Outcomes of scrotal exploration for acute scrotal pain suspicious of testicular torsion: a consecutive case series of 173 patients

What's known on the subject? and What does the study add? Acute scrotal pain is a urological emergency. Prompt assessment is required to diagnose the cause. Patients older than 11 years are unlikely to have torsion of a testicular appendage and assessment should focus on discriminating between testicular torsion and epididymo-orchitis. Reasons for delay in presentation with acute scrotal pain need to be addressed. There is an association between testicular torsion and cold weather. OBJECTIVE center dot To determine the surgical outcome of all scrotal explorations performed on patients presenting with acute scrotal pain suspicious of testicular torsion. PATIENTS AND METHODS center dot Data was collected prospectively from a consecutive case series of patients of all ages who had scrotal exploration for acute testicular pain from 1998 to 2008. center dot The main outcome measures were pathology found during scrotal exploration, relationship between patient age and cause of scrotal pain, orchidectomy rate and the association between testicular torsion and cold weather. RESULTS center dot Data for 173 patients out of 179 was available for analysis. center dot The median age of the patients was 14 (0-92) years. 51% (n = 89) had testicular torsion, 24% (n = 42) had torsion of testicular appendages, 9% (n = 16) had epididymo-orchitis, and other pathology made up 5%. center dot No obvious pathology was seen in 10% (n = 17). center dot Patients with Torsion of Appendages were significantly younger than other patients with scrotal pain (P < 0.0001). center dot Age was not useful in discriminating between patients with Testicular Torsion from other patients with scrotal pain. 9% (n = 16) of all patients required an orchidectomy. center dot Frequency of Testicular Torsion was higher during the colder half of the year (n = 0.02). CONCLUSIONS center dot Testicular torsion was the most common finding at surgical exploration, followed by torsion of testicular appendages. center dot Age had limited value in diagnosing the cause of acute scrotal pain. center dot Testicular torsion was associated with cold weather. center dot Our findings support the practice of surgical exploration for acute scrotal pain suspicious of testicular torsion in patients of any age.