Colour Doppler ultrasonography replacing surgical exploration for acute scrotum: myth or reality?
BACKGROUND
Traditionally, every patient with an acute scrotum needed surgical exploration for definitive exclusion of testicular torsion.


OBJECTIVE
In this study, we aimed to evaluate the improved accuracy in clinical diagnosis with colour Doppler Ultrasonography (US) added to normal clinical assessment.


METHODS
We retrospectively reviewed 626 patients, who presented with acute scrotal pain between January 1998 and June 2004. Following history and physical examination, the patients either proceeded directly to surgery or underwent US examination. If clinical suspicion of testicular torsion persisted after US, the patients would still undergo scrotal exploration.


RESULTS
Of the 294 patients who had routine scrotal exploration without preliminary US, only 23 (7.8%) were found to have testicular torsion. Amongst the 332 cases that had initial US, 9 (2.7%) patients revealed testicular torsion that was confirmed at subsequent surgery. The remaining 323 patients had initial negative US, but 29 were explored eventually on clinical indications. Of these, 4 (1.2% of 323) cases were diagnosed intra-operatively as testicular torsion. None of the remaining 294 patients who were managed conservatively proved to have testicular torsion after a minimum follow-up of 2 weeks. For testicular torsion, US yielded a sensitivity of 69.2% (95% confidence interval =38.9-89.5), specificity of 100% (95% CI=98.5-100), positive predictive value of 100% and negative predictive value of 97.5%.


CONCLUSIONS
US has proven to decrease the number of emergency scrotal explorations, length of hospital stay and hence reduce the cost of management of acute scrotum.
Lam
Winnie Wing-Chuen
WW
Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore. winnie.lam.w.c@singhealth.com.sg
Yap
Te-Lu
TL
Jacobsen
Anette Sundfor
AS
Teo
Harvey James Eu-Leong
HJ
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012611:Scrotum / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color