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Acute scrotum is a medical emergency that requires prompt accurate diagnosis to appropriately triage potentially surgical conditions. Numerous differential diagnoses with overlapping clinical presentations make this a diagnostic challenge. Ultrasound is the established first-line imaging modality for acute scrotal disease and can be used to diagnose most scrotal disorders promptly and with high accuracy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Testicular and scrotal abnormalities can occur in children, adolescents, and adults. The lesions, often accompanied by pain and swelling/enlargement of the scrotum, can cause anxiety in patients and their parents. Regardless of age, proper diagnosis is based on adequate anamnesis and physical examination. Color Doppler ultrasound is the first-line test in the differential process of testicular and scrotal diseases. Testicular and scrotal lesions require differentiation for benign and malignant processes as well as therapeutic management, including urgent surgical intervention. The aim of this paper is to present the most common causes of testicular and scrotal abnormalities in pediatric and adult patients and to outline the symptoms and diagnostic and therapeutic management. [ABSTRACT FROM AUTHOR]

Case Presentation: A 44-year-old Black male presented to the emergency department with left scrotal pain. His initial workup did not identify an etiology of his symptoms; however, he returned the following day with worsening pain and a radiology-performed ultrasound then revealed a segmental testicular infarct.Discussion: Segmental testicular infarcts are a rare, often idiopathic, source of scrotal pain. Diagnosis is made by ultrasound, and repeat imaging may be required if not apparent on initial evaluation. Management is typically conservative although some require surgical intervention.

Introduction: Varicocelectomy is the prevailing management of scrotal pain secondary to varicocele. However, the literature is controversial on this topic. Some data showed that pain may persist after the surgery even if the varicocele is not detected postoperatively. Objectives: The objectives of the study were to identify the effect of varicocelectomy in patients with chronic scrotal pain, to report the association between the clinical grade and postoperative pain resolution, and to identify the need for a secondary procedure after varicocelectomy to control the pain. Materials and Methods: This was a retrospective study of 47 patients who underwent varicocelectomy between March 2016 and December 2018. Results: Postoperatively, the pain totally resolved after surgery in 64.3% of patients with scrotal pain; it improved in 21.4%, 11.9% have persistent pain, and the pain got worse in only 2.4%. Our study showed 100% complete resolution or improvement with Grade I, 85.7% in Grade II, and 81.3% in Grade III. In addition, all patients who underwent bilateral varicocelectomy had pain that either completely resolved or improved postoperatively. On the other hand, all patients who had persistent pain or pain worsening postoperatively had unilateral varicocelectomy. An additional intervention for postoperative pain control was needed in only 14% of patients, 7% of them underwent embolization, 4.7% had a cord block, and 2.3% were sent to a pain clinic. Conclusion: Varicocelectomy offers good outcomes in most patients with varicocele-related scrotal pain. The most significant predictor for success was low grade and bilaterality. However, there is a subset of patients whose symptoms will not improve postoperatively. Careful preoperative counseling and expectation management are crucial when discussing surgical options for those patients. [ABSTRACT FROM AUTHOR]

Introduction: Varicocelectomy is the prevailing management of scrotal pain secondary to varicocele. However, the literature is controversial on this topic. Some data showed that pain may persist after the surgery even if the varicocele is not detected postoperatively. Objectives: The objectives of the study were to identify the effect of varicocelectomy in patients with chronic scrotal pain, to report the association between the clinical grade and postoperative pain resolution, and to identify the need for a secondary procedure after varicocelectomy to control the pain. Materials and Methods: This was a retrospective study of 47 patients who underwent varicocelectomy between March 2016 and December 2018. Results: Postoperatively, the pain totally resolved after surgery in 64.3% of patients with scrotal pain; it improved in 21.4%, 11.9% have persistent pain, and the pain got worse in only 2.4%. Our study showed 100% complete resolution or improvement with Grade I, 85.7% in Grade II, and 81.3% in Grade III. In addition, all patients who underwent bilateral varicocelectomy had pain that either completely resolved or improved postoperatively. On the other hand, all patients who had persistent pain or pain worsening postoperatively had unilateral varicocelectomy. An additional intervention for postoperative pain control was needed in only 14% of patients, 7% of them underwent embolization, 4.7% had a cord block, and 2.3% were sent to a pain clinic. Conclusion: Varicocelectomy offers good outcomes in most patients with varicocele-related scrotal pain. The most significant predictor for success was low grade and bilaterality. However, there is a subset of patients whose symptoms will not improve postoperatively. Careful preoperative counseling and expectation management are crucial when discussing surgical options for those patients.

