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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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2
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Sosnowska-Sienkiewicz P, Januszkiewicz-Lewandowska D, Mańkowski P. Testicular and scrotal abnormalities in pediatric and adult patients. POLISH JOURNAL OF SURGERY 2023; 96:88-96. [PMID: 38348982 DOI: 10.5604/01.3001.0053.9349] [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: 02/15/2024]
Abstract
Testicular and scrotal abnormalities can occur in children, adolescents, and adults. The lesions, often accompanied by pain and swelling/enlargement of the scrotum, can cause anxiety in patients and their parents. Regardless of age, proper diagnosis is based on adequate anamnesis and physical examination. Color Doppler ultrasound is the first-line test in the differential process of testicular and scrotal diseases. Testicular and scrotal lesions require differentiation for benign and malignant processes as well as therapeutic management, including urgent surgical intervention. The aim of this paper is to present the most common causes of testicular and scrotal abnormalities in pediatric and adult patients and to outline the symptoms and diagnostic and therapeutic management.
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Affiliation(s)
| | | | - Przemysław Mańkowski
- Department of Pediatric Surgery, Traumatology and Urology, Poznań University of Medical Sciences, Poland
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3
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Elhag H, Al-Tairy F, Dahdaha MS, Shaeshaa A, Yigit Y. Inferior Vena Cava Thrombosis in a Patient with Factor V Leiden Syndrome Presenting with Scrotal Pain. Case Rep Med 2023; 2023:6234371. [PMID: 37790840 PMCID: PMC10545471 DOI: 10.1155/2023/6234371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023] Open
Abstract
Thrombosis in the inferior vena cava (IVC) is a rare but serious condition that can lead to significant morbidity and mortality. We present a case report of a 39-year-old male who presented to the emergency department with right flank pain that had progressed to severe back pain, bilateral flank pain, scrotal pain, and leg pain over the course of two days. The pain was severe enough to affect his daily activities. Laboratory investigations revealed a D-dimer level of 17 ng/mL, creatinine level of 110 µmol/L, and a white blood cell count of 10 × 109/L with a CRP level of 5 mg/L. Urine analysis was positive for blood. Doppler ultrasound of both legs showed deep vein thrombosis extending from the external iliac veins to the distal veins of both legs. Further investigation with computed tomography of the abdomen revealed a large thrombus in the distal vena cava extending to the renal artery and both external and internal iliac veins. The patient was diagnosed with Factor V Leiden syndrome based on genetic testing, which revealed a heterozygous mutation in the F5 gene. He was successfully treated with low molecular weight heparin and warfarin, and after five days of hospitalization, he was discharged with warfarin for long-term anticoagulation. This case report emphasizes the importance of considering IVC thrombosis in patients with a constellation of symptoms, including scrotal pain, and the role of genetic testing in identifying underlying hypercoagulable states.
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Affiliation(s)
- Helmy Elhag
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Fadl Al-Tairy
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Shaeshaa
- Department of Emergency Medicine, Lincoln County Hospital, Lincolnshire, UK
| | - Yavuz Yigit
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Blizard Institute, Queen Mary University, London, UK
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4
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Damrow T, Bellinger R, Lin J, Walker JA. An Unusual Case of Acute Scrotal Pain. Cureus 2023; 15:e45221. [PMID: 37842505 PMCID: PMC10576437 DOI: 10.7759/cureus.45221] [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: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Patients frequently present to the emergency department with complaints of scrotal or testicular pain. Generally, there is an algorithmic approach to workup, which includes assessment for torsion, infection, or vascular causes, and musculoskeletal causes of pain are also sometimes considered. Spinal cord pathology, however, is less often explored as a cause of testicular pain. Here, we present a case of a 45-year-old man with end-stage renal disease and hypertension who presented with acute testicular pain. After a comprehensive workup, however, the source of pain was not initially found. Progression of the patient's symptoms led to the diagnosis of spontaneous spinal subdural hematoma. This atypical presentation of a rare diagnosis is also interesting due to the patient's concomitant diagnosis of an otherwise asymptomatic COVID-19 infection. While our case represents an atypical combination of clinical features, it also illustrates the importance of continued vigilance and ongoing workup when patients present with severe pain and unclear causes of their symptoms.
