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Çocuklarda akut skrotumun retrospektif değerlendirilmesi: tek merkezde onbir yıllık deneyim

Year 2022, Volume 10, Issue 2, 58 - 62, 01.09.2022
https://doi.org/10.21765/pprjournal.1101241

Abstract

Amaç Hastanemiz Çocuk Cerrahisi Kliniği'nde son 11 yılda akut skrotum tanısı ile takip ve tedavi edilen hastalarda çocukluk çağında akut skrotum tanısı ile takip ve tedavi edilen hastalarda altta yatan neden ve sonuçların insidansı geriyedönük olarak incelendi. Material ve Method Bu çalışmaya Kasım 2010 ile Ekim 2021 arasında Çocuk Cerrahisi Kliniği tarafından akut skrotum tanısı konan toplam 216 hasta dahil edildi. Hastaların yaşı, başvuru şikayetleri, fizik muayene, laboratuvar ve radyolojik sonuçları, ek anomalileri, medikal ve cerrahi tedavi sonuçları analiz edildi. Sonuçlar Hastaların yaşları 3 hafta ile 17 yaş arasında olup, ortalama yaş 9,9 ± 4,4 yıl. Ağrı ve şişlik en sık akut skrotumda 119 hastada (%55.1) sağ tarafta, 97 hastada (%44.9) sol taraftadır. Akut skrotum nedenleri 98'inde (%45.4) orşit/epididimoorşit (O/EO), 52'sinde (%24.1) strangüle kasık fıtığı (SIH), 38'inde (%17.6) testis torsiyonu (TT) ve testis apendiksinin torsiyonu idi. (TTA) 11'inde (%5.1), 5'inde testis rüptürü (%2.3), idiyopatik skrotal ödem 5'te (%2.3), intravajinal apse 3'te (%1.4), testis kanseri 2'de (%0.9), hidrosel 2'de (%0.9) . O/EO olan hastaların 7'sinde (%7.1) vezikoüreteral reflü tespit edildi. Sonuç Bu seride O/EO akut skrotal ağrının en sık nedeni olarak bulundu. Akut skrotuma akut karın gibi yaklaşılmalıdır çünkü sadece alt kadran karın ağrısı testis torsiyonuna neden olabilir.

References

  • 1. Mellick LB, Mowery ML, Al-Dhahir MA. Cremasteric Reflex. StatPearls [Internet] StatPearls Publishing; Treasure Island (FL): 2 Jul 2021.
  • 2. Marte A. The history of varicocele: from antiquity to the modern ERA. Int Braz J Urol 2018 May-Jun;44(3):563-576.
  • 3. Raghavendran M, Venugopal A, Kiran Kumar G. Thrombosed varicocele - a rare cause for acute scrotal pain: a case report. BMC Urol 2018 May 08;18(1):34.
  • 4. Roth B, Giannakis I, Ricklin ME, Thalmann GN, Exadaktylos AK. An Accurate Diagnostic Pathway Helps to Correctly Distinguish Between the Possible Causes of Acute Scrotum. Oman Med J 2018 Jan;33(1):55-60.
  • 5. Kim JS, Shin YS, Park JK. Clinical features of acute scrotum in childhood and adolescence: Based on 17 years experiences in primary care clinic. Am J Emerg Med 2018 Jul;36(7):1302-1303.
  • 6. Ring N, Staatz G. [Diagnostic Imaging in Cases of Acute Scrotum]. Aktuelle Urol 2017 Sep;48(5):443-451.
  • 7. Pogorelić Z, Mustapić K, Jukić M, Todorić J, Mrklić I, Mešštrović J, Jurić I, Furlan D. Management of acute scrotum in children: a 25-year single-center experience on 558 pediatric patients. Can J Urol. 2016 Dec;23(6):8594-8601.
  • 8. García-Fernández G, Bravo-Hernández A, Bautista-Cruz R. [Testicular torsion: A case report]. Cir Cir. 2017 Sep - Oct;85(5):432-435.
  • 9. Crawford P, Crop JA. Evaluation of scrotal masses. Am Fam Physician. 2014 May 01;89(9):723-7.
  • 10. Yeap E, Pacilli M, Nataraja RM. Inguinal hernias in children. Aust J Gen Pract 2020 Jan-Feb;49(1-2):38-43.
  • 11. Gordhan CG, Sadeghi-Nejad H. Scrotal pain: evaluation and management. Korean J Urol 2015 Jan;56(1):3-11.
  • 12. Sheth KR, Keays M, Grimsby GM et.al. Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST Score. J Urol 2016 Jun;195(6):1870-6.
  • 13. Wang F, Mo Z. Clinical evaluation of testicular torsion presenting with acute abdominal pain in young males. Asian J Urol. 2019 Oct;6(4):368-372.
  • 14. Howe AS, Vasudevan V, Kongnyuy M, et.al. Palmer LS. Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion. Transl Androl Urol 2017 Dec;6(6):1159-1166.
  • 15. Güneş M, Umul M, Çelik AO, Armağan HH, Değirmenci B. A novel approach for manual de-torsion of an atypical (outward) testicular torsion with bedside Doppler ultrasonography guidance. Can Urol Assoc J. 2015 Sep-Oct;9(9-10): E676-8.
  • 16. Ufuk F, Herek D, Herek Ö, Akbulut M. Diffusion-Weighted Imaging and Color Doppler Ultrasound in Evaluation of Partial Testicular Torsion in Rat Model. Pol J Radiol 2017;82:542-546.
  • 17. Ayvaz OD, Celayir AC, Moralioglu S, Bosnali O, Pektas OZ, Pelin AK, Caman S. Four-year retrospective look for acute scrotal pathologies. North Clin Istanb 2015;2(3):182-188.
  • 18. Beck V, Grabbert M, Apfelbeck M, Schulz G, Stief CG, Tritschler S. [The acute scrotum - primary diagnostic approach and treatment]. MMW Fortschr Med 2016 Oct;158(17):49-50.
  • 19. Tanaka K, Ogasawara Y, Nikai K, Yamada S, Fujiwara K, Okazaki T. Acute scrotum and testicular torsion in children: a retrospective study in a single institution. J Pediatr Urol. 2020 Feb;16(1):55-60.
  • 20. Friedman AA, Palmer LS, Maizels M, Bittman ME, Avarello JT. Pediatric acute scrotal pain: A guide to patient assessment and triage. J Pediatr Urol 2016 Apr;12(2):72-5. 21. Rottenstreich M, Glick Y, Gofrit ON. The clinical findings in young adults with acute scrotal pain. Am J Emerg Med 2016 Oct;34(10):1931-1933.
  • 22. Pogorelić Z, Mrklić I, Jurić I. Do not forget to include testicular torsion in differential diagnosis of lower acute abdominal pain in young males. J Pediatr Urol 2013 Dec;9(6 Pt B):1161-5.
  • 23. Iio K, Nomura O, Kinumaki A, Aoki Y, Satoh H, Sakakibara H, Hataya H. Testicular Torsion in an Infant with Undescended Testis. J Pediatr 2018 Jun;197:312-312.e1.
  • 24. Hayon S, Michael J, Coward RM. The modern testicular prosthesis: patient selection and counseling, surgical technique, and outcomes. Asian J Androl 2020 Jan-Feb;22(1):64-69.

