Role of Early Scrotal Exploration for Torsion of Testis and Appendages in Children

Yoo, Tag Keun; Woo, Young Nam

Abstract

After the analysis of 40 pediatric patients who underwent exploratory surgery under the diagnostic impression of testicular torsion for the period of 8 years from January 1981 to December 1988 in terms of age distribution, clinical features, diagnostic methods, therapeutic options, outcome and follow up, the results can be summarized as follows : 1. The most common causes of the disorder were testicular torsion (50% ), and torsion of append ages (33%). The remaining 17% of the cases were acute epididymitis (13%), orchids (2%), and hydrocele (2%). The prevalent ages for testicular torsion was over 11 years old (80%). On the other hand, torsion of appendages mainly affected children below 11 years old. 2. The observation of the presence or absence of the cremasteric reflex helped to differentiate the diagnosis of acute scrotum. Testicular scanning in 2 cases with vague symptoms provided to determine testicular torsion. With the endoscopic evaluation of the inside of tunica vaginalis, which was the first trial in these cases, we diagnosed 2 cases of testicular torsion. 3. Among the 20 patients with testicular torsion, 7 required orchiectomy because of obvious necrosis. There were 13 testes considered to be salvageable and they were fixed successfully. The early salvage rate of surgery in testicular torsion was 100% (9/9) for the patients operated less than 24 hours after torsion, and 36% (4/11) for the patients over 24 hours. The overall immediate testicular salvage rate was 65% (13/20). 4. Semen analyses revealed normal for 2 patients who underwent orchiectomy for testicular torsion that had lasted over 48 hours. Testicular scans 2 weeks after fixation in 2 patients with testicular torsion that had lasted 12 and 16 hours, showed normal perfusion. In conclusion, immediate scrotal exploration followed by appropriate treatment would result to maximal testicular salvage, minor morbidity and rapid symptomatic improvement in patients with pediatric acute scrotum.