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Explorative surgery for acute scrotal pain: The importance of patient age, side affected, time to surgery and surgeon

Andrea Fabiani, Massimo Calabrese, Alessandra Filosa, Fabrizio Fioretti, Valentina Maurelli, Michele Scandola, Stefano Noventa, Flavia Tombolini, Francesco Catanzariti, Lucilla Servi, Gabriele Mammana
  • Andrea Fabiani
    Surgery Department, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, Macerata, Italy | andreadoc1@libero.it
  • Massimo Calabrese
    Operative Unit of Urology SS. Filippo e Nicola Hospital, Avezzano (AQ), Italy
  • Alessandra Filosa
    Section of Pathological Anatomy, Department of Clinical Pathology, Area Vasta 3, ASUR Marche, Macerata Hospital, Macerata, Italy
  • Fabrizio Fioretti
    Surgery Department, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, Macerata, Italy
  • Valentina Maurelli
    Surgery Department, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, Macerata, Italy
  • Michele Scandola
    Department of Human Sciences, University of Verona - IRCCS Santa Lucia Foundation, Rome, Department of Psychology, University of Rome "Sapienza", Rome, Italy
  • Stefano Noventa
    Center for Assessment, University of Verona, Verona, Italy
  • Flavia Tombolini
    Urologic Clinic, Polytechnic University of Marche Region, Italy
  • Francesco Catanzariti
    Surgery Department, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, Macerata, Italy
  • Lucilla Servi
    Surgery Department, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, Macerata, Italy
  • Gabriele Mammana
    Surgery Department, Section of Urology, ASUR Marche Area Vasta 3, Macerata Hospital, Macerata, Italy

Abstract

Introduction and objective: Testicular torsion must be diagnosed quickly and accurately. The delay of the diagnosis and the subsequent delay of surgery may lead to loss testicular viability and orchidectomy. Aim of our retrospective evaluation was to define which element should be considered as major support to the clinician in distinguishing spermatic cord torsion from the other diseases mimicking this clinical emergency requiring surgical exploration. Material and methods: We retrospectively reviewed all clinical and instrumental data of emergency scrotal exploration performed for acute scrotal pain at two different Urological Department in a 10 year period. Results of surgical exploration represented the four diagnostic categories in which patients were divided for statistical evaluation. We evaluated the relationship between diagnosis performed by testicular surgical exploration and the all clinical data available including surgeon involved in the procedures. Results: A total of 220 explorative scrotal surgery were considered. We divided the cases in 4 categories according to the diagnostic results of each surgical procedure. Of all, spermatic cord torsion was diagnosed in 45% (99/220). The total testis salvage rate was of 78.8%. The patients with a diagnosis of spermatic cord torsion were older than patients with appendix torsion (15 vs 11 years in mean). When the affected side was the left, the probability to have a diagnosis of spermatic cord torsion was higher than the right side [χ2 (2, N = 218) = 11.77, p < 0.01]. Time elapsing between onset of symptoms and testicular salvagewas significantly lower even than in case of appendix torsion/necrosis (p < .0001), and of others pathologies diagnosed (p = .0383). Conclusion: In case of spermatic cord torsion, in addition to the clinical data, patient age and left side affected may represent an independent diagnostic predicting factor. The time elapsing between onset of symptoms and explorative surgery remain the only still prognostic factor for testicular viability.

Keywords

Spermatic cord torsion; Testicular necrosis; Testicular appendages; Scrotal surgery; Doppler ultrasound.

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Submitted: 2015-11-01 19:27:51
Published: 2016-10-05 16:52:26
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Copyright (c) 2016 Andrea Fabiani, Massimo Calabrese, Alessandra Filosa, Fabrizio Fioretti, Valentina Maurelli, Michele Scandola, Stefano Noventa, Flavia Tombolini, Francesco Catanzariti, Lucilla Servi, Gabriele Mammana

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