370 Scrotal Ultrasound in Young Men with Acute Scrotal Pain: A Retrospective Consecutive Case Series Audit

Introduction

Although not recommended by EAU guidelines, many men with acute scrotal pain undergo ultrasound (US) to screen for occult tumours. This has low diagnostic yield and must be weighed against the increased risks of coronavirus due to additional hospital attendances, inconvenience for the patient, and demand on NHS resources. We evaluated our case series to determine current practice and diagnostic yield.

Method

141 consecutive cases of scrotal pain and/or swelling were identified from our Trust’s Surgical Assessment Unit (September-December 2020). Clinical diagnosis, and where performed, timing, indication and outcome of scrotal US was recorded.

Results

109/141 patients underwent scrotal US; the only urgent clinical indications were suspected collection/abscess (5 cases) or testicular mass (4). Relative indications included uncertain diagnosis (27 cases), suspected missed testicular torsion (6) and suspected hernia (1). 66/109 US performed were for ‘soft’ indications, however one occult testicular tumour, one acute testicular torsion and two inguinal herniae were unexpectedly found.

Conclusions

Scrotal US changed immediate patient management in 1/109 cases (acute testicular torsion). Early outpatient US would be sufficient to diagnose occult testicular tumour, missed testicular torsions and groin herniae. There is too much reliance on US; more focus on history and examination is needed.

Auditing HIV Testing Rates across Europe: Results from the HIDES 2 Study

European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32–97), lowest in Northern Europe (median 44%, IQR 22–68%) and highest in Eastern Europe (median 99%, IQR 86–100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0–4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested.

Transitional cell carcinoma of the bladder with parotid metastasis: a case report

Transitional cell carcinoma (TCC) of the bladder is the most common urothelial malignancy. Sites of metastatic spread are usually predictable; typically the pelvic and para-aortic lymphatics, followed by extra-vesical tissues, i.e. liver, lung, bone and adrenal glands. There is currently little literature describing metastatic spread to the head and neck region, and none to the authors’ knowledge, of spread to the parotid salivary glands. This report describes a rare case of parotid metastasis of bladder TCC in a 75-year-old Caucasian woman.