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Annals of Medicine and Surgery (2012) Jul 2020Acute scrotal pain is a urological emergency. While for testicular torsion and acute epididymitis clinical recommendations are well established, few is known about low... (Review)
Review
BACKGROUND
Acute scrotal pain is a urological emergency. While for testicular torsion and acute epididymitis clinical recommendations are well established, few is known about low incidence causes of acute scrotal pain. Our aim is to identify and characterise rare differential diagnoses of acute scrotal pain in order to give diagnostic and therapeutic recommendations.
MATERIALS AND METHODS
A systematic literature search was performed in PubMed, Web of Science and the Cochrane Library databases up to February 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The systematic review protocol was registered on PROSPERO (CRD42018099472).
RESULTS
Eighty-four publications were selected for analysis. The databases provided mostly case reports, series and small studies, overall reporting on a cohort of 245 cases. Tumors, segmental testicular infarction, testicular vasculitis, pancreatitis, brucellosis, spermatic vein thrombosis, acute aortic syndrome and appendicitis were identified as rare underlying causes of acute scrotal pain and were characterised. As a result of our data analysis we were able to draw an overview of the rare differential diagnoses and diagnostic management of acute scrotal pain.
CONCLUSION
Rare differential diagnoses of acute scrotal pain are susceptible to misinterpretation as testicular torsion or acute epididymo-orchitis. Surgical management is indicated in case of suspicion for torsion or tumor. We herein present knowledge of the rare differential diagnoses and raise awareness for associated systemic disease in order to facilitate disease management and increase the potential for testicle-sparing treatment.
PubMed: 32547738
DOI: 10.1016/j.amsu.2020.05.031 -
BMJ Case Reports Apr 2018The clinical differential diagnosis of scrotal pain with a mass in a prepubertal boy is difficult. Often conditions such as testicular torsion and epididymo-orchitis are... (Review)
Review
The clinical differential diagnosis of scrotal pain with a mass in a prepubertal boy is difficult. Often conditions such as testicular torsion and epididymo-orchitis are diagnosed. We present a rare cause of scrotal pain, idiopathic scrotal fat necrosis. This condition has a typical clinical presentation and ultrasound findings that have been described in a limited number of case reports. However, if it is diagnosed correctly and confirmed with ultrasound, we hope that people will be treated without surgical intervention. We present a case of scrotal wall necrosis and a literature review.
Topics: Analgesia; Child; Conservative Treatment; Diagnosis, Differential; Fat Necrosis; Genital Diseases, Male; Humans; Male; Pain; Remission, Spontaneous; Scrotum; Ultrasonography, Doppler
PubMed: 29666095
DOI: 10.1136/bcr-2017-224087 -
BJUI Compass Jul 2022To evaluate the role of a urine dipstick in the assessment of acute scrotal pain emergency department presentations.
OBJECTIVE
To evaluate the role of a urine dipstick in the assessment of acute scrotal pain emergency department presentations.
METHODS
A single institution, prospective case series, from February 2020 to February 2021. All patients who received a bedside review by a urology doctor for acute scrotal pain were included. Urine dipstick results were pre-defined as having had an impact on the emergency clinician's diagnosis if it showed pyuria and/or nitrituria and the final diagnosis was epididymitis-orchitis or haematuria and the final diagnosis was ureterolithiasis.
RESULTS
139 patients presented to the emergency department with a complaint of acute scrotal pain. 85 (61%) were referred for bedside urology review. Median age of 17 years (P25 12 yrs, P75 31 yrs). 2.3% ( = 2) had proven testicular torsion, 28.5% ( = 24) had epididymitis-orchitis and 8.2% ( = 7) had ureterolithiasis. 68 (80%) of patients received a primary diagnosis of testicular torsion by the emergency department clinician. Following review by a urology unit doctor, 14 proceeded to scrotal exploration for concern of testicular torsion. 7 patients were diagnosed with ureterolithiasis, all of whom had haematuria on their urine dipsticks (100%, 95% CI: 59-100%), 100% of these urine dipsticks were initiated by the urology unit doctor following bedside review. 22 patients were diagnosed with epididymitis-orchitis. 8 of these had pyuria, nitrituria and/or haematuria on their urine dipstick (36%, 95% CI: 17-59%) and only one urine dipstick was completed prior to referral. 20.6% of patients perceived to have testicular torsion by the emergency department had a positive urine dipstick that aligned with their final alternative diagnosis (95% CI: 12-32%).
