The Diagnosis and Treatment of the Acute Scrotum in Children and Adolescents

Abstract

Diagnosing acute scrotal pain and swelling in children and adolescents is urgent and often difficult. A review of 395 boys hospitalized with acute scrotal pain and/or swelling shows that a useful approach is to divide these patients into four groups--those with intermittent but recurrent episodes of pain, those with pathognomonic physical findings, those with definite epididymitis, and a remaining group with nonspecific swelling and tenderness. Five per cent of boys in this series presented with recurring episodes of scrotal pain; these boys should undergo a simple scrotal operation that yields excellent results. Eight per cent had pathognomonic physical findings; treatment in these boys is straightforward. Eighteen per cent had a definite diagnosis of acute epididymitis (i.e., three nonpathognomonic but suggestive findings of acute epididymitis or two suggestive findings plus a radionuclide scan showing bilateral perfusion); nonoperative therapy is indicated in this group. In the remaining boys, scrotal exploration is the diagnostic (and usually therapeutic) procedure of choice.

The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

“…While cold weather was implicated in at least one review [12], an increase in the incidence of torsions in winter was not found in the Al-Jahra series. Most reviews of torsions indicated that testicular appendages are more often involved than the testes, and that the left scrotal contents are more often involved than the right ones [8,[13][14][15].These findings were also reproduced in this series.…”

“…Intrascrotal torsions are common in transpubertal and postpubertal age due to the increase in testicular mass [7][8][9]. Vigorous exercise, local trauma, a powerful cremasteric reflex and sexual excitement are possible precipitating factors of TT [2,10].…”

Scrotal Disorders: Evaluation of Testicular Enhancement Patterns at Dynamic Contrast-enhanced Subtraction MR Imaging

“…In patients with scrotal symptoms such as pain, swelling, and redness, it is important to differentiate testicular diseases from extratesticular scrotal disorders (1,2). Testicular diseases, including testicular torsion, malignant testicular tumor, and traumatic damage, require surgical exploration, whereas other testicular diseases and extratesticular scrotal disorders such as acute epididymo-orchitis, appendiceal torsion, and so on can be treated by means of conservative therapy (1)(2)(3).…”

Management of epididymo-orchitis in Genitourinary Medicine clinics in the United Kingdom's North Thames region 2000

“…The presenting symptom is unilateral testicular pain. Testicular torsion is the main differential diagnosis and should be considered in all cases, since delay in emergency surgery will adversely effect prognosis 1,2 . Differential diagnosis is based on symptoms at presentation (especially onset, duration and severity of pain), microbiological assessment and, if indicated, colour Doppler ultrasound 3 .…”