 h. Absence of cremasteric reflex presented in 94.9% patients. All boys had an ultrasound of the scrotum; decreased or absent blood flow was observed in all orchidectomy patients. Heterogeneous echogenicity presented in all cases of orchidectomy. At surgery, viable testes were present in 46 boys (39%) and preserved; in 72 boys with nonviable testes, they were removed. The median duration of symptoms at presentation was 12 h when the testes were successfully conserved and 90 h when they were removed. Testicular salvage depends critically on early surgical intervention. Ultrasound is a useful tool for the clinical assessment of patients with TT, however, sonographic interpretation must be in conjunction with the clinical manifestations. We advocate immediate surgical exploration with suspected TT. Long-term hormonal levels are within the normal range regardless of the fate of the testis. Further follow-up is needed to confirm fertility after TT.

scholarly journals Bilateral Epididymal Cyst in 14 year-old Boy: a case report

2014 ◽  
Vol 4 (1) ◽  
pp. 68-71
Author(s):  
Yiğit Akin ◽  
Mehmet Sarac ◽  
Isil Basara ◽  
Selcuk Yucel ◽  
Ahmet Kazez
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Medical Treatment ◽  
Cyst Wall ◽  
Testicular Torsion ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Testis Tumor ◽  
Histopathological Evaluation ◽  
History Of

Bilateral epididymal cysts are rare in childhood. Clinically they may present as acute scrotum and should be differentiated from other pathologies. Here in, we report bilateral epididymal cysts in a 14-year-old boy. He was admitted to emergency department with symptoms of acute left scrotum. There was no history of trauma or infection. Blood analyses, including testis tumor markers were unremarkable. Bilateral epididymal cysts were diagnosed on ultrasonography evaluation. Medical treatment did not stop his scrotal pain. During scrotal exploration, there was no evidence of testicular torsion or any other pathology. An excision of cyst was performed. Histopathologically, the cyst wall was lined by columnar epithelia. As a result of these findings, a pathological diagnosis of epididymal cyst was made. The synchronized evaluation of clinical and ultrasonography findings with an appropriate histopathological evaluation can usually diagnose this rare pathology.

scholarly journals The Diagnostic Accuracy of Testicular Torsion by Doctors on Duty Using Sonographic Evaluation with Color Doppler

2020 ◽  
Vol 14 (5) ◽  
pp. 155798832095300
Author(s):  
Akinori Nakayama ◽  
Hisamitsu Ide ◽  
Akiyoshi Osaka ◽  
Yasuyuki Inoue ◽  
Yukihito Shimomura ◽  
...  
Keyword(s):  
Blood Flow ◽  
Diagnostic Accuracy ◽  
Testicular Torsion ◽  
Color Doppler ◽  
Ultrasonic Transducer ◽  
Color Doppler Ultrasound ◽  
Medical Emergency ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Testicular Blood Flow

As testicular torsion is a medical emergency, it requires quick diagnosis and treatment. Color Doppler ultrasound (CDUS) is useful for the diagnosis of testicular torsion. An accurate diagnosis can be difficult when CDUS indicates the preservation of blood flow in the testis. We examined the accuracy of testicular torsion diagnosis in patients with acute scrotum made by doctors on duty using CDUS. The subjects included 26 patients who visited our department between January 2016 and June 2018 presenting with acute scrotal pain. Patients were placed into one of three groups based on testicular blood flow evaluated by CDUS. The first group had no testicular blood flow, the second had diminished blood flow, and the last group had normal or increased blood flow. Patients were also diagnosed through scrotal exploration. Finally, patients were further divided into two groups identified by CDUS frequency utilized during diagnosis (12 MHz groups and ≤8 MHz groups), and the diagnostic accuracy of the two groups was compared. Characterizing torsion by either the absence of or diminished, testicular blood flow in the CDUS evaluation, the sensitivity and specificity of the CDUS performed by doctors on duty accounted for 69.2% and 53.8%, respectively. No improvement in diagnostic accuracy was evident despite the usage of a 12-MHz ultrasonic transducer. In this study, the sensitivity of CDUS performed by doctors on duty was about 70%, suggesting that scrotal exploration should be performed promptly even if testicular blood flow is observed and testicular torsion is suspected from medical history and body findings.