CONCLUSION
A collection of clinical findings is required to diagnose the aetiology of acute scrotal pain. Information that can be easily, quickly, cheaply, and reliably collected, such as a urine dipstick, can assist in clinical decision making.
PubMed: 35783592
DOI: 10.1002/bco2.138 -
Translational Andrology and Urology Dec 2017Chronic scrotal pain (CSP) may be debilitating in men presenting for treatment for CSP, but we have little information on the frequency and severity of CSP in the men...
BACKGROUND
Chronic scrotal pain (CSP) may be debilitating in men presenting for treatment for CSP, but we have little information on the frequency and severity of CSP in the men who do not seek care for the CSP. Our objective was to identify the frequency and characteristics of CSP in a population of men presenting for reasons other than CSP to a urology clinic.
METHODS
Men presenting to a urology clinic for investigation of male infertility (INF) completed a standardized CSP questionnaires if they self-reported having CSP. This prospectively collected database was then retrospectively analyzed.
RESULTS
Forty-five of 1,203 (3.7%) of INF patients (mean age 35: range, 24-59), reported having CSP (INF/CSP). Our comparison group was 131 men presenting for investigation of CSP [mean age 43¡À12 (SD) years with a mean duration of CSP of 4.7¡À5.95 years]. On average, men with INF/CSP had less severe and frequent pain than those with CSP, with significantly less pain during "bad" pain episodes (5.2¡À2.2 . 7.4¡À2.1, VAS score 0-10, P<0.0001 Student's -test), less frequent "bad" pain episodes (23%¡À21% . 42%¡À30% of the time, P<0.0001 Student's -test) and lower proportion of men who reported having severe pain (VAS score 7-10/10) (4/45 . 46/131, P<0.001, chi-squared test). Both groups reported a negative impact of the pain on quality of life (QOL), with 60% and 86% of men with INF/CSP and CSP alone reporting that they would feel 'mostly dissatisfied', 'unhappy', or 'terrible' if they had to continue life with their present scrotal pain symptoms.
CONCLUSIONS
Clinicians should be aware that CSP is common among men presenting for conditions other than CSP and that even if the pain levels are not "severe", the chronic pain often has a significant negative impact on QOL.
PubMed: 29354503
DOI: 10.21037/tau.2017.11.28 -
Reviews in Urology 2019Chronic scrotal content pain (CSCP) refers to bothersome pain localized to structures within the scrotum that has been present for ≥ 3 months. Etiologies include...
Chronic scrotal content pain (CSCP) refers to bothersome pain localized to structures within the scrotum that has been present for ≥ 3 months. Etiologies include infection, trauma, and referred pain from the spine, abdomen, and retroperitoneum. However, in many patients there is no obvious identifiable cause. The initial evaluation should include a thorough history and physical examination with adjunctive imaging and laboratory tests as indicated. Treatments vary based on the underlying etiology and include both nonsurgical and surgical options with high levels of success when selectively utilized. The spermatic cord block with local anesthetic is an important tool that helps identify those patients who may benefit from surgery such as microscopic denervation of the spermatic cord. Other treatments including pelvic floor physical therapy may also be indicated in specific circumstances. Using a thoughtful and thorough approach to evaluation and treatment of CSCP, urologists can work with patients to achieve significant improvements in quality of life.
PubMed: 31768134
DOI: No ID Found -
Annals of the Royal College of Surgeons... May 2022Acute scrotal pain is a common paediatric surgical emergency. Assessment and timely exploration are required to rule out testicular torsion (TT) and prevent unnecessary... (Observational Study)
Observational Study
INTRODUCTION
Acute scrotal pain is a common paediatric surgical emergency. Assessment and timely exploration are required to rule out testicular torsion (TT) and prevent unnecessary morbidity.
METHODS
A retrospective observational cohort study was carried out at two district general hospitals in the UK for boys aged ≤16 years presenting with acute scrotal pain between January 2014 and October 2017 managed by adult general surgery (AGS) at one hospital and adult urology (AU) at the other.
