Diagnosis and treatment children with acute scrotal pain. Twenty years single centre experience

Abstract

The aim of study was to determine the value of Doppler ultrasonography in the diagnosis of acute scrotal pain in the different stages of acute scrotum. The case notes of 344 boys with an acute scrotum aged from 1 st day of life to 17 years old were reviewed in the Department of Pediatric Surgery of StSMU (Russia). The size and ultrasonography structure of the testis and its epididymis, as well as the testicular blood flow, were assessed. The sensitivity of ultrasonography findings for testicular torsion without scrotal edema was relatively low (50%), but with scrotal edema - increased to 83.3%. The specificity of sonography for testicular torsion in the presence or absence of edema of the scrotum did not change significantly (83.2%). The characteristic ultrasonography evidence of torsion of a testicular appendage was an increase in size of the epididymis and its heterogeneous echostructure. The sensitivity of these signs was high (83.3%) in all boys. The sonography signs of acute epididymitis are an enlarged epididymis and its homogeneity. The sensitivity (83.3%) and specificity (87.5%) of the findings did not depend on the presence or absence of scrotal edema. Operative exploration was performed on 240 patients. Surgical findings were: testicular torsion - 61, torsion of a testicular appendage - 164, acute epididymitis - 20. Thus, the sensitivity and specificity of physical examination signs of the acute scrotum in the absence of scrotal edema in children are higher than the ultrasonography findings, but significantly drops after the onset of scrotal edema.