Management of acute testicular pain in children: changing trends with improvements in scrotal ultrasonography over 18 years.

Lin Kyaw; Candy Suet Cheng Choo; Lin Yin Ong; Te-lu Yap; Harvey James Teo; Shireen Anne Nah

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Management of acute testicular pain in children: changing trends with improvements in scrotal ultrasonography over 18 years.

Author: Lin KYAW ¹ ; Candy Suet Cheng CHOO ² ; Lin Yin ONG ^{3
,

4} ; Te-Lu YAP ^{3
,

4} ; Harvey James TEO ⁵ ; Shireen Anne NAH ^{6
,

7
,

8}
Author Information

1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
2. Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
3. Paediatric Surgery, KK Women's and Children's Hospital
4. Division of Surgery, Duke-NUS Medical School, Singapore.
5. Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore.
6. Paediatric Surgery, KK Women's and Children's Hospital, Singapore
7. Division of Surgery, Duke-NUS Medical School, Singapore
8. Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Publication Type:Journal Article
Keywords: Acute scrotum; emergency; testicular torsion; timing; ultrasonography
MeSH: Male; Child; Humans; Female; Scrotum/surgery*; Spermatic Cord Torsion/surgery*; Acute Pain/diagnostic imaging*; Ultrasonography; Retrospective Studies
From:Singapore medical journal 2023;64(4):249-254
CountrySingapore
Language:English
Abstract: INTRODUCTION:Doppler scrotal ultrasonography (US) is the modality of choice in diagnosing testicular torsion. We aimed to evaluate the performance of scrotal US in diagnosing testicular torsion over the past 18 years in our institution and determine the factors contributing to the length of wait times for it.
METHODS:A retrospective review was conducted of boys who presented with acute scrotal pain from 2014 to 2015. US reports, operative findings, final diagnosis and key time points of the patients' journey (time to emergency department consultation, time to admission, time to US and time to operating theatre [OT]) were collected. US performance results were compared with those observed in a historical cohort from 1998 to 2004. Wait times were compared between operated and non-operated patients.
RESULTS:Data from 519 boys with a mean age of 9.15 years was collected. Of these, 438 (84.4%) boys had undergone initial scrotal US; of these scrotal US cases, 28 were surgically explored, with 23 confirmed to have torsion. Another five cases were explored without prior US, and all were confirmed to have torsion. Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (P < 0.0001, r = 0.96) and time to OT (P < 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery.
CONCLUSION:There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with acute scrotum should target time to US and time to OT.