title: Is it possible to distinguish testicular torsion from other causes of acute scrotum in patients who underwent scrotal exploration? A multi-center clinical trial.
abstract: BACKGROUND
  To assess the clinical presentation of patients who underwent surgical exploration for acute scrotum and to investigate the potentially related factors for differential dignosis.
  
  
  METHODS
  We retrospectively analyzed the medical records of 97 patients who underwent surgical exploration for acute scrotum between May 2007 and July 2013. The patients were divided into two groups as follows: Group1 included patients with testicular torsion (TT) and Group 2 contained patients with acute scrotal pathologies other than TT, including torsion of the testicular appendage, epididymo-orchitis, trauma and Henoch-Schönlein purpura. The physical examination findings, colour Doppler ultrasound (CDUS) and laboratory findings for the groups were compared.
  
  
  RESULTS
  In total, 97 scrotal explorations were carried out for acute scrotum. Group 1 included 72 patients (74.2%) and Group 2 included 25 patients (25.8%). Group 2 was comprised of patients with torsion of the testicular appendage (n = 13), epididymo-orchitis (n = 8), testicular trauma (n = 2) and Henoch-Schönlein purpura (n = 2). In Group 1, 32 cases (44.4%) presented to a hospital less than 6 hours after onset of pain. More than half (64%) of Group 2's cases presented more than 24 hours after pain onset. Fever and pyuria appeared more frequently in Group 2 than in Group 1 and the results reached statistical significance (p = 0.001 and p = 0.044, respectively). Group 1 had more testicular tenderness than Group 2 (p <0.001). Our testicular salvage rate was 59.7%, and 40.3% of patients underwent orchiectomy.
  
  
  CONCLUSIONS
  CDUS predicted the diagnosis of TT (sensitivity 98.6%). Furthermore, clinical findings may also play a substantial role in the differential diagnosis of acute scrotum.
authors.affiliation: Suleyman Demirel University, Faculty of Medicine, Department of Urology, Isparta, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Güneş
authors.affiliation: Suleyman Demirel University, Faculty of Medicine, Department of Urology, Isparta, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Umul
authors.affiliation: Suleyman Demirel University, Faculty of Medicine, Department of Urology, Isparta, Turkey.
authors.forename: Muammer
authors.initials: M
authors.lastname: Altok
authors.affiliation: Haydarpasa Training and Research Hospital, Department of Urology, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Akyüz
authors.affiliation: Tepecik Training and Research Hospital, Department of Urology, Izmir, Turkey.
authors.forename: Cemal Selçuk
authors.initials: CS
authors.lastname: İşoğlu
authors.affiliation: Fatih Sultan Mehmet Training and Research Hospital, Department of Urology, Istanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Uruç
authors.affiliation: Dumlupınar University, Faculty of Medicine, Department of Urology, Kutahya, Turkey.
authors.forename: Bekir
authors.initials: B
authors.lastname: Aras
authors.affiliation: Haydarpasa Training and Research Hospital, Department of Urology, Istanbul, Turkey.
authors.forename: Zülfü
authors.initials: Z
authors.lastname: Sertkaya
authors.affiliation: Fatih Sultan Mehmet Training and Research Hospital, Department of Urology, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ürkmez
authors.affiliation: Suleyman Demirel University, Faculty of Medicine, Department of Urology, Isparta, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Baş
authors.affiliation: Haydarpasa Training and Research Hospital, Department of Urology, Istanbul, Turkey.
authors.forename: Muzaffer Oğuz
authors.initials: MO
authors.lastname: Keleş
keywords: acute scrotum; epididymoorchitis; testicular torsion; torsion of testicular appendages