title: Explorative surgery for acute scrotal pain: The importance of patient age, side affected, time to surgery and surgeon.
abstract: OBJECTIVE
  Testicular torsion must be diagnosed quickly and accurately. The delay of the diagnosis and the subsequent delay of surgery may lead to loss testicular viability and orchidectomy. Aim of our retrospective evaluation was to define which element should be considered as major support to the clinician in distinguishing spermatic cord torsion from the other diseases mimicking this clinical emergency requiring surgical exploration.
  
  
  METHODS
  We retrospectively reviewed all clinical and instrumental data of emergency scrotal exploration performed for acute scrotal pain at two different Urological Department in a 10 year period. Results of surgical exploration represented the four diagnostic categories in which patients were divided for statistical evaluation. We evaluated the relationship between diagnosis performed by testicular surgical exploration and the all clinical data available including surgeon involved in the procedures.
  
  
  RESULTS
  A total of 220 explorative scrotal surgery were considered. We divided the cases in 4 categories according to the diagnostic results of each surgical procedure. Of all, spermatic cord torsion was diagnosed in 45% (99/220). The total testis salvage rate was of 78.8%. The patients with a diagnosis of spermatic cord torsion were older than patients with appendix torsion (15 vs 11 years in mean). When the affected side was the left, the probability to have a diagnosis of spermatic cord torsion was higher than the right side [χ2 (2, N = 218) = 11.77, p &lt; 0.01]. Time elapsing between onset of symptoms and testicular salvagewas significantly lower even than in case of appendix torsion/necrosis (p &lt; .0001), and of others pathologies diagnosed (p = .0383).
  
  
  CONCLUSIONS
  In case of spermatic cord torsion, in addition to the clinical data, patient age and left side affected may represent an independent diagnostic predicting factor. The time elapsing between onset of symptoms and explorative surgery remain the only still prognostic factor for testicular viability.
authors.affiliation: Surgery Department, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, Macerata. andreadoc1@libero.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fabiani
authors.forename: Massimo
authors.initials: M
authors.lastname: Calabrese
authors.forename: Alessandra
authors.initials: A
authors.lastname: Filosa
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fioretti
authors.forename: Valentina
authors.initials: V
authors.lastname: Maurelli
authors.forename: Michele
authors.initials: M
authors.lastname: Scandola
authors.forename: Stefano
authors.initials: S
authors.lastname: Noventa
authors.forename: Flavia
authors.initials: F
authors.lastname: Tombolini
authors.forename: Francesco
authors.initials: F
authors.lastname: Catanzariti
authors.forename: Lucilla
authors.initials: L
authors.lastname: Servi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Mammana
mesh_terms: D059787:Acute Pain / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D004630:Emergencies; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000175:diagnosis / Q000601:surgery*; D066231:Surgeons; D013997:Time Factors; D055815:Young Adult