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Is the conservative management of the acute scrotum justified on clinical grounds?
Author(s) -
Watkin N.A.,
Reiger N.A.,
Moisey C.U.
Publication year - 1996
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1046/j.1464-410x.1996.16321.x
Subject(s) - conservative management , acute scrotum , scrotum , medicine , intensive care medicine , surgery
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. Patients and 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. Conclusion In the absence of supportive radiological investigations, a small but significant number of twisted testes will be missed if conservative management is adopted.