RESULTS
Some 565 patients were eligible for inclusion (=364 AGS, =201 AU). A higher proportion of patients underwent surgical exploration at AGS compared with AU (277/346 (80.1%) vs 96/201 (47.8%); <0.001). Of those who underwent exploration, 101/373 (27.1%) had TT, of whom 25/101 (24.8%) underwent orchidectomy and 125/373 (33.5%) had torted testicular appendage. There was no statistically significant difference in rates of orchidectomy between AGS (19/68, 27.9%) and AU (6/33, 18.2%) with testicular salvage rates of 72.1% and 81.8%, respectively (=0.334). Patients were twice as likely to be readmitted at AGS as at AU (28/346 (8.1%) vs 8/201 (4.0%); =0.073).
CONCLUSION
Although intraoperative findings were similar between adult general surgeons and urologists, there were significant differences in surgical management, with a higher rate of surgical exploration by general surgeons. Testicular salvage and 30-day postoperative morbidity rates at both institutions were acceptable but the readmission rate was high at 6.6%. It is not known why there is a heterogeneity in management of acute scrotal pain between specialist centres, and further prospective investigations are warranted.
Topics: Adult; Child; Genital Diseases, Male; Humans; Male; Pain; Retrospective Studies; Scrotum; Skin Diseases; Spermatic Cord Torsion; Surgeons; United Kingdom; Urologists
PubMed: 34939856
DOI: 10.1308/rcsann.2021.0190 -
Journal of Pediatric Hematology/oncology Aug 2021Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood and affects the small blood vessels, leading to arthritis, abdominal pain, and renal... (Review)
Review
Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood and affects the small blood vessels, leading to arthritis, abdominal pain, and renal involvement. However, scrotal involvement is a rare complication of HSP and scrotal pain. Swelling is the most frequent clinical presentation and can be easily confused with testicular torsion. If not treated in time, the scrotal inflammation will result in irreversible testicular necrosis. We report a 6-year-old male with HSP and scrotal involvement, characterized by swelling and pain on the left side of the scrotum, rashes on both lower extremities, and epididymitis. He was treated with conservative care, corticosteroids, and antibiotic therapy. We were able to avoid surgical intervention. On the 10 days of treatment, he recovered sufficiently well and was discharged. We have reviewed the literature related to HSP with scrotal involvement, identified 21 cases, and revealed that steroid therapy and/or antibiotics are the first-line of therapy in children with scrotal involvement. Vasculitis in the scrotum may predispose to testicular torsion, which is a complication that should not be overlooked. Clinicians should be aware of the atypical types of HSP. Timely diagnosis and appropriate treatment are essential for achieving the best results.
Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Child; Humans; IgA Vasculitis; Male; Scrotum; Spermatic Cord Torsion
PubMed: 33885039
DOI: 10.1097/MPH.0000000000002161 -
Immunity, Inflammation and Disease Oct 2023In recent years, there has been an increase in the number of patients diagnosed with pediatric diseases who have severe Mycoplasma pneumoniae (MP) pneumonia, and there...
BACKGROUND INTRODUCTION
In recent years, there has been an increase in the number of patients diagnosed with pediatric diseases who have severe Mycoplasma pneumoniae (MP) pneumonia, and there has also been an increased attention to serious extrapulmonary complications. However, cases with abdominal pain, acute abdomen, scrotal swelling and pain, and fever as the primary symptoms have been rarely reported.
CASE DESCRIPTION
A 3-years-and-8-months-old male patient diagnosed with pediatric disease was reported with abdominal pain, scrotal swelling and pain, and fever as the primary symptoms in the present study. No respiratory symptoms were observed throughout the disease. Through computed tomography (CT) scanning, the patient was diagnosed with severe MP pneumonia based on the symptoms of abdominal pain and fever, as well as pulmonary infection, pleural effusion, and retroperitoneal exudation. Laboratory tests supported the diagnosis of MP infection, and the diagnosis was confirmed by severe MP pneumonia. The therapeutic effects of azithromycin were poor, and the symptoms were quickly alleviated with the addition of gamma globulin and methylprednisolone. After discharge, azithromycin sequential therapy was administered. The chest CT was normal at the follow-up 1-month later.
