PTU - Polskie Towarzystwo Urologiczne
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CODE: 17 - Why we do not relay on ultrasonography in boys with acute scrotum syndrome?
Article published in Urologia Polska 2006/59/Suplement 1.


Paweł Kroll 1, Andrzej Jankowski 1, Przemysław Mańkowski 1, Anna Jażdżewska 1, Paweł Juszczak 1, Małgorzata Warzywoda 2
1 Katedra Chirurgii Dziecięcej, Klinika Chirurgii, Urologii i Traumatologii Dziecięcej AM w Poznaniu
2 Zakład Radiologii Pediatrycznej AM w Poznaniu


Introduction. Differential diagnosis of acute testicular pain is challenging. The most important question is: to operate or not to operate? There is no discussion of need for surgery in cases of spermatic cord torsion. If the torsion of the testicular appendix is still controversial as potentially influencing fertility it should be differentiated from epididymitis and orchitis.
Objectives. Critical analysis of accuracy of ultrasonographic findings in boys presented with "acute scrotum syndrome".
Materials and methods. Charts of boys admitted to our institution with initial diagnosis of acute scrotum syndrome were retrospectively reviewed. Within last 3 years 191 children were hospitalized because of acute scrotum. All of them had testicular pain and tenderness without history of any trauma. In all of them ultrasound with Doppler was performed. The most important ultrasound finding was testicular and spermatic cord blood flow. In 44 cases orchitis/epididymitis was diagnosed and children were managed conservatively. In 147 children admitted with acute scrotum syndrome testicular exploration was performed. We compared findings from testicular exploration with preoperative suggestions from ultrasonography.
Results. From 147 boys intraoperative findings were: testicular cord torsion in 41 and torsion of the testicular appendix in 106 cases. In the group of 41 boys with testicular cord torsion: preoperative suggestion from ultrasonographic examination was: spermatic cord torsion in 19 cases, in 22 boys normal blood flow was observed in Doppler sonography. In 106 boys with torsion of the testicular appendix: in 33 cases preoperative ultrasonography positively correlated with intraoperative findings, in 73 cases orchitis was suggested. Mean postoperative hospitalization was 3,2 days. No postoperative surgical complications were observed in this group of patients.
Conclusions. Doppler sonography results may be misleading in boys with testicular cord torsion. The majority of boys with final diagnosis of torsion of the testicular appendix had false diagnosis of orchitis after the Doppler ultrasonography.