Re‐exploration of the acute scrotum

Abstract

RESULTSThe median (range) age of the patients was 11.5 (2-15) years; 61 had two scrotal explorations and three were explored three times. Of the patients, 32 presented with right testicular pain, 31 had left pain, and one had bilateral testicular pain. In the second exploration, 56 of 64 had the contralateral testis explored, five had an ipsilateral exploration and three had bilateral exploration. Forty-eight of the 64 boys (70%) had torsion of the contralateral appendix testis at the second exploration, and 5.3% (45/ 840) of the total number of children operated for acute scrotum had metachronous torsion of the appendix testis. The median interval between the first and second exploration was 8 months (1 day to 10.5 years). Two boys had three scrotal explorations, and three of 64 (4.7%) boys developed complications that required re-exploration. CONCLUSIONSMost indications for recurrent scrotal exploration in this study are because of a twisted contralateral appendix testis, but the risk of developing this pathology is similar to the complication rate of repeat scrotal exploration. These data support our policy that the contralateral testis should not be routinely explored nor its appendix removed unless there is ipsilateral testicular torsion. KEYWORDSrecurrent scrotal exploration, appendix testis, torsion, children OBJECTIVETo investigate children and adolescents who had scrotal exploration more than once. 1994 and 2004, 64 of 840 (7.6%) boys had more than one scrotal exploration at our institution. The age, laterality of the explorations, the interval between and findings at operation, whether the testes were managed by orchidopexy and how, and the complications, were reviewed from the medical records and the operating reports of the patients. All the boys were followed at the outpatient clinic 2-4 weeks after surgery. PATIENTS AND METHODS Between

Re‐presentations and recurrent events following initial management of the acute paediatric scrotum: a 5‐year review

“…1,5 However, there are only limited reports of early outcomes and re-presentation rates, particularly with comparison of conservative and operative management, with limited data on short-term morbidity associated with scrotal exploration. 3,[5][6][7][8][9][10] This study demonstrated a 10% re-presentation rate following initial management of the acute scrotum, with similar frequency of return in those managed conservatively and operatively at first presentation. Exploration rate on second presentation was notably higher in the subgroup of patients initially discharged without surgical intervention (71%).…”

“…7 Similarly, in our centre, boys are just as likely to return with TA torsion on the contralateral side as they are to return with complications following surgical intervention (2.6% and 2.2%, respectively). This gives an incidence of return and operative intervention for contralateral TA of 2.6% (8/308); the number-neededto-treat with bilateral scrotal exploration and excision of non-torted TAs to prevent one re-presentation and exploration for a contralateral TA is therefore 39 (1/0.026).…”

“…Ben-Meir et al reported a frequency of metachronous TA of 5.3%, comparable to post-operative complication rates of 4.7%. 7 Similarly, in our centre, boys are just as likely to return with TA torsion on the contralateral side as they are to return with complications following surgical intervention (2.6% and 2.2%, respectively). The median age at initial presentation with TA torsion for these boys with confirmed metachronous TA torsion was 10.7 years; there were similar numbers of boys aged less than 11 years and over 11 years with subsequent metachronous TA torsion, suggesting that contralateral exploration should be considered independent of age at initial presentation and exploration.…”

“…Mushtaq et al described a return rate of 4% in those undergoing exploration, 38% of whom were metachronous, compared with 10% and 25% in our cohort, respectively. 7,8,11 Four and a half percent of boys in our centre re-presented following surgery with pain, swelling or redness deemed within normal post-operative limits, and were subsequently discharged with no intervention. 7 They described a re-exploration rate of 7.6% (64/840) over a 11-year period, with three of these boys each requiring three acute scrotal explorations.…”

Normoxic Expression of Hypoxia‐Inducible Factor 1 in Rat Leydig Cells In Vivo and In Vitro

“…In addition, clinical conditions such as testicular torsion and varicocele affect oxygen levels in the testis. Testicular torsion, or torsion of the spermatic cord, is a urologic medical emergency that primarily affects adolescent boys (Pentyala et al, 2001; Ben‐Meir et al, 2006; Ringdahl and Teague, 2006). Torsion can obstruct arterial and venous pathways, resulting in alterations in blood flow, ischemia, and hypoxia and causing acute or chronic cellular and molecular damage depending on the degree of cord rotation, duration of torsion, and subsequent tissue reperfusion that may occur following intervention (Pentyala et al, 2001; Ringdahl and Teague, 2006).…”