CONCLUSION
Severe MP pneumonia in patients with pediatric diseases may include abdominal pain, scrotal swelling and pain, and fever as the primary symptoms. Care should be taken to avoid missed diagnoses and misdiagnoses in clinical practice.
Topics: Child; Humans; Male; Infant; Mycoplasma pneumoniae; Azithromycin; Abdomen, Acute; Pneumonia, Mycoplasma; Abdominal Pain
PubMed: 37904684
DOI: 10.1002/iid3.955 -
Pediatric Emergency Care Oct 2023Factors associated with testicular torsion (TT) and consequent orchiectomy in patients presenting to pediatric emergency departments (PEDs) with scrotal pain (SP) are...
OBJECTIVE
Factors associated with testicular torsion (TT) and consequent orchiectomy in patients presenting to pediatric emergency departments (PEDs) with scrotal pain (SP) are not well described. We report the factors predicting TT and consequent orchiectomy in children with SP.
METHODS
The data on patients (aged ≤18 years) who presented with SP to PEDs at 4 branches of the Chang Gung Hospital through 10 years were analyzed.
RESULTS
In all, 256 pediatric patients presented with SP. Their mean age was 11.60 ± 4.61 years and 72.7% (n = 186) were aged 10 to 18 years. The pain was left-sided in 54.7% (n = 140) and the interval between SP onset and PED arrival was 22.45 ± 31.27 hours. Overall, 84 (32.8%) patients needed surgery and 72 (28.1%) had TT. Of the patients with TT, 28 (38.9%) patients needed an orchiectomy. After analysis, TT and consequent orchiectomy were associated with a longer interval between SP onset and PED arrival, absent of testicular ultrasonic blood flow, interval between SP onset and surgery of more than 24 hours, and a high degree of TT. None of them experienced recurrent SP symptoms or TT again.
CONCLUSIONS
The rate of TT in patients presenting to PEDs with an SP was 28.1%, and 38.9% of the patients with TT needed an orchiectomy. Early diagnosis and intervention helped to prevent subsequent orchiectomy in pediatric patients with TT.
Topics: Male; Child; Humans; Adolescent; Spermatic Cord Torsion; Orchiectomy; Retrospective Studies; Testis; Pain
PubMed: 37624776
DOI: 10.1097/PEC.0000000000003037 -
Therapeutic Advances in Urology 2023Chronic scrotal content pain, sometimes referred to as chronic orchialgia, is a common urological condition that gives rise to persistent and often severe painful...
BACKGROUND
Chronic scrotal content pain, sometimes referred to as chronic orchialgia, is a common urological condition that gives rise to persistent and often severe painful stimuli to the scrotum and surrounding structures. Despite its relative commonality, accounting for over 2% of urological visits, chronic scrotal content pain is complex to manage and patients may be required to access multiple providers and undergo invasive procedures, including microsurgical spermatic cord denervation (MSCD) surgery.
OBJECTIVE
The objective of this study was to understand the experiences and perspectives of persons with chronic scrotal content pain and accessing MSCD surgery.
DESIGN
An exploratory qualitative design, guided by interpretive description and integrated knowledge translation, was adopted.
METHODS
We conducted in-depth qualitative interviews with six patients with chronic scrotal content pain who underwent MSCD surgery in a surgical center in Western Canada. Data were analyzed thematically.
RESULTS
Analysis of the study data resulted in three core themes: living with chronic scrotal content pain, quality of life, and MSCD procedure and outcomes. We highlight the debilitating nature of pain and the broad impacts upon health, quality of life, and social functioning. Participants described how MSCD surgery offered an effective solution for persistent and debilitating pain. For the participants, MSCD surgery offered hope and the chance to regain their normality.
CONCLUSION
For those with chronic scrotal content pain, access to a pain specialist, along with the adoption of a biopsychosocial approach to pain and early access to MSCD surgery, may improve patient experiences and outcomes. Considering the high prevalence of urological pain, greater interdisciplinary care is needed in order to support more effective and timely management.
PubMed: 37767052
DOI: 10.1177/17562872231196685