Background: Scrotal pain is a common urological condition. Common causes of scrotal pain are Hydrocele, testicular torsion, epididymitis, epididymo-orchitis and occasionally due to post vasectomy pain, varicocele, testicular trauma etc. Ultrasound is an ideal imaging modality for the evaluation of scrotum in all age group patients. Scrotal ultrasound can differentiate between solid and cystic masses and localize the mass as either testicular or Para testicular. Objectives: The aim of study is to evaluate causes of scrotal pain on ultrasound and to determine the common causes of scrotal pain. Methodology: Patients presented with scrotal pain who were referred to radiology department of our hospital were included in the study. All patients were subjected to ultrasound of scrotum with color Doppler study when needed. Descriptive variables were studied and analyzed. Results: In the present study out of 160 cases, maximum i.e. 33 (20.62%) patients were ranged in age from 61-70 years. It was observed that majority of cases had hydrocele (35.62%) followed by Non specificorchalgia (26.25%), inflammatory lesion (20%) and others like varicocele (8.1%), torsion infarct (3.4%) Spermatocele (5%), undescended testis (8%). Among 42 cases of inflammatory scrotal pathology, acute epididymo orchitis was present among 12 (28.57%) cases followed by acute epididymitis. Conclusion: Our research led us to the conclusion that hydrocele was the most frequent cause of scrotal pain. For assessing patients with scrotal pathological disorders, Ultrasonography is an excellent, safe, and reliable tool. [ABSTRACT FROM AUTHOR]

Inflammation of the vas deferens or what known as acute vasitis is an under-reported condition that usually presents with scrotal or inguinal pain and swelling which can be misdiagnosed and treated as many other conditions. Here, we present one of the first cases to be reported in the literature with bilateral manifestation. A 28-year-old male patient presented complaining of bilateral testicular and inguinal pain associated with inguinal swelling for 3 days. Initially, the patient was being evaluated as a case of incarcerated bilateral inguinal hernia, but with the aid of radiological imaging, the patient was diagnosed correctly and the unnecessary surgical intervention was prevented.

Inflammation of the vas deferens or what known as acute vasitis is an under-reported condition that usually presents with scrotal or inguinal pain and swelling which can be misdiagnosed and treated as many other conditions. Here, we present one of the first cases to be reported in the literature with bilateral manifestation. A 28-year-old male patient presented complaining of bilateral testicular and inguinal pain associated with inguinal swelling for 3 days. Initially, the patient was being evaluated as a case of incarcerated bilateral inguinal hernia, but with the aid of radiological imaging, the patient was diagnosed correctly and the unnecessary surgical intervention was prevented. [ABSTRACT FROM AUTHOR]