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Affiliation(s)
- Thomas Damrow
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
| | - Ryan Bellinger
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
| | - Judy Lin
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
- Department of Emergency Medicine, Burnett School of Medicine at Texas Christian University, Fort Worth, USA
| | - Jennifer A Walker
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
- Department of Emergency Medicine, Burnett School of Medicine at Texas Christian University, Fort Worth, USA
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5
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Kefalas C, Karlafti E, Zatagias A, Karakatsanis A, Tsakiris G, Michalopoulos A, Paramythiotis D. Transabdominal Preperitoneal inguinal hernia repair leading to orchiectomy: A case report. Ann Med Surg (Lond) 2022; 80:104288. [PMID: 36045854 PMCID: PMC9422286 DOI: 10.1016/j.amsu.2022.104288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Charalampos Kefalas
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
- Corresponding author.
| | - Eleni Karlafti
- Emergency Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Apostolos Zatagias
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Anestis Karakatsanis
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Georgios Tsakiris
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
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6
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Choi JB, Han KH, Lee Y, Ha US, Cho KJ, Kim JC, Koh JS. The incidence of testicular torsion and testicular salvage rate in Korea over 10 years: A nationwide population-based study. Investig Clin Urol 2022; 63:448-454. [PMID: 35670008 PMCID: PMC9262487 DOI: 10.4111/icu.20220122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/19/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We performed a nationwide epidemiological study of testicular torsion using the National Health Insurance System database for the entire male population of Korea. MATERIALS AND METHODS Age, sex, socioeconomic status, regional information, and diagnostic codes were retrieved from January 2009 to December 2019. To clearly identify the diagnosis of testicular torsion, patients who had not undergone orchiectomy or orchiopexy were excluded from the study. Multivariable logistic regression models were used to analyze the association between demographic characteristics and testicular loss. RESULTS The overall incidence of testicular torsion in males was 2.02 cases per 100,000 person-years and 6.99 cases per 100,000 person-years in males under 19 years of age. Testicular torsion most commonly occurred either in infancy or adolescence. The total testicular salvage rate was 75.22% and highest in children at 79.91%. The rate of orchiectomy was high in infancy and in the oldest patients. We determined that age distribution was related to the risk of testicular loss. CONCLUSIONS This study is the first nationwide epidemiological study of testicular torsion, which contains the entire Korean population. Although the testicular salvage rate in Korea was higher compared to other countries, it is necessary to educate males under 19 years of age on the seriousness of acute testicular pain to minimize the possibility of testicular loss.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Hun Han
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yunhee Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang Jun Cho
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Sung Koh
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Melchionna A, Collà Ruvolo C, Capece M, La Rocca R, Celentano G, Califano G, Creta M, Napolitano L, Morra S, Cilio S, Turco C, Caputo V, Longo N, Mirone V, Imbimbo C. Testicular pain and youtube™: are uploaded videos a reliable source to get information? Int J Impot Res 2022; 35:140-146. [PMID: 35136203 DOI: 10.1038/s41443-022-00536-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 01/22/2023]
Abstract
Several previous studies on YouTube™ on urological field have already been published. The aim of the current study was to evaluate the quality information of YouTubeTM videos on testicular pain. Using Google Trends tool, the frequency of worldwide YouTubeTM and Google Search on testicular pain was examined from 2010 to 2020. The keywords "testicular pain", "testicular ache" and "scrotal pain" were used on the YouTube platform and the first 100 YouTubeTM videos were analyzed for each one. The Patient Education Materials Assessment Tool (PEMAT) for Audiovisual (A/V) Materials, the DISCERN score and Misinformation tool were used to assess video quality. According to YouTube™ Search the mean relative frequency search for "testicular pain" ranged from 10.5 to 30.0%. According to GoogleTM Search it ranged from 73.7 to 91.0%, Of all 300 videos, 117 were eligible for the analysis. The median number of views, thumbs-up and thumbs-down was respectively: 47060 (interquartile range [IQR] = 6297.0-144188.0), 289 (IQR = 40-912) and 19 (IQR = 4-53). Of all videos, 68.4% and 31.6% were produced respectively by Medical Doctors and Other. The median PEMAT Actionability and Understandability scores were 66.7% and 66.7%, respectively. The median DISCERN score ranged from 1 to 5, with an overall median score of 3, defined from question 16. The median misinformation score ranged from 2 to 5. In conclusion, an increased interest on testicular pain was recorded on both YouTubeTM and Google search during the last decade. However, according to the quality assessment tools used, YouTube™ users cannot get trustful and exhaustive information on testicular pain. Therefore, authors with/without medical background should improve the quality of information on YouTube™ videos.
