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Anheuser P, Steffens J. [Acute genital diseases]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:557-565. [PMID: 38689028 DOI: 10.1007/s00120-024-02335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
Acute genital diseases can occur at any age and are characterized by complaints of various kinds of the external genitalia. Pain, swelling, and redness of the scrotum, adjacent groin region, and immediate surroundings are the leading symptoms, the severity of which may vary. In addition, peritonitic symptoms such as nausea, vomiting, and circulatory sensations may be present and are comparable to symptoms of an acute abdomen. The term "acute scrotum" encompasses various clinical entities, where scrotal symptoms are predominant and represent a urological emergency situation. Immediate and comprehensive diagnostics are necessary to ensure timely management in case of necessary surgical intervention.
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Affiliation(s)
- Petra Anheuser
- Abteilung für Urologie, AK Wandsbek, Alphonsstraße 14, 22403, Hamburg, Deutschland.
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
| | - Joachim Steffens
- Abteilung für Urologie und Kinderurologie, St. Antonius Hospital Eschweiler, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
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Buch Kjeldgaard A, Kinder-Klausen MS, Nerstrøm M, Cohen J, Henriksen BM, Thorup JM. The impact of ultrasound on testicular loss in cases of testicular torsion in children. Pediatr Surg Int 2024; 40:83. [PMID: 38507099 PMCID: PMC10954916 DOI: 10.1007/s00383-024-05663-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Ultrasound as a diagnostic tool in suspicion of testicular torsion is still highly debated. In this investigation, we aimed to evaluate whether time spent on scrotal ultrasonography had a negative impact on testicular loss. METHODS Patients' records containing a scrotal ultrasound and/or surgical procedure codes for testicular interventions on suspicion of testicular torsion were examined. Patients aged 0-15 years admitted during 2015-2019 at Copenhagen University Hospital, Rigshospitalet were included. RESULTS In total, 1566 patients underwent an ultrasound and 142 of these proceeded to surgery while 13 patients proceeded directly to surgery without an ultrasound. The rate of testicular loss with a preceding ultrasound was 23% versus 42% without (p = 0.18). Four cases of testicular torsion were misdiagnosed by ultrasound resulting in a sensitivity of 95.4% and specificity of 95.6%. The mean diagnostic delay from ultrasound examination was 55 ± 39 min, and the mean time from ultrasound to surgery was at 169 ± 76 min versus 171 ± 72 min without ultrasound. CONCLUSION In a clinical setting, ultrasound provided a reliable tool for the diagnosis of testicular torsion and did not seem to increase the orchiectomy rate.
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Affiliation(s)
- Anastasia Buch Kjeldgaard
- Department of Pediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Laboratory of Tissue Engineering, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | | | - Malene Nerstrøm
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jonathan Cohen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birthe Merete Henriksen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Mogens Thorup
- Department of Pediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Gang XH, Duan YY, Zhang B, Jiang ZG, Zhang R, Chen J, Teng XY, Zhang DB. Clinical characteristics of testicular torsion and factors influencing testicular salvage in children: A 12-year study in tertiary center. World J Clin Cases 2024; 12:1251-1259. [PMID: 38524506 PMCID: PMC10955544 DOI: 10.12998/wjcc.v12.i7.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/09/2024] [Accepted: 02/04/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents. Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion. AIM To predict the possibility of testicular salvage (TS) in patients with testicular torsion in a tertiary center. METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University. Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion. The data included clinical findings, physical examinations, laboratory data, color Doppler ultrasound findings, operating results, age, presenting institution status, and follow-up results. RESULTS Our study included 75 patients. TS was possible in 57.3% of all patients; testicular torsion occurred mostly in winter, and teenagers aged 11-15 years old accounted for 60%. Univariate logistic regression analyses revealed that younger age (P = 0.09), body mass index (P = 0.004), torsion angle (P = 0.013), red blood cell count (P = 0.03), neutrophil-to-lymphocyte ratio (P = 0.009), and initial presenting institution (P < 0.001) were associated with orchiectomy. In multivariate analysis, only the initial presenting institution predicted TS (P < 0.05). CONCLUSION The initial presenting institution has a predictive value for predicting TS in patients with testicular torsion. Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.
