Acute scrotum and testicular torsion in children: a retrospective study in a single institution. Issue 1 (February 2020) - Tanaka, Keiichiro
Summary: Introduction: Testicular torsion (TT), as per the reported incidences in children and preadolescents, is an emergency medical condition that requires prompt surgical treatment. In cases of TT, early and accurate diagnosis of acute scrotum (AS) is important to preserve testicular fertility. In this study, the authors aimed to determine the incidence, clinical examination, etiology, clinical predictors, and treatment of patients with AS and TT. Material and methods: The authors retrospectively reviewed all children (age, ≤15 years) with AS who visited their hospital between January 2012 and June 2019. Data on age and diagnosis, clinical findings, mode of treatment, and blood examination results were collected. Results: The authors examined 165 children aged between 0 days and 15 years (mean age, 9.4 years). Final diagnosis identified 72 patients with torsion of the appendix testis, 44 patients with epididymitis, and 38 patients with TT. Testes were salvaged in 23 of the 38 patients with TT (60.5%). Statistically significant variables revealed that the risk factors of TT were age (older than 12 years), white blood cell (WBC) count (>12, 000 cells/mm 3 ), and laterality (left side). The level of C-reactive protein (CRP), duration of symptoms, and degree of torsion were significantly higher in the non-salvageable testis group than in the salvageable testis group. Furthermore, the significant predictive factor for non-salvageable testis was the level of CRP >1.0 mg/dl. Conclusion: The study results indicates that age, WBC count, and laterality are key factors to distinguish TT from AS. Salvageability largely depended on the duration of symptoms and the degree of TT. The salvage rate of the testis can be improved by educating pediatricians, parents, patients, and medical staff about the early diagnosis and treatment of torsion. Table 1 Details of patients with AS ( n = 165). Table 1 Age (yrs) 9.4 ± 0.6 Final diagnosis Surgical treatment Conservative treatment Torsion of the appendix testis 72 (43.6%) 51 21 Epididymitis 44 (26.7%) 19 25 TT 38 (23.0%) 38 0 Torsion of the appendix epididymis 5 (3.0%) 5 0 Scrotal dermatitis 2 (1.2%) 0 2 Torsion of the epididymis 1 (0.6%) 1 0 Tumor of the spermatic cord 1 (0.6%) 1 0 Acute hydrocele 1 (0.6%) 0 1 Trauma 1 (0.6%) 0 1 Total 165 (100%) 115 50 Laterality Right side 66 (40.0%) Left side 93 (56.4%) Both sides 6 (3.6%) First diagnosis TT Not TT Final diagnosis TT 38 0 Not TT 23 127 Sensitivity 38/38 (100%) Specificity 127/150 (84.7%)