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Affiliation(s)
- Alberto Melchionna
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy.
| | - Marco Capece
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Simone Morra
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Simone Cilio
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Carmine Turco
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Vincenzo Caputo
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Nicola Longo
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy
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8
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Hanumanthappa J, Naushad VA, Mohammed O, Ariboyina AK, Chellapandian SB, Mat Khan SK. Evaluating Acute Testicular Pain Using Point-of-Care Hand-Held Doppler in the Emergency Department: A Prospective Pilot Study. Cureus 2021; 13:e17699. [PMID: 34650873 PMCID: PMC8487873 DOI: 10.7759/cureus.17699] [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] [Accepted: 09/03/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Testicular pain is one of the common conditions in patients visiting the emergency department. The causes of acute testicular pain vary from non-urgent inflammatory conditions like epididymo-orchitis to testicular torsion which is a surgical emergency. Early diagnosis of testicular torsion with early initiation of appropriate surgical intervention helps in salvaging the testes. There is a need for a simple, rapid bedside diagnostic tool for the evaluation and triaging of subjects with acute testicular pain in the emergency department. The aim of this study is to determine whether hand-held Doppler (HHD) examination by the emergency department (ED) physician can safely rule out testicular torsion in a case of acute testicular pain. Materials and Methods A prospective pilot study was conducted in the emergency department of Alkhor Hospital, Hamad Medical Corporation, Qatar. The subjects between 18 to 50 years of age who presented to the ED with testicular pain were included. Subjects with recent trauma to the scrotum, or recent genitourinary surgery and those who had pain for more than 48 hours were excluded. Point-of-care HHD was done by a single ED physician who was blinded for the Doppler study results done by the radiologist. The results of the HHD performed by the ED physician and Doppler study performed by the radiologist were compared and analyzed. Results Forty-five patients were included in the study. The mean age was 28 years and the mean duration of pain was 20 hours. HHD ruled out testicular torsion in 44 subjects with a specificity of 97.8%. In one subject, HHD was reported as torsion testis which was ruled out by the radiologist. The radiologist Doppler ruled out torsion in all 45 subjects. Conclusion The diagnostic performance of HHD by the ED physicians was almost equal to that of radiologists in ruling out testicular torsion. HHD can be used as a first-line triaging tool by the ED physician to rule out torsion of testis in patients presenting with acute testicular pain. We conclude that patients with testicular pain with a negative HHD for torsion testis can be safely discharged from the emergency department.
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Affiliation(s)
| | - Vamanjore A Naushad
- College of Medicine, Qatar University, Doha, QAT.,Internal Medicine, Weill Cornell, Doha, QAT.,General Internal Medicine, Hamad General Hospital /Hamad Medical Corporation, Doha, QAT
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9
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Pheochromocytoma Presenting as Testicular Pain: An Unusual Case Report. Case Rep Endocrinol 2021; 2021:6699409. [PMID: 33953991 PMCID: PMC8062206 DOI: 10.1155/2021/6699409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/07/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
Pheochromocytoma (PCC) is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla which are derived from the neural crest. This report illustrates a 51-year-old Caucasian male with a history of hypertension diagnosed two years ago who presented to the hospital due to acute onset of right testicular pain of 3-day duration. Laboratory results and imaging revealed a presumptive diagnosis of PCC. The patient had undergone robot-assisted laparoscopic right adrenalectomy 14 days after being diagnosed with PCC due to perioperative management with phenoxybenzamine. The final pathology report revealed a PCC. At follow-up two weeks after discharge, the patient reported complete resolution of his testicular pain.
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10
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Gkantseva-Patsoura S, Katsaras G, Georgiadou P, Lainakis N, Liovarou E, Theofanopoulos R, Theodoraki M. Idiopathic scrotal hematoma in a neonate. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2021; 19:Doc01. [PMID: 33642965 PMCID: PMC7894276 DOI: 10.3205/000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Neonatal scrotal hematoma is considered a surgical emergency in the neonatal period. Up to recently, immediate surgical exploration was considered the gold standard for the diagnosis and treatment in the underlying causes. Objective: In this article, we present a case of idiopathic scrotal hematoma in a neonate. Method: It was managed conservatively with clinical and ultrasonographic follow-up. Result: The hematoma had gradually subsided, and any surgical intervention was avoided to the neonate. Conclusion: With good clinical and imaging follow-up, some cases could be managed nonoperatively.