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Affiliation(s)
- Xiang-Hui Gang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Yuan-Yuan Duan
- Department of Ultrasound Diagnosis, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Bin Zhang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Zheng-Gan Jiang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Rong Zhang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Jun Chen
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
| | - Xiang-Yu Teng
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Duo-Bing Zhang
- Department of Urology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China
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Wang Y, Wang K, Yu L, Ma X. A rare case of scrotal emergency: torsion of epididymal cyst-a case report and literature review. Front Pediatr 2024; 11:1245842. [PMID: 38264504 PMCID: PMC10803493 DOI: 10.3389/fped.2023.1245842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
As a benign disease, the incidence of epididymal cyst (EC) is 5%-25%, and it is relatively common in adults but rare in children. Although the pathogenesis of EC is still unclear, the symptoms of most asymptomatic patients can disappear with conservative treatment. EC torsion is even rarer in adults and children. Only ten cases have been reported in the literature, and we add this 3-year-old boy as the eleventh case of EC torsion. He was admitted to the hospital due to scrotum emergency without a history of EC or recent scrotal trauma. The ultrasonic examination revealed signs of an epididymal cyst. However, the pain and swelling of his scrotum were very similar to those of patients with testicular torsion, so we performed surgery on him. Therefore, EC torsion is very necessary to attract our attention as a differential diagnosis of testicular torsion in scrotal emergencies. Furthermore, our case is also the second youngest case of EC torsion.
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Affiliation(s)
| | | | | | - Xue Ma
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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5
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Fukuzawa H, Minoda N, Okamoto M, Tsuruno Y, Watanabe A. Contrast-enhanced ultrasound findings in testicular torsion and non-testicular torsion. J Med Ultrason (2001) 2024; 51:133-138. [PMID: 37994998 DOI: 10.1007/s10396-023-01384-x] [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: 07/23/2023] [Accepted: 09/27/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Testicular torsion requires emergency surgery; thus, prompt and correct diagnosis is very important. Ultrasound with color Doppler is usually the first-choice modality for diagnosis; however, skill and experience are required for confident diagnosis. Recently, contrast-enhanced ultrasound for the diagnosis of testicular torsion has been reported, but there have been only a few reports. This study aimed to compare contrast-enhanced ultrasound findings in cases of testicular torsion and non-testicular torsion. METHODS Patients who underwent contrast-enhanced ultrasound for acute scrotum at our institution between April 2010 and January 2023 were divided into testicular torsion (n = 17) and non-testicular torsion (n = 16) groups. The respective contrast-enhanced ultrasound findings were retrospectively examined and compared. RESULTS In 16 out of 17 cases of testicular torsion, the parenchyma of the affected testis was not enhanced. In the remaining case, reduced contrast enhancement was observed; however, it was still notably less than that observed on the unaffected testis. On the other hand, in all cases of non-testicular torsion (n = 16), the parenchyma of the affected testis was notably enhanced. CONCLUSION Contrast-enhanced ultrasound is considered an easy and accurate method for diagnosing testicular torsion.
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Affiliation(s)
- Hiroaki Fukuzawa
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, 670-8540, Japan.
| | - Naoki Minoda
- Department of Clinical Laboratory, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, 670-8540, Japan
| | - Mitsumasa Okamoto
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, 670-8540, Japan
| | - Yudai Tsuruno
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, 670-8540, Japan
| | - Aya Watanabe
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, 670-8540, Japan
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Kummari S, Das S, Mahajan S. Role of High-Resolution Ultrasonography With Colour and Duplex Doppler in the Evaluation of Acute Scrotal Diseases. Cureus 2023; 15:e49231. [PMID: 38143647 PMCID: PMC10739279 DOI: 10.7759/cureus.49231] [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] [Received: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction The term 'acute scrotum' denotes the sudden initiation of pain in the scrotal region. Acute scrotum is a frequent medical condition in children and adults. Ultrasound facilitates precise diagnosis and differentiation of numerous causes of acute scrotum. The objective of our research was to assess the utility of ultrasonography in the identification and prevalence determination of causes of acute scrotum. Materials and methods Patients with acute scrotal pain referred to the Department of Radiodiagnosis at Great Eastern Medical School & Hospital (GEMS), Srikakulam, India, were added in the research. This is a prospective observational study. High-frequency linear transducer (4-15 MHz) was used for imaging. Grey scale, colour and duplex Doppler were performed routinely. The ultimate diagnosis was established by considering the clinical results, follow-up observations, intraoperative observations and, when accessible, histopathological analysis. For the statistical analysis, IBM SPSS Statistics for Windows, version 22 (released 2013; IBM Corp., Armonk, New York, United States). was used. Descriptive analysis was conducted. The Kendall rank correlation coefficient was used to evaluate the non-parametric association between side and torsion. Results A total of 120 patients were included for statistical analysis. Inflammatory pathology was the most common cause of acute scrotum, followed by testicular torsion and torsion of testicular appendage. Testicular torsion and side of pain did not show a significant association. Conclusion High-resolution ultrasonography with colour and duplex Doppler sonography is an excellent imaging modality exhibiting exceptional sensitivity and specificity for the accurate diagnosis of acute scrotal diseases. Inflammatory pathology was the most common cause of acute scrotum, followed by testicular torsion and torsion of the testicular appendage.
