Experiences of 313 Cases of Acute Scrotum: Properties of Acute Epididymitis and Differential Diagnosis of Testicular Torsion

Abstract

Purpose: An acute scrotum is a pathologic condition of the scrotum or intrascrotal contents that require emergency medical or surgical treatment. Because proper treatment and the outcomes are very important in reproduction, the records of patients who had acute scrotal diseases were reviewed for early and proper diagnosis and treatment. Materials and Methods: The medical records of 313 patients with acute scrotal pain and swelling were retrospectively reviewed. The final diagnoses were made from the symptoms, a physical examination, the laboratory tests, a color Doppler ultrasound (US), and the surgical findings in cases that underwent surgery. Age, the presence of a urinary tract infection, an underlying disease, seasonal distributions, laterality and the accuracy of color Doppler US in acute epididymitis and testicular torsion were all analyzed. The missed cases of testicular torsion were also reviewed carefully. Results: The most common disease of an acute scrotum was acute epididymitis in both adults and children. Urinary tract infections were not common in children with acute epididymitis. Testicular torsion occurred commonly in the left side, while acute epididymitis developed in same distributions. The mean age of an acute scrotum were 24.1 years; a testicular torsion was 16.0 years and an acute epididymitis was 25.4 years. The color Doppler US demonstrated a 82.5% sensitivity, a 100% specificity, a 100% positive predictive value and a 97.5% negative predictive value for testicular torsion. Conclusions: Acute epididymitis is also common in children. Although color Doppler US is useful in a differential diagnosis of an acute scrotum, a careful physical examination and follow up of the patient status are important to reduce the incidence of a misdiagnosis.