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Affiliation(s)
| | - George Katsaras
- Paediatric Department, General Hospital of Pella - Hospital Unit of Edessa, Greece
| | - Petroula Georgiadou
- Neonatal Intensive Care Unit, General State Hospital of Nikaia "Agios Panteleimon", Piraeus, Greece
| | - Nikolaos Lainakis
- Paediatric Surgery Department, General State Hospital of Nikaia "Agios Panteleimon", Piraeus, Greece
| | - Eirini Liovarou
- Radiology Department, General State Hospital of Nikaia "Agios Panteleimon", Piraeus, Greece
| | - Rita Theofanopoulos
- Neonatal Intensive Care Unit, General State Hospital of Nikaia "Agios Panteleimon", Piraeus, Greece
| | - Martha Theodoraki
- Neonatal Intensive Care Unit, General State Hospital of Nikaia "Agios Panteleimon", Piraeus, Greece
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11
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Siregar S, Sasongko Noegroho B, Adriansjah R, Mustafa A, Wijayanti Z. Intratesticular Human Adipose-Derived Stem Cell (hADSC) Transplantation Decreased Oxidative Stress in Testicular Torsion Model of Wistar Rat. Res Rep Urol 2021; 13:1-8. [PMID: 33442548 PMCID: PMC7797314 DOI: 10.2147/rru.s283861] [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] [Received: 09/25/2020] [Accepted: 11/16/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Testicular torsion is a sudden rotation of the testis towards its axis, which causes the twisting of the spermatic cord. Post-detorsion reperfusion will cause inflammation and trigger oxidative stress, which generates reactive oxygen species (ROS). Malondialdehyde (MDA) is an organic compound formed from ROS frequently used as an oxidative stress biomarker during ischemia and ischemia-reperfusion injury. In some organs, stem cell administration on the damaged organ is essential in preventing cellular damage and death. This study aimed to learn about the effect of hADSC administration on an ischemia-reperfusion injury. Material and Methods A total of 22 Wistar rats divided into 5 groups, two groups each consist of 5 male Wistar rats with testicular torsion model without hADSC therapy (group I), while 2 other groups consist of 5 rats with testicular torsion model were given 1.0×106 cells intratesticular hADSC injection 30 minutes after testicular detorsion (group II). Both groups were euthanized at 1 and 4 weeks of observation. The last group consists of 2 rats without any treatment or model (negative control group). Following euthanasia, testicular tissue was harvested for MDA expression measurement using ELISA and histopathological examination. Statistical analysis using an one way ANOVA was done with SPSS version 21.0. Results The result of MDA examination using the ELISA method has shown a concentration difference between group I (control) and group II (hADSC treatment). Testicular MDA concentration in the treatment group was significantly lower on the 1st and 4th week of observation (p2=0.000, p4=0.016). Post hoc analysis showed no statistically different between therapy and healthy group (p=0.972). On histopathological examination, Johnsen score in the treatment group was significantly higher on the 4th week of observation (p=0.044). Post hoc analysis showed no statistically different between therapy and healthy group (p=0.195). Conclusion Intratesticular hADSC administration can inhibit ROS formation due to ischemia-reperfusion injury in testicular tissue after testicular detorsion in Wistar rats.
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Affiliation(s)
- Safendra Siregar
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Banding, Indonesia
| | - Bambang Sasongko Noegroho
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Banding, Indonesia
| | - Ricky Adriansjah
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Banding, Indonesia
| | - Akhmad Mustafa
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Banding, Indonesia
| | - Zola Wijayanti
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Banding, Indonesia
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12
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Moubasher A, Waqar M, Raison N, Brunckhorst O, Ahmed K. A Review of the Management of Chronic Scrotal Pain. Cureus 2020; 12:e11979. [PMID: 33312831 PMCID: PMC7725413 DOI: 10.7759/cureus.11979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/30/2022] Open
Abstract
Chronic scrotal pain (CSP) is a common and poorly understood medical condition that significantly affects individuals' quality of life. Many patients seek evaluation and management of their symptoms from multiple physicians. Our review aims to address diagnostic modalities, clinical evaluation, and surgical and non-surgical management. We conducted a computerised detailed search of the PubMed, Medline, Embase and Cochrane databases for reports pertaining to CSP using the Medical Subject Headings keywords 'chronic scrotal pain', 'testicular pain' and 'orchialgia', and we included in the review those that fulfilled the inclusion (adult male with CSP presenting with the criteria of CSP ) and exclusion (extra-scrotal pain) criteria. After the direct causes of CSP were identified by reviewing the clinical evaluations (history taking and examination are mandatory) and the diagnostic evaluations (urine analysis is crucial and ultrasound can be helpful), the most-used medical and non-surgical treatments for CSP were tricyclic antidepressants (success rate of up to 66.6%) and spermatic block (success rate of more than 90%), and the most-used surgical procedure was microsurgical denervation of the spermatic cord (success rate of up to 70%). The evidence currently available remains rare and of low quality, making it difficult to strongly recommend individual treatment options. However, multimodal treatment modalities using physical therapy and psychotherapy may help patients and provide useful tools for coping with this condition. There are also useful non-surgical and surgical options for CSP that depend on the patient's state, the severity of the complaint and what options have already been tried.
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Affiliation(s)
- Amr Moubasher
- Urology, King's College Hospital, London, GBR
- Dermatology and Andrology, Assiut University, Assiut, EGY
| | | | - Nicholas Raison
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
| | - Oliver Brunckhorst
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
| | - Kamran Ahmed
- Urology, King's College Hospital, London, GBR
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
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13
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Affiliation(s)
- Nicole M Kapral
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Arthur J Pesch
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA..
