Is the conservative management of the acute scrotum justified on clinical grounds?
OBJECTIVE
To determine whether there is justification for a policy of conservative management of acute scrotal emergencies, based on the ability to exclude a twisted testicle or the assumption that there is a "missed torsion' when the duration of symptoms is prolonged.


METHODS
The case notes of 209 consecutive emergency scrotal explorations, carried out in one district general hospital over a 7-year period, were reviewed. The decision to operate was based solely on a clinical diagnosis, with no information from additional radiological investigations.


RESULTS
The commonest finding was testicular torsion (39.5%) with an orchidectomy rate of 22%. Only 5% of scrotal torsions occurred in patients < 12 years of age, whereas 26% occurred in those > 20 years of age. In five of 82 cases (6%) of confirmed testicular torsion, the surgeon did not consider this the most likely diagnosis. With a pain duration of < 16 h, 89% of testes were salvaged, but with pain for > 16 h this decreased to 25%. In three cases the testis was viable after pain had been present for > 24 h.


CONCLUSIONS
In the absence of supportive radiological investigations, a small but significant number of twisted testes will be missed if conservative management is adopted.
Watkin
N A
NA
Department of Urology, Royal United Hospital NHS Trust, Bath, UK.
Reiger
N A
NA
Moisey
C U
CU
D000208:Acute Disease; D000293:Adolescent; D017677:Age Distribution; D003657:Decision Making; D005832:Genital Diseases, Male / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology; D012611:Scrotum / Q000601:surgery*; D012680:Sensitivity and Specificity; D013086:Spermatic Cord Torsion / Q000601:surgery; D016896:Treatment Outcome