Is the conservative management of the acute scrotum justified on clinical grounds?
Version of Record online: 29 OCT 2003
British Journal of Urology
Volume 78, Issue 4, pages 623–627, October 1996
How to Cite
Watkin, N.A., Reiger, N.A. and Moisey, C.U. (1996), Is the conservative management of the acute scrotum justified on clinical grounds?. British Journal of Urology, 78: 623–627. doi: 10.1046/j.1464-410X.1996.16321.x
- Issue online: 29 OCT 2003
- Version of Record online: 29 OCT 2003
- Cited By
- Spermatic cord torsion;
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.