Retrospective Evaluation of Acute Scrotum in Children: Eleven Years Experience of a Single Centre

Year 2022, Volume 10, Issue 2, 58 - 62, 01.09.2022
https://doi.org/10.21765/pprjournal.1101241

Abstract

Objective Incidence of underlying causes and outcomes in patients followed up and treated in the last 11 years by the Pediatric Surgery Clinic of our hospital with the diagnosis of acute scrotum in childhood were analyzed retrospectively. Materials and Methods A total of 216 patients diagnosed with acute scrotum by the Pediatric Surgery Clinic between November 2010 and October 2021 were included in this study. The age, presentation complaints, physical examination, laboratory and radiological results, additional anomalies, medical and surgical treatment results of the patients were analyzed. Results The patients were aged between 3 weeks to 17 years, with a mean age of 9.9 ± 4.4 years. Pain and swelling are most common in acute scrotum present on the right side in 119 patients (55.1%) and on the left side in 97 patients (44.9%). Causes of acute scrotum were orchitis /epididymoorchitis (O/EO) in 98 (45.4%), strangulated inguinal hernia (SIH) in 52 (24.1%), testicular torsion (TT) in 38 (17.6%), and torsion of testicular appendage (TTA) in 11 (5.1%), testicular rupture in 5 (2.3%), idiopathic scrotal edema 5 (2.3%), intravaginal abscess 3 (1.4%), testicular cancer 2 (0.9%), hydrocele 2 (0.9%). Vesicoureteral reflux was detected in 7 (7.1%) of the patients with O/EO. Conclusion In this series, O/EO was found to be the most common cause of acute scrotal pain. The acute scrotum should be approached like the acute abdomen because only lower quadrant abdominal pain may be the cause of testicular torsion.

