Urologia médica e cirúrgica
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Scrotal Exploration for Suspected Testicular Torsion: Can we Prevent Unnecessary Surgery?

Sergiy Tadtayev and Evangelos M Mazaris

Testicular pain is a common reason for seeking urgent urological advice and many patients with uncertain diagnosis undergo scrotal exploration. The role of ultrasound in triage of these patients is well recognised, but limited availability out-of-hours and inherent delays often make its use impractical. The aim of this study was to review local practices in relation to scrotal explorations and preoperative ultrasound and to highlight ways for improvement. We completed a retrospective study of 117 emergency scrotal explorations for suspected testicular torsion performed at our hospital in a four year period (2006-2010). Eleven patients (9.40%) had preoperative ultrasound. Analysis indicated that 32 patients (27%) had testicular torsion, 40 (34%) torsion of hydatid of Morgagni, 20 (17%) epididymo-orchitis, 1 (1%) testicular trauma and no cause for pain was found in 24 (21%) of cases. There were seven reported complications (5.98% rate). A significant proportion of patients undergoing scrotal exploration had pathology not requiring surgery. In cases where pain is of long duration (e.g. >12 hours) and clinical picture not suggestive of testicular torsion, ultrasound may be able to prevent unnecessary surgery by ruling out testicular torsion.