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Affiliation(s)
| | - Saraswata Das
- Department of Radiodiagnosis, College of Medicine and JNM Hospital, Kalyani, IND
| | - Suvanya Mahajan
- Department of Radiology, Government Medical College, Jammu, Jammu, IND
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Reddy K, Ramteke H, Patel DJ, Deshpande SG, Patil M, Nayak K. Testicular Torsion and Irreversible Loss in an Adolescent Male: A Harrowing Case Report With Emphasis on Timely Intervention and Literature Review. Cureus 2023; 15:e42754. [PMID: 37654931 PMCID: PMC10468147 DOI: 10.7759/cureus.42754] [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: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Testicular torsion is a condition characterized by the twisting of the testis and spermatic cord within the scrotum, resulting in the obstruction of venous return and subsequent swelling. If left untreated, the torsion can progress to block the arterial blood supply, leading to ischemia. Prolonged ischemia can result in testicular necrosis and decreased fertility. Recognizing the urgency of this condition, timely diagnosis and management are crucial. In this clinical case, a 16-year-old male presented with left-sided scrotal pain following a minor trauma. Despite prompt medical attention, the delay in seeking treatment resulted in irreversible testicular necrosis. The case emphasizes the urgency of diagnosing and managing testicular torsion to prevent serious consequences such as testicular loss and reduced fertility. It serves as a poignant reminder for healthcare professionals to remain vigilant in recognizing this urological emergency and advocating for timely intervention to optimize patient outcomes.
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Affiliation(s)
- Kavyanjali Reddy
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshal Ramteke
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dharmesh J Patel
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swati G Deshpande
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mihir Patil
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Krushank Nayak
- Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kommentar zu Hodentorsion: Risikoabschätzung mithilfe des TWIST-Scores. Aktuelle Urol 2023; 54:16-18. [PMID: 36787771 DOI: 10.1055/a-1946-2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Komarowska M, Kowalska M, Grubczak K, Pawelczyk A, Hermanowicz A, Debek W, Matuszczak E. Situation of Pediatric Patients with Testicular Torsion in Times of COVID-19. Emerg Med Int 2023; 2023:9960452. [PMID: 37197364 PMCID: PMC10185415 DOI: 10.1155/2023/9960452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/23/2023] [Accepted: 04/23/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To assess whether the COVID-19 pandemic had an influence on presentation of testicular torsion and/or increase in the frequency of orchiectomy. Patients and Methods. This retrospective study included boys under 18 years of age with testicular torsion divided in two groups: pre-COVID operated in 2019 vs. COVID-19 group from 2020. We compared demographic data as well as local and general symptoms. We analyzed additional tests, intraoperative findings, length of operation and hospitalization, and followup. Results. We analyzed the data collected from 44 patients (24 boys from first group vs. 20 boys from second group). The median age was 13.4 years vs. 14.5 years in the latter. The median time of symptoms duration was 6.5 hours and 8.5 hours, respectively. The main manifestation was testicular pain without additional signs. The results of the laboratory tests did not reflect local advancement. In the 2019 group, Doppler ultrasound showed absent blood flow in the affected testicle in 62% vs. 80% in 2020. The mean time from admission to surgery was virtually identical: 75 minutes in 2019 vs. 76 minutes in 2020. The mean duration of scrotal revision was similar in both groups. There was only one significant difference: the degree of twisting. In 2019, the mean was 360° vs. 540° in 2020. Incidence of orchiectomy also did not significantly vary between the analyzed time periods, with 21% during the pandemic and 35% during the pre-COVID-19 period. Conclusion. We did not observe an increase in the number of testicular torsion cases during the COVID-19 pandemic. Most importantly, the rates of orchiectomy did not significantly differ between the patients with testicular torsion presenting during the COVID-19 outbreak.