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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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Thomas SZ, Diaz VI, Rosario J, Kanyadan V, Ganti L. Emergency Department Approach to Testicular Torsion: Two Illustrative Cases. Cureus 2019; 11:e5967. [PMID: 31799101 PMCID: PMC6863585 DOI: 10.7759/cureus.5967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We present two cases of young men with spontaneous nontraumatic testicular pain. While the differential diagnosis for scrotal or testicular pain can include less urgent causes, such as epididymitis, hydrocele, referred pain, idiopathic scrotal edema, and inguinal hernia, for example, the most feared etiology for acute scrotal pain is testicular torsion. The fact that a testicle can torse and detorse is also a confounding factor. In this case review, we explore factors affecting the timely diagnosis, management, and outcomes of acute testicular pain. Prompt diagnosis is imperative in order to salvage a torsed testicle.
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Affiliation(s)
- Sherwin Z Thomas
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Vanessa I Diaz
- Emergency Medicine, University of Central Florida / Osceola Regional Medical Center, Orlando, USA
| | - Javier Rosario
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | - Latha Ganti
- Emergency Medicine, Envision Physician Services, Orlando, USA
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16
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Piszker AJ, Lee YF, Roberts JE, Cleary RK. Perforated diverticulitis of the sigmoid colon contained within an inguinal hernia sac. BMJ Case Rep 2019; 12:12/5/e227990. [PMID: 31061191 DOI: 10.1136/bcr-2018-227990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a patient with perforated diverticulitis contained within an inguinal hernia sac-a diagnostic and treatment dilemma. A 61-year-old man presented to the emergency department with left testicular and groin pain, and loose stool. CT imaging showed a left inguinal hernia containing a perforated segment of sigmoid colon. A segmental sigmoidcolectomyy and end colostomy Hartmannn's procedure) was performed after reducing the incarcerated inguinal contents. The inguinal hernia was not repaired because of faecal contamination of the hernia sac and risk for recurrence. Pathological examination of theresectedd bowel specimen showed perforated sigmoid diverticulitis in an inguinal hernia sac. The patient had an uneventful recovery and is awaiting definitive inguinal hernia repair andtakedownn of his colostomy.
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Affiliation(s)
- Alexander J Piszker
- School of Osteopathic Medicine, Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | - Yongjin F Lee
- Colon & Rectal Surgery, St. Joseph Mercy Ann Arbor, Ypsilanti, Michigan, USA
| | - Jacob E Roberts
- General Surgery, St. Mary Mercy Livonia, Livonia, Michigan, USA
| | - Robert K Cleary
- Colon & Rectal Surgery, St. Joseph Mercy Ann Arbor, Ypsilanti, Michigan, USA
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17
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Two Case Reports of Varicocele Rupture during Sexual Intercourse and Review of the Literature. Case Rep Urol 2019; 2018:4068174. [PMID: 30643660 PMCID: PMC6311255 DOI: 10.1155/2018/4068174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022] Open
Abstract
Varicocele is characterized by the dilatation of the veins of the spermatic cord. Its prevalence in general male population is 15% while in the infertile population the prevalence rises up to 25%. The varicocele is considered an etiological factor for male infertility. Although different pathophysiological patterns have been proposed, there is no consensus in the urological society to date. In most of the cases varicocele is asymptomatic but sometimes gives mild symptoms as dull pain at the scrotal region. A rare complication of this condition is the spontaneous or traumatic rupture and hematoma formation, either as spermatic cord hematoma or as scrotal hematoma. We are presenting two cases of varicocele rupture, presented with acute painful swelling of the left inguinal and scrotal region during sexual intercourse. Imaging studies revealed a scrotal hematoma in the first case and a spermatic cord hematoma in the second case, without signs of active bleeding. Both patients were treated conservatively and recovered uneventfully. Subsequently, we reviewed the literature in an effort to find the key points for the diagnosis and treatment of this condition.
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18
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Krishnaraju VS, Malik D, Kumar R, Bora GS, Mittal BR, Bhattacharya A. Incremental Role of 18FDG PET/CT in Assessment of Testicular Viability. Nucl Med Mol Imaging 2018; 52:377-379. [PMID: 30344786 DOI: 10.1007/s13139-018-0531-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/05/2018] [Accepted: 06/11/2018] [Indexed: 11/28/2022] Open
Abstract
Testicular torsion is a common differential diagnosis of acute scrotal pain along with acute epididymo-orchitis, which may lead to testicular non-viability. Doppler ultrasound and testicular scintigraphy are two routinely used modalities for the assessment of testicular viability. However, in some cases, these investigations may prove inadequate in differentiating between the two entities with widely differing management. Here, we present a case of a 52-year-old male with questionable viability of testis, who was investigated initially using testicular scintigraphy and was further subjected to a regional 18F-FDG PET/CT scan, in view of inconclusive findings with the conventional modalities.