Introduction: One of the most common urological emergency conditions is acute scrotum. Scrotal pain is commonly seen in early adults in the emergency departments with an association of different pathologies. The aim of this study was to determine the comparison of high-resolution sonography and colour Doppler flow imaging in patients presenting with acute scrotum. Material & Methods: A descriptive study was conducted at the Department of Radiology, Lady Reading Hospital, Peshawar, Pakistan. This study enrolled a purposive sample of emergency department patients presenting with acute scrotal pain. The pattern of blood flow, peak systolic velocity, resistive index, pulsatility index, mean and standard deviation were calculated for the continuous variables. Descriptive analyses were performed to investigate the distribution of data. Results: A total of 72 patients were enrolled in our study. The mean age of patients was recorded 36.33±11.66 years. The most common scrotal pathologies that associated with scrotal pain was hydrocele 31(38.8%), followed by varicocele 22(27.5%), testicular torsion 9(11.3%), cyst 8(10.0%), epididymo-orchitis 7(8.8%), pyocele 6(7.5%), orchitis 4(5.0%), increase scrotal wall thickness 3(3.8%), undescended testis 3(3.8%), inguinoscrotal hernia 1(1.3%), testicular atrophy 1(1.3%), rete testis 1(1.3%), hemangioma 1(1.3%), hematoma 1(1.3%), scrotal mass 1(1.3%), testicular microlithiasis 1(1.3%), and normal scrotal sonography 4(5.0%) of cases respectively. Conclusion: High-resolution ultrasonography along with colour and power Doppler should be used as 1st line imaging modality in patients presenting with acute scrotal pain.

Pulsed radiofrequency, short bursts of radiofrequency energy, has been used by pain practitioners as a non- or minimally neurodestructive technique, an alternative to radiofrequency heat lesions. The clinical advantages and mechanisms of this treatment remain unclear. To review the current clinical implication of the pulsed radiofrequency technique for male patients with chronic scrotal pain. We systematically searched the English literature available at the EMBASE, MEDLINE/PubMed, Google Scholar, and Cochrane Library from inception to 22 November 2022. Only reports on a pulsed radiofrequency application on male patients with chronic scrotal pain were included. The final analysis yielded six reports on the clinical use of pulsed radiofrequency applications in male patients with chronic scrotal pain: six full publications, three case reports, one case series, one prospective uncontrolled pilot study, and one prospective randomized, controlled clinical trial. The accumulation of these data shows that using pulsed radiofrequency generates an increasing interest in pain physicians, radiologists, and urologists for managing chronic scrotal pain. No side effects related to the pulsed radiofrequency technique were reported to date. Further research on the clinical and biological effects is justified. Large sample sizes and randomized clinical trials are warranted. [ABSTRACT FROM AUTHOR]

Testicular torsion (TT) is a urological emergency, which requires a time-sensitive approach to diagnosis and management. TT predominantly presents with severe, sudden onset, unilateral testicular pain in men under the age of 21. It is a clinical diagnosis with assistance from a scrotal ultrasound or confirmation via scrotal exploration. Here we present an interesting case of a 67-year-old man with TT. This case demonstrates that medical professionals should have a high degree of clinical suspicion for men of all ages with unilateral scrotal pain.

Scrotal pain and swelling are common presentation, the prompt evaluation and diagnosis is needed due to wide range of causes, uncommon causes of orchialgia should be kept in mind whenever there is no clear diagnosis. Spermatic vein thrombosis usually presents with orchialgia along with episodes of acute exacerbation of pain. The diagnosis is challenging and need high index of suspension and detailed radiological evaluation. We present a case of metachronous bilateral unprovoked spermatic vein thrombosis treated conservatively with anticoagulation with good response and resolution of symptoms.

A previously healthy child, presented with severe abdominal and scrotal pain with scrotal swelling for five days. There was associated fever, vomiting, and diarrhea. There was history of COVID-19 infection in the previous month. The patient was febrile (39°C), and in pain. His other vitals were unremarkable. Testicular torsion and appendicitis were ruled out by ultrasound. Abdominal CT scan showed signs indicating terminal ileitis. His MIS-C panel revealed elevated inflammatory markers and cardiac enzymes and positive SARS-CoV-2 IgG levels. All cultures and RT-PCR COVID-19 were negative. Echocardiogram showed only minor mitral and tricuspid regurgitation. The patient was diagnosed as a case of MIS-C. and recovered completely on management. Our patient showed an inexplicable previously unreported complaint of scrotal pain and swelling as a symptom of MIS-c. Further research tackling MIS-C's different presentations and comparing the efficacy of the different treatment methods will help us better manage this disease. [ABSTRACT FROM AUTHOR]

Segmental testicular infarction(STI) is a rare unknown condition. Clinical presentation is non-specific and management is unconsensual. We report clinical and surgical management of a segmental testicular infarction. A 18-years old adult presented to emergency with acute right testicular pain. The only triggering factor was a stressful situation. Examination revealed a slightly swollen, non-ascending testicle with no inflammatory signs. We suspected spermatic –cord torsion(SCT), we decided to explore it surgically. Exploration showed a well-demarcated infarcted inferior pole of right testicle. Partial orchiectomy was performed. STI is a rare entity often clinically confused with SCT. Diagnosis is based on intraoperative findings.