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Affiliation(s)
- Marta Komarowska
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Kowalska
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
| | - Kamil Grubczak
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland
| | - Alicja Pawelczyk
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
| | - Adam Hermanowicz
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
| | - Wojciech Debek
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Matuszczak
- Department of Pediatric Surgery and Urology, Medical University of Bialystok, Bialystok, Poland
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Mecarini F, Fanos V, Crisponi G. Genital anomalies in newborns. J Perinatol 2021; 41:2124-2133. [PMID: 33649448 DOI: 10.1038/s41372-021-00991-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/15/2021] [Accepted: 02/03/2021] [Indexed: 02/05/2023]
Abstract
Examination of genitalia should be an essential part of newborn assessment. Early detection of congenital disorders is essential to begin appropriate medical or surgical therapy and to prevent complications that could profoundly affect a child's life. The present review aims to describe the main genital anomalies in infants and provide images in order to help the physician in current clinical practice.
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Affiliation(s)
- Federico Mecarini
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy.
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Giangiorgio Crisponi
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
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Feng S, Yang H, Lou Y, Ru W, Wang A, Liu W. Clinical Characteristics of Testicular Torsion and Identification of Predictors of Testicular Salvage in Children: A Retrospective Study in a Single Institution. Urol Int 2020; 104:878-883. [PMID: 32966996 DOI: 10.1159/000506236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Testicular torsion (TT) is a serious surgical emergency. Prompt diagnosis and treatment of TT are essential to improve the incidence of salvaged testes. The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. MATERIALS AND METHODS We retrospectively reviewed the records of 136 males who presented with TT to our institution. Clinical findings, physical examinations, laboratory data, color Doppler ultrasound findings, operating results, and the results of follow-up were collected and analyzed. Patients with neonatal torsion, negative scrotal exploration, or testicular appendix torsion were excluded. A multivariable logistic regression model was used to identify predictors of testicular salvage. Receiver operator characteristics analyses were performed to determine the probability of a non-salvageable torsed testis based on time and degree of twisting. RESULTS A total of 136 children with TT were identified. Patients were aged from 1 to 16 years, with a mean age of 9.7 years (median, 12; range, 1-16 years). The peak incidences of TT were found between ages of 12 and 14 years. Acute TT is significantly more common in the winter. Testicular salvage occurred in 49 (36%) cases. Of the 49 cases of testicular salvage, 5 patients developed subsequent testicular atrophy. Cutoff values of 13.5 h and 530 degrees of torsion would provide sensitivities of 96 and 61%, with specificity of 80 and 70%, respectively. Multivariate analysis showed that time to surgery and degree of testicular twist were correlated with the risk of a non-salvageable testis. CONCLUSIONS Testicular salvage can be predicted by the duration of symptoms along with degree of twisting. Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. A certain percentage of children with TT presenting with lower abdominal pain should have their testicles checked to make sure that they do not have torsion, especially those visitors in cold season.
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Affiliation(s)
- Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Huajun Yang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Yi Lou
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Wei Ru
- Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Aihe Wang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Weiguang Liu
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China,
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12
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Uçar M, Akkoç A. Nadir Bir Olgu; Testiküler Rüptür. ACTA MEDICA ALANYA 2017. [DOI: 10.30565/medalanya.338763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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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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Crisci V, Esposito C, Giurin I, Vitale V, Vallone G. Idiopathic scrotal hematoma simulating a testicular torsion, in association with cryptorchidism: US findings. Pol J Radiol 2014; 79:219-21. [PMID: 25061495 PMCID: PMC4108190 DOI: 10.12659/pjr.890915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 11/17/2022] Open
Abstract
Background An acute scrotum concerns endoscrotal organs (testicles, spermatic cord, tunica vaginalis) and is characterized by pain, swelling and hyperemia of the hemi-scrotum. It represents one of the most common surgical emergencies in children often caused by testicular torsion; the diagnosis is mostly clinical but must be supported by ultrasonographic examination of the scrotal region in association with a colour Doppler study of the spermatic cord vessels and glandular parenchyma. An idiopathic scrotal hematoma is a very rare condition that can simulate it. Case Report A 3-day-old full-term baby, otherwise in good health, showed swelling and pain of the left inguinal-scrotal region. A testicular torsion was suspected, so the baby underwent an ultrasound examination of the testis and spermatic cord that showed a left scrotal hematoma with superior displacement of the didymus; the right testicle was located in the internal inguinal canal. Surgical intervention confirmed the sonographic diagnosis of left testicular hematoma and of the right cryptorchidism. Conclusions Although testicular torsion is the most frequent cause of acute scrotum, the possibility of a persistent idiopathic scrotal haematoma and/or haematoma secondary to a trauma of the inguino-scrotal region, must be always taken into account. US diagnosis can avoid unnecessary emergency surgical treatment, required in case of testicular torsion.
