Scrotal Exploration for Testicular Torsion and Testicular Appendage Torsion: Emergency and Reality

Abstract

Background:Scrotal exploration is considered the procedure of choice for acute scrotum.Objectives:We evaluated the importance of early diagnosis and testicular salvage on the therapeutic outcomes of patients with pediatric testicular torsion (TT) and testicular appendage torsion (TAT) in our geographic area. Patients and Methods:We performed a retrospective database analysis of patients who underwent emergency surgery for TT or TAT between January 1996 and June 2009. Patient history, physical examination findings, laboratory test results, color Doppler sonography (CDS) results, and surgical findings were reviewed.Results:A total of 65 cases were included in our analysis. Forty-two cases were followed up for at least 3 months. Testicular tenderness was identified as the major clinical manifestation of TT, while only a few patients with TAT presented with swelling. CDS was an important diagnostic modality. The orchiectomy rate was 71% in the TT group.Conclusions:Cases of acute scrotum require attention in our area. Early diagnosis and scrotal exploration could salvage the testis or preserve normal function without the need for surgery.

Simultaneous Testicular and Appendix Testis Torsion

“…6 Management options include conservative approach (analgesics, cooling, and reduced activity) or scrotal exploration with excision in cases where the diagnosis is uncertain and/or the pain is unbearable. 7 Testicular torsion and TAT have been assumed as isolated entities, but as our case illustrates, a relationship may exist. In the present case, the history of insidious pain and the findings at exploration (normal testis, necrotic appendix) suggest that TAT happened first.…”

Outcomes of routine surgical exploration in children who admitted to the emergency service with acute scrotum

“…Orchiectomy was required in 5 patients because of necrosis. Results in an orchiectomy rate are ranging from 39% to 71% in most series in boys undergoing surgery for testicular torsion [6,8]. Our low rate of orchiectomy (15%) suggests that we are not selective in approach to the patient with acute scrotum suspicious of testicular torsion.…”

“…Actually, in cases due to torsion of the appendix testis, emergency operation is not necessary, scrotal pain resolve spontaneously within a few days and do not require any intervention. It has been putted forward that nonsurgical approach to torsion of the appendix testis have admitted that 22% of cases need emergency surgery for differential diagnosis and 14% of conservatively treated patients develop persistent pain [6]. The overlap in clinical findings between testicular torsion and torsion of the appendix testis was so great that we could not reliably make this differentiation; and urgent scrotal exploration performed for these cases.…”

The applied value of medical history, physical examination, colour-Doppler ultrasonography and testis scintigraphy in the differential diagnosis of acute scrotum

“…Forty‐three patients underwent testicular detorsion and orchidopexy. According to the surgical protocol, all 28 patients with appendage torsion confirmed in the exploration had excision of the appendage, since it shortened the course of management and reduced morbidity (Yu et al., ). Two of three post‐hernioplasty patients we described above had an orchiectomy.…”