Emergency scrotal exploration in children: Is it time for a change in mindset in the UK?

Autor: Anna Radford, Charlotte Melling, Leigh McDonald, Supul Henneyake, Amy Goaman, Milan Gopal, Elizabeth O'Connor, Vikrant Kumbhar, Haitham Dagash
Rok vydání: 2021
Předmět:
Zdroj: Journal of Pediatric Urology. 17:190.e1-190.e7
ISSN: 1477-5131
DOI: 10.1016/j.jpurol.2020.11.029
Popis: Summary Introduction Acute scrotal pain is a common problem in children. Amongst the various causes, only testicular torsion (TT) needs urgent, and arguably any, surgical intervention. However TT accounts for only approximately 25% of cases. The diagnosis of TT is currently based mainly on history and clinical examination in the UK. Objective We sought to find the incidence of finding TT during emergency scrotal exploration in four paediatric surgical centres in the UK. We also assessed the preoperative utilisation of clinical risk scores and Doppler ultrasound (DUS) to aid in the diagnosis. Patients and methods A retrospective review of 50 consecutive scrotal explorations done for acute scrotal pain at four tertiary pediatric surgical centres in 2019, including the preoperative utilisation of DUS, was analysed. Additionally an online survey was also sent out to consultant members of the British Association of Paediatric Urology to gauge their threshold for exploration, use of preoperative investigations and incidence of finding TT in their practice. Results In the four UK centres reviewed, TT was found in 24.5% (SD = 8.54) of explorations. The overall utilisation of preoperative DUS was 10%. The online survey revealed a low threshold for exploration. However 72% of respondents recalled finding TT in Discussion The incidence of finding TT during exploration in this cohort is the same as the incidence of TT in a population of children presenting with acute scrotal pain. We hypothesise that this is due to low accuracy of clinical assessment, low utilisation of preoperative clinical and radiological aids and the practice of exploring torted testicular appendages. Improving awareness and training in these modalities will increase diagnostic accuracy, limiting emergency scrotal explorations to those children with a higher risk of testicular torsion. A care pathway for children presenting with acute scrotal pain is suggested () Conclusions There is a low incidence of finding testicular torsion during paediatric scrotal explorations in the UK. There is low preoperative utilisation of clinical risk scores and Doppler ultrasound, which if utilised, could improve diagnostic accuracy. Download : Download high-res image (203KB) Download : Download full-size image Summary Figure . Care pathway for children presenting with acute scrotal pain. Abbreviations: TT-Testicular torsion; DUS-Doppler ultrasound; POCUS-Point of care ultrasound; TWIST-Testicular Workup for Ischemia and Suspected Torsion. ∗ DUS evaluation should include blood flow within the testis, twisting of the spermatic cord, redundant spermatic cord within the scrotum and abnormal lie of the testis.
Databáze: OpenAIRE
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