Summary
Introduction
Acute scrotal pain is a common problem in children. Amongst the various causes, only
testicular torsion (TT) needs urgent, and arguably any, surgical intervention. However
TT accounts for only approximately 25% of cases. The diagnosis of TT is currently
based mainly on history and clinical examination in the UK.
Objective
We sought to find the incidence of finding TT during emergency scrotal exploration
in four paediatric surgical centres in the UK. We also assessed the preoperative utilisation
of clinical risk scores and Doppler ultrasound (DUS) to aid in the diagnosis.
Patients and methods
A retrospective review of 50 consecutive scrotal explorations done for acute scrotal
pain at four tertiary pediatric surgical centres in 2019, including the preoperative
utilisation of DUS, was analysed. Additionally an online survey was also sent out
to consultant members of the British Association of Paediatric Urology to gauge their
threshold for exploration, use of preoperative investigations and incidence of finding
TT in their practice.
Results
In the four UK centres reviewed, TT was found in 24.5% (SD = 8.54) of explorations.
The overall utilisation of preoperative DUS was 10%. The online survey revealed a
low threshold for exploration. However 72% of respondents recalled finding TT in <50%
of explorations, with just over a third reporting finding TT in only 10% of explorations.
There was low utilisation of preoperative DUS and clinical risk scores.
Discussion
The incidence of finding TT during exploration in this cohort is the same as the incidence
of TT in a population of children presenting with acute scrotal pain. We hypothesise
that this is due to low accuracy of clinical assessment, low utilisation of preoperative
clinical and radiological aids and the practice of exploring torted testicular appendages.
Improving awareness and training in these modalities will increase diagnostic accuracy,
limiting emergency scrotal explorations to those children with a higher risk of testicular
torsion. A care pathway for children presenting with acute scrotal pain is suggested
()
Conclusions
Graphical AbstractCare pathway for children presenting with acute scrotal pain. Abbreviations: TT-Testicular
torsion; DUS-Doppler ultrasound; POCUS-Point of care ultrasound; TWIST-Testicular
Workup for Ischemia and Suspected Torsion. ∗ DUS evaluation should include blood flow
within the testis, twisting of the spermatic cord, redundant spermatic cord within
the scrotum and abnormal lie of the testis.
Keywords
Abbreviations:
TT (Testicular torsion), TAT (Torsion of appendage of testis), DUS (Doppler ultrasound)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 01, 2020
Accepted:
November 21,
2020
Received in revised form:
November 18,
2020
Received:
October 3,
2020
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company. All rights reserved.