scholarly journals Acute scrotum: differential diagnosis and treatment

2018 ◽  
Vol 97 (3) ◽  
pp. 278-282
Author(s):  
João Arthur Brunhara Alves Barbosa ◽  
Marco Antonio Arap
Keyword(s):  
Blood Flow ◽  
Differential Diagnosis ◽  
Testicular Torsion ◽  
Color Doppler ◽  
Testicular Tumor ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Acute Scrotum ◽  
Viral Etiology ◽  
Scrotal Pain

Acute scrotum (AS) is a clinical syndrome characterized by scrotal pain of acute onset, often accompanied by scrotal swelling and other local and systemic signs and symptoms. It may be the initial presentation of several diseases including testicular torsion, orchitis, epididymitis, hydatid torsion, strangulated hernia and, less frequently, scrotal hematoma and testicular tumor. In the setting of emergency services, physicians should be extremely careful with the possibility of testicular torsion. This condition consists in the torsion of the spermatic cord, leading to an interruption of the testicular blood flow, with ischemia and ultimately necrosis. It is associated with acute severe pain, nausea, absence of the cremasteric reflex, and a high-riding testis. Physical examination may help diagnosis. However, a color Doppler ultrasound of the scrotum is usually required for a definitive diagnosis. Ultrasound will reveal a reduction or no blood flow to the affected testis; surgical treatment is mandatory and should be performed as early as possible. A differential diagnosis is orchiepididymitis. It may be of viral etiology in early childhood and bacterial after the beginning of sexual activity. The most specific sign associated with this condition is the relief of pain after elevation of the testis, known as Prehn’s sign. Treatment for bacterial cases requires antibiotics, while cases of viral etiology require only symptomatics. Hydatid torsion, including torsion of appendix testicularis and appendix epididymis may mimic testicular torsion but on ultrasound, blood flow is preserved, and a twisted appendix is often seen. Treatment for this condition consists only in symptomatic control. Testicular torsion should be treated as early as possible, since a delay of 6 hours may result in organ loss. Surgery consists of bilateral orchiopexy in case of a viable testicle and orchiectomy of a necrotic organ, always with fixation of the contralateral testicle.

scholarly journals Real-time Point-of-care Ultrasound for the Diagnosis and Treatment of Testicular Torsion

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 70-72
Author(s):  
Rahul V. Nene ◽  
Rachna Subramony ◽  
Michael Marcias ◽  
Colleen Campbell ◽  
Amir Aminlari
Keyword(s):  
Blood Flow ◽  
Real Time ◽  
Testicular Torsion ◽  
Point Of Care ◽  
Diagnosis And Treatment ◽  
Acute Scrotum ◽  
Point Of Care Ultrasound ◽  
Scrotal Pain ◽  
Real Time Analysis ◽  
Acute Scrotal Pain

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.  

scholarly journals Testicular Torsion and Contralateral Torsion of the Appendix Testis

2021 ◽  
Author(s):  
Oğuzhan Yusuf Sönmez ◽  
Mehmet Sevim ◽  
Halil İbrahim İvelik ◽  
Burak İşler ◽  
Bekir Aras
Keyword(s):  
Testicular Torsion ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Clinical Suspicion ◽  
Acute Scrotum ◽  
Hormonal Stimulation ◽  
Scrotal Pain ◽  
Mild Abdominal Pain ◽  
Urological Emergency ◽  
Appendix Testis

Testicular torsion is a urological emergency that results in deterioration of the blood supply of the testicle and ischemia as a result of the rotation of the spermatic cord around itself. It may show a wide clinical variety with inflammatory manifestations varying from mild abdominal pain to severe scrotal pain. Orchiectomy may be required in cases which are delayed and cannot be operated urgently. Torsion of the testis and epididymis are other frequently seen causes of acute scrotum in children. Growth of masses and hormonal stimulation in the adolescent age cause an increase in the tendency of the torsion of appendix testis which have a small pedicle and epididymis. In the presence of sudden scrotal pain, testicular torsion should be considered, if there is clinical suspicion, patients should be evaluated with color doppler ultrasound (CDUS) and scrotal exploration should be performed immediately. A 20-year-old male whose clinical picture, and scrotal ultrasonography suggested the presence of testicular torsion is presented in this case report.

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