References

  • 1. Mellick LB, Mowery ML, Al-Dhahir MA. Cremasteric Reflex. StatPearls [Internet] StatPearls Publishing; Treasure Island (FL): 2 Jul 2021.
  • 2. Marte A. The history of varicocele: from antiquity to the modern ERA. Int Braz J Urol 2018 May-Jun;44(3):563-576.
  • 3. Raghavendran M, Venugopal A, Kiran Kumar G. Thrombosed varicocele - a rare cause for acute scrotal pain: a case report. BMC Urol 2018 May 08;18(1):34.
  • 4. Roth B, Giannakis I, Ricklin ME, Thalmann GN, Exadaktylos AK. An Accurate Diagnostic Pathway Helps to Correctly Distinguish Between the Possible Causes of Acute Scrotum. Oman Med J 2018 Jan;33(1):55-60.
  • 5. Kim JS, Shin YS, Park JK. Clinical features of acute scrotum in childhood and adolescence: Based on 17 years experiences in primary care clinic. Am J Emerg Med 2018 Jul;36(7):1302-1303.
  • 6. Ring N, Staatz G. [Diagnostic Imaging in Cases of Acute Scrotum]. Aktuelle Urol 2017 Sep;48(5):443-451.
  • 7. Pogorelić Z, Mustapić K, Jukić M, Todorić J, Mrklić I, Mešštrović J, Jurić I, Furlan D. Management of acute scrotum in children: a 25-year single-center experience on 558 pediatric patients. Can J Urol. 2016 Dec;23(6):8594-8601.
  • 8. García-Fernández G, Bravo-Hernández A, Bautista-Cruz R. [Testicular torsion: A case report]. Cir Cir. 2017 Sep - Oct;85(5):432-435.
  • 9. Crawford P, Crop JA. Evaluation of scrotal masses. Am Fam Physician. 2014 May 01;89(9):723-7.
  • 10. Yeap E, Pacilli M, Nataraja RM. Inguinal hernias in children. Aust J Gen Pract 2020 Jan-Feb;49(1-2):38-43.
  • 11. Gordhan CG, Sadeghi-Nejad H. Scrotal pain: evaluation and management. Korean J Urol 2015 Jan;56(1):3-11.
  • 12. Sheth KR, Keays M, Grimsby GM et.al. Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST Score. J Urol 2016 Jun;195(6):1870-6.
  • 13. Wang F, Mo Z. Clinical evaluation of testicular torsion presenting with acute abdominal pain in young males. Asian J Urol. 2019 Oct;6(4):368-372.
  • 14. Howe AS, Vasudevan V, Kongnyuy M, et.al. Palmer LS. Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion. Transl Androl Urol 2017 Dec;6(6):1159-1166.
  • 15. Güneş M, Umul M, Çelik AO, Armağan HH, Değirmenci B. A novel approach for manual de-torsion of an atypical (outward) testicular torsion with bedside Doppler ultrasonography guidance. Can Urol Assoc J. 2015 Sep-Oct;9(9-10): E676-8.
  • 16. Ufuk F, Herek D, Herek Ö, Akbulut M. Diffusion-Weighted Imaging and Color Doppler Ultrasound in Evaluation of Partial Testicular Torsion in Rat Model. Pol J Radiol 2017;82:542-546.
  • 17. Ayvaz OD, Celayir AC, Moralioglu S, Bosnali O, Pektas OZ, Pelin AK, Caman S. Four-year retrospective look for acute scrotal pathologies. North Clin Istanb 2015;2(3):182-188.
  • 18. Beck V, Grabbert M, Apfelbeck M, Schulz G, Stief CG, Tritschler S. [The acute scrotum - primary diagnostic approach and treatment]. MMW Fortschr Med 2016 Oct;158(17):49-50.
  • 19. Tanaka K, Ogasawara Y, Nikai K, Yamada S, Fujiwara K, Okazaki T. Acute scrotum and testicular torsion in children: a retrospective study in a single institution. J Pediatr Urol. 2020 Feb;16(1):55-60.
  • 20. Friedman AA, Palmer LS, Maizels M, Bittman ME, Avarello JT. Pediatric acute scrotal pain: A guide to patient assessment and triage. J Pediatr Urol 2016 Apr;12(2):72-5. 21. Rottenstreich M, Glick Y, Gofrit ON. The clinical findings in young adults with acute scrotal pain. Am J Emerg Med 2016 Oct;34(10):1931-1933.
  • 22. Pogorelić Z, Mrklić I, Jurić I. Do not forget to include testicular torsion in differential diagnosis of lower acute abdominal pain in young males. J Pediatr Urol 2013 Dec;9(6 Pt B):1161-5.
  • 23. Iio K, Nomura O, Kinumaki A, Aoki Y, Satoh H, Sakakibara H, Hataya H. Testicular Torsion in an Infant with Undescended Testis. J Pediatr 2018 Jun;197:312-312.e1.
  • 24. Hayon S, Michael J, Coward RM. The modern testicular prosthesis: patient selection and counseling, surgical technique, and outcomes. Asian J Androl 2020 Jan-Feb;22(1):64-69.

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Original Articles
Authors

Mehmet UYSAL> (Primary Author)
KARAMANOGLU MEHMETBEY UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF PEDIATRIC SURGERY
0000-0003-1561-6601
Türkiye


Bülent IŞIK>
KARAMANOGLU MEHMETBEY UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF BASIC MEDICAL SCIENCES, DEPARTMENT OF MEDICAL PHYSIOLOGY
0000-0001-8753-8302
Türkiye

Publication Date September 1, 2022
Acceptance Date August 19, 2022
Published in Issue Year 2022, Volume 10, Issue 2

Cite

Vancouver Uysal M. , Işık B. Retrospective Evaluation of Acute Scrotum in Children: Eleven Years Experience of a Single Centre. Pediatric Practice and Research. 2022; 10(2): 58-62.