Acute scrotum is referred to patients presenting with acute pain or swelling in scrotum or its contents. Clinical evaluation and appropriate radiological investigations helps us to pin point the aetiology of acute scrotum. Male genitourinary cases range from 0.5-2.5% of all emergency cases, although very few cases report the incidence of acute scrotum. Purpose of this case report is to highlight two very rarely reported events presented as scrotal pain and testicular swelling in a 39-year-old male and a 31-year-old- male patient. After radiological examination a diagnosis of acute scrotum was made. Commonly causation is attributed to either acute torsion or acute epididymo-orchitis. Routinely, management of acute scrotum include colour doppler scrotum, based on its findings further treatment is decided either surgical exploration or conservative treatment. Early evaluation and timely management is imperative in preserving the viability of gonads.

Epididymal cysts are fluid filled cysts arising from the epididymis, with an incidence ranging from 5 to 20% in pediatric age group. Being not so common, these lesions might be underestimated as an etiology of scrotal pain in children.We present a 13-year-old male child with history of right sided scrotal pain of 1 month duration. Clinical examination and scrotal ultrasonography established the diagnosis of epididymal cyst. Following 4 months of expectation, and upon persistence of patient's complaint and failure of lesion's resolution, surgical excision of the cyst was done.

Doppler ultrasound can diagnose testicular torsion with high sensitivity and specificity but may delay surgical treatment. This study aims to assess whether the use of doppler ultrasound, in cases with intermediate clinical suspicion of testicular torsion, can improve diagnostic accuracy compared to clinical assessment alone. We implemented a new clinical algorithm where patients with intermediate suspicion of testicular torsion undergo doppler ultrasound within 60 min. This study compared the patients that presented within one year prior to the implementation (group 1) to the patients who presented within one year after the implementation (group 2). The primary outcome measure was failure to confirm testicular torsion upon surgical exploration (negative surgical exploration). Missed testicular torsion was one of the secondary endpoints. 590 consecutive patients were included. 322 (55%) in group 1 and 268 (45%) in group 2. There were 9 (2.8%) testicular torsions in group 1 vs 9 (3.4%) in group 2 (p = 0.69) and 2 (0.6%) missed testicular torsions in group 1 vs 0 in group 2 (p = 0.50). Doppler ultrasound was performed in 65 patients (24.2%) in group 2 vs 0 in group 1 (p < 0.01). Negative surgical exploration was performed in 27 (8.4%) patients in group 1 vs 8 (3.0%) in group 2 (p < 0.01). Doppler ultrasound assessment of patients at intermediate clinical risk of testicular torsion significantly reduced the frequency of negative surgical explorations without increased rate of missed testicular torsions. [ABSTRACT FROM AUTHOR]

Abdullah Laher,1 Shavania Ragavan,2 Puja Mehta,2 Ahmed Adam2 1Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Division of Urology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaCorrespondence: Abdullah LaherDepartment of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 Jubilee Road, Parktown, Johannesburg 2193, South AfricaTel +27 84 840 2508Email abdullahlaher@msn.comAbstract: Testicular torsion is a challenging and time-sensitive diagnosis that is encountered frequently in daily practice, especially in the emergency room. A thorough history, the presence of a painful and swollen testis and testicular ultrasonography plays a vital role in the prompt diagnosis of testicular torsion. Prompt diagnosis is essential to prevent complications of testicular torsion which include testicular infarction, necrosis, and sub/infertility. This can be challenging as there are various other