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Affiliation(s)
- Venkata Subramanian Krishnaraju
- 1Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector -12, Chandigarh, 160012 India
| | - Dharmender Malik
- 1Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector -12, Chandigarh, 160012 India
| | - Rajender Kumar
- 1Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector -12, Chandigarh, 160012 India
| | - Giridhar S Bora
- 2Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector -12, Chandigarh, 160012 India
| | - Bhagwant Rai Mittal
- 1Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector -12, Chandigarh, 160012 India
| | - Anish Bhattacharya
- 1Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector -12, Chandigarh, 160012 India
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Saleem D, Muneer S, Younus Khan RF, Ochani RK, Ahmed SS, Begg M, Siddiqi TJ, Abbas SR, Naseeb MW, Farooqui MO, Shaikh FH, Kirmani R, Ullah H, Fatima K. Knowledge, Attitude and Practices Regarding Benign Testicular Disorders in the Educated Young Men of Pakistan. Cureus 2017; 9:e1563. [PMID: 29057175 PMCID: PMC5640388 DOI: 10.7759/cureus.1563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background It has been seen that despite the increasing incidence of benign testicular disorders (BTDs), little work has been done towards its awareness among the male populace. Also, the trend of not seeking help in this regard is concerning. In this study, we aim to better perceive the level of understanding and common practices regarding BTDs among educated young men. Methods A cross-sectional study was carried out among two groups of ages 14-20 and 21-28 years. The inclusion criterion was that of educated males in an urban setting. Data were collected through a standardized questionnaire using cluster sampling by independent interviewers. The questionnaire consisted of four parts dealing with demographics, knowledge, attitudes and practices. Chi-square and Mann-Whitney U test were used as the primary statistical tests. Results The sample population consisted of an equal number of participants between the ages of 14 and 20, and between 21 and 28 years (n = 200, 50%). About half the participants (n = 215, 53.8%) were not familiar with the term BTDs. The majority (n = 324, 78.8%) of participants were not aware of symptoms of BTDs. Three-fourth of the participants believed that the subject is considered taboo in Pakistan (n = 307, 73.6%) while a majority of participants (n = 340, 85%) believed media coverage can help spread awareness of BTDs. A huge number (n = 268, 67%) thought that BTDs can cause fertility problems while one-third of them would not perform testicular self-examination (TSE) in case of pain or swelling in the scrotal region (n = 119, 29.8). The level of education and age were significantly associated with the knowledge regarding symptoms and types of BTDs. Conclusion Knowledge of BTDs and practices of TSE in the young educated men of Karachi are alarmingly poor. Therefore, there is an urgent need to create awareness at all levels using different strategies and platforms.
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Affiliation(s)
- Dua Saleem
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Samra Muneer
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | | | - Rohan Kumar Ochani
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Syed Saadan Ahmed
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Maha Begg
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Tariq J Siddiqi
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Syed Raza Abbas
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Muhammad W Naseeb
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | | | - Fahad H Shaikh
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | | | - Hurmat Ullah
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Kaneez Fatima
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
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20
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Kashanian JA, Mazur DJ, Hehemann MC, Morrison CD, Oberlin DT, Raup VT, Choi AW, Trinh B, Said MA, Keeter MK, Brannigan RE. Scrotal Ultrasound for Pain: Low Frequency of Absolute Surgical Indications. Urology 2017; 108:17-21. [PMID: 28705576 DOI: 10.1016/j.urology.2017.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/10/2017] [Accepted: 03/18/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the results of scrotal ultrasounds (US) conducted for scrotal or testicular pain and review the pathologic findings of orchiectomies done for lesions that were suspicious for malignancy on US. MATERIALS AND METHODS We retrospectively reviewed the indications and findings of all scrotal US completed at our institution from 2002 to 2014. If a patient underwent an orchiectomy for an intratesticular lesion that was concerning for malignancy on US, the pathology report was also reviewed. RESULTS There were 18,593 scrotal US performed, with 7,668 (41.2%) conducted for scrotal pain. Of the US performed for pain, 80.4% revealed benign or normal findings, and only 2.2% demonstrated a finding that is an absolute indication for surgery (intratesticular lesion suspicious for malignancy 0.8%, abscess 0.7%, torsion 0.6%, infiltrative process such as lymphoma 0.1%). For those patients undergoing an orchiectomy, 75% had malignancy on pathologic analysis. CONCLUSION The majority of the 7668 US performed to evaluate scrotal or testicular pain reveal normal or benign findings. A low percentage demonstrates a finding that necessitates urgent or emergent surgery.
