The paediatric acute scrotum: are we still managing correctly?

Abstract

Objective The objective of this study was to investigate current  investigation and management practice in a general district hospital in the UK of the paediatric acute scrotum. Summary background Diagnosis and  management of the paediatric acute scrotum remains an elusive and often challenging area of urology. In response to this, the urology team developed local guidelines to aid the management and treatment of this potentially life-changing condition.
Patients and methods We reviewed the notes of allchildren (younger than 16 years of age) who presented  with a diagnosis of acute scrotum over a 2-year period in  Harrogate district hospital. We assessed the adherence to local guidelines, specifically the following: immediate urology review (within 1 h) and all patients with symptoms for less than 24 h should have immediate scrotal exploration. We also reviewed the discharge diagnosis.
Results A total of 55 case notes were reviewed, of which 44 were eligible for data analysis; 23 patients were seen within an hour or under from the review request. In total, 21 patients were transferred to the theatre, with 19% having a final diagnosis of testicular torsion, yielding an overall incidence on the basis of eligible patients of 9%.
Conclusion The paediatric acute scrotum is a potentially life-changing diagnosis, and timely review and action of management is important.

Keywords: acute scrotum, paediatric, testicular torsion, time to theatre, ultrasound scan