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Affiliation(s)
- Vincenzina Crisci
- Department of Biomorphological and Functional Sciences, Section of Radiology, University Hospital Federico II, Naples, Italy
| | - Ciro Esposito
- Department of Tanslational Medical Sciences, "Federico II" University of Naples, Naples, Italy
| | - Ida Giurin
- Department of Tanslational Medical Sciences, "Federico II" University of Naples, Naples, Italy
| | - Valerio Vitale
- Department of Biomorphological and Functional Sciences, Section of Radiology, University Hospital Federico II, Naples, Italy
| | - Gianfranco Vallone
- Department of Biomorphological and Functional Sciences, Division of Pediatric Diagnostics, University Federico II of Naples, Naples, Italy
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15
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D'Andrea A, Coppolino F, Cesarano E, Russo A, Cappabianca S, Genovese EA, Fonio P, Macarini L. US in the assessment of acute scrotum. Crit Ultrasound J 2013; 5 Suppl 1:S8. [PMID: 23902859 PMCID: PMC3711727 DOI: 10.1186/2036-7902-5-s1-s8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The acute scrotum is a medical emergency . The acute scrotum is defined as scrotal pain, swelling, and redness of acute onset. Scrotal abnormalities can be divided into three groups , which are extra-testicular lesion, intra-testicular lesion and trauma. This is a retrospective analysis of 164 ultrasound examination performed in patient arriving in the emergency room for scrotal pain. The objective of this article is to familiarize the reader with the US features of the most common and some of the least common scrotal lesions. Methods Between January 2008 and January 2010, 164 patients aged few month and older with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analyzed. The presentation symptoms including scrotal pain, painless scrotal mass or swelling, and trauma. Results Of 164 patients, 125 (76%) presented with scrotal pain, 31 (19%) had painless scrotal mass or swelling and 8 (5%) had trauma. Of the 125 patients with scrotal pain, 72 had infection,10 had testicular torsion, 8 had testicular trauma, 18 had varicocele, 20 had hydrocele, 5 had cryptorchidism, 5 had scrotal sac and groin metastases, and 2 had unremarkable results. In the 8 patients who had history of scrotal trauma, US detected testicular rupture in 1 patients, scrotal haematomas in 2 patients . Of the 19 patients who presented with painless scrotal mass or swelling, 1 6 had extra-testicular lesions and 3 had intra-testicular lesions. All the extra-testicular lesions were benign. Of the 3 intra-testicular lesions, one was due to tuberculosis epididymo-orchitis, one was non-Hodgkin’s lymphoma, and one was metastasis from liposarcoma Conclusions US provides excellent anatomic detail; when color Doppler and Power Doppler imaging are added, testicular perfusion can be assessed
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Santos M, Kohl M. Testicular torsion masked by painful abdomen. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:41. [PMID: 23413384 DOI: 10.3238/arztebl.2013.0041b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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von Zastrow C. Pain may present in variable ways. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:41. [PMID: 23413383 PMCID: PMC3566627 DOI: 10.3238/arztebl.2013.0041a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Günther P. In reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:42. [PMID: 23413385 PMCID: PMC3566629 DOI: 10.3238/arztebl.2013.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Patrick Günther
- *Sektion Kinderchirurgie, Klinik für Allgemein-, Viszeral- und, Transplantations-chirurgie, Universitätsklinikum Heidelberg,
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