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Affiliation(s)
- James A Kashanian
- Department of Urology, Weill Cornell Medicine, Weill Cornell Medical College, New York, NY
| | - Daniel J Mazur
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Marah C Hehemann
- Department of Urology, Loyola University Health System, Maywood, IL
| | - Christopher D Morrison
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniel T Oberlin
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Valary T Raup
- Department of Surgery, Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew W Choi
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brian Trinh
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mohammed A Said
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Mary Kate Keeter
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Robert E Brannigan
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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21
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Chang CD, Lin JW, Lee CC, Chen YT, Huang CC, Lee YW, Ng SH, Ko SF. Acute Epididymo-orchitis-Related Global Testicular Infarction: Clinical and Ultrasound Findings With an Emphasis on the Juxta-epididymal String-of-Bead Sign. Ultrasound Q 2017; 32:283-9. [PMID: 27556195 DOI: 10.1097/ruq.0000000000000225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute epididymo-orchitis (AEO)-related global testicular infarction (GTI) is rare. We report herein the clinical and ultrasound findings of 6 patients with AEO-related GTI. Seventeen patients with torsion-related GTI were also reviewed and compared. The echotexture of AEO-related GTI ranged from mildly inhomogeneous to diffuse heteroechoic, depending on the severity of testicular necrotic changes. All of the patients showed a juxta-epididymal string-of-bead pattern on color Doppler ultrasound, which was ascribed to patent arteries (5/6, 87%) and collateral vessels (1/6, 13%) in the tunica albuginea. There were no significant differences in age, laterality, leukocyte count, testicular volume ratio (infarcted/normal), frequencies of heteroechoic testicular parenchyma, scrotal skin thickening, and hydrocele between the 2 groups. However, the left testis was predominantly affected in both groups. Compared with torsion-related GTI, patients with AEO-related GTI had significantly longer duration from scrotal pain onset to surgery (13.5 ± 5.2 vs 2.6 ± 2.0 days, P < 0.001), a higher level of serum C-reactive protein (110.0 ± 82.0 vs 41.2 ± 35.9 mg/dL, P = 0.013), a higher frequency of the juxta-epididymal string-of-bead sign (100% vs 12%, P < 0.001), and a lower frequency of the whirlpool/knot sign (0% vs 88%, P = 0.002). Although the testis in AEO-related GTI may appear variable from mildly to extensively heteroechoic on gray-scale ultrasound, this unusual disease can be characterized by an avascular testis with a juxta-epididymal string-of-bead sign on color Doppler ultrasound.
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Affiliation(s)
- Ching-Di Chang
- *Departments of Radiology and †Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; ‡Department of Biomedical Engineering, I-Shou University; and §Division of Urology, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
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22
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Abstract
Chronic orchialgia is a vexing condition defined as chronic or intermittent scrotal pain lasting at least three months that significantly interferes with daily activities. There are currently no guidelines regarding the diagnosis and management of this condition despite it being the cause of 2.5-4.8% of urologic clinic visits. Men often present with chronic orchialgia in their mid to late 30s, although the condition can present at any age. A broad differential diagnosis of chronic orchialgia includes epididymitis, testicular torsion, tumors, obstruction, varicocele, epididymal cysts, hydrocele, iatrogenic injury following vasectomy or hernia repair, and referred pain from a variety of sources including mid-ureteral stone, indirect inguinal hernia, aortic or common iliac artery aneurysms, lower back disorders, interstitial cystitis, and nerve entrapment due to perineural fibrosis; approximately 25-50% of chronic orchialgia is idiopathic in nature. In such cases, it is reasonable to consider psychological and psychosocial factors that may be contributing to chronic pain. Invasive testing is not recommended in the work-up of chronic orchialgia.
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Affiliation(s)
| | - Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.,Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Calixte N, Brahmbhatt J, Parekattil S. Genital pain: algorithm for management. Transl Androl Urol 2017; 6:252-257. [PMID: 28540232 PMCID: PMC5422702 DOI: 10.21037/tau.2017.03.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/13/2017] [Indexed: 11/12/2022] Open
Abstract
Chronic testicular pain although becoming very common in our patient population poses a challenge to the physician, the patient and his family. The pathogenesis of chronic orchialgia (CO) is not well understood. The objective of this paper is to review the current literature on chronic testicular pain and its management and to propose an algorithm for its treatment. Abstracts, original papers and review articles were reviewed during a literature search using words such as testicular pain, CO, and microsurgical anatomy of spermatic cord. Chronic scrotal content pain (CSP) is a difficult condition to treat and could be idiopathic or secondary. Conservative therapy is the first line of treatment attempted to allow the patient to return to his routine activities. When conservative treatment fails, patients can now turn toward surgical options such as microsurgical denervation of the spermatic cord (MDSC) which has a success rate published in the 60-85% range and/or minimally invasive therapies such as microcryoablation of the spermatic cord, Botox or Amniofix injection. There is an increase in referrals for CO. The true pathogenesis is still unclear and the road to complete recovery is unsure for certain patients. This paper proposes an algorithm for the management of patients suffering with CO.
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Affiliation(s)
- Nahomy Calixte
- South Lake Hospital, 1900 Don Wickham Drive, Clermont, FL 34711, USA
| | - Jamin Brahmbhatt
- South Lake Hospital, 1900 Don Wickham Drive, Clermont, FL 34711, USA
| | - Sijo Parekattil
- South Lake Hospital, 1900 Don Wickham Drive, Clermont, FL 34711, USA
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Lorenzo L, Rogel R, Sanchez-Gonzalez JV, Perez-Ardavin J, Moreno E, Lujan S, Broseta E, Boronat F. Evaluation of Adult Acute Scrotum in the Emergency Room: Clinical Characteristics, Diagnosis, Management, and Costs. Urology 2016; 94:36-41. [PMID: 27210570 DOI: 10.1016/j.urology.2016.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 04/18/2016] [Accepted: 05/05/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the clinic characteristics, diagnosis, management, and costs of the adult acute scrotum in the emergency room (ER). Acute scrotum is a syndrome characterized by intense, acute scrotal pain that may be accompanied by other symptoms. It is usual in children and commonly found as well in adults, with different causal pathologies between these groups. METHODS Between November 2013 and September 2014, 669 cases of adult acute scrotum who presented to our ER were prospectively analyzed. Patients under 15 years of age were excluded. Patient age, reason for consultation, investigations performed, final diagnosis, management, and costs were evaluated. For the statistical analysis, the Mann-Whitney, Kruskal-Wallis U, and chi-square tests were used. RESULTS A total of 669 cases of acute scrotum were analyzed. The mean age at presentation was 40.2 ± 17.3 years. The most presented diagnoses were orchiepididymitis (28.7%), epididymitis (28.4%), symptoms of uncertain etiology (25.1%), and orchitis (10.3%). Diagnostic tests were carried out in 57.8% of cases. Most cases were treated as outpatients (94.2%), with 5.83% admitted and 1% undergoing surgical treatment. Overall, 13.3% of patients represented to the ER. Abnormal results in blood and urine tests were more common among older patients and infectious pathologies. The average cost generated by an acute scrotum ER consult was 195.03€. CONCLUSION Infectious pathologies are the most common causes of acute scrotum at ER. Abnormal blood and urine tests are unusual and are more common in older patients and infectious pathologies.
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Affiliation(s)
- Laura Lorenzo
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Ramon Rogel
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain.
| | | | - Javier Perez-Ardavin
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Elena Moreno
- Department of Biological Statistics, Instituto de Investigaciones Sanitarias La Fe, Valencia, Spain
| | - Saturnino Lujan
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Enrique Broseta
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Francisco Boronat
- Department of Urology, University and Polytechnic Hospital La Fe, Valencia, Spain
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Saab MM, Landers M, Hegarty J. Males' Awareness of Benign Testicular Disorders: An Integrative Review. Am J Mens Health 2016; 12:556-566. [PMID: 26783155 DOI: 10.1177/1557988315626508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Disorders that affect the testes can range from painless and benign to debilitating and life threatening. Despite the availability of literature on the etiology, diagnosis, and treatment of benign testicular disorders (BTD), very little is known about men's awareness of these conditions. The aim of this review was to extract and analyze evidence from studies that explored males' awareness of BTD. Four e-databases (CINAHL, MEDLINE, PsychINFO, and PubMed) were thoroughly searched and four articles met the review inclusion criteria. The quality of the included studies was appraised and data were extracted and cross-checked using a standardized data extraction table. It was determined that participants lacked education about testicular self-examination and scrotal signs and symptoms which contributed to their lack of awareness of BTD. Help seeking in the event of scrotal abnormalities was suboptimal which is alarming given the acuteness of some BTD such as testicular torsion. Individuals who are at risk for health disparities were underrepresented in the reviewed literature. Findings from this review highlight the need to address barriers to BTD knowledge and help seeking. This could be achieved through making use of past interventions that succeeded in increasing men's awareness of testicular cancer such as university campaigns and mass media. From a practical standpoint, clinicians must be encouraged to educate young men about BTD. This could be attained through tailoring creative educational interventions that are sensitive to the needs of individuals who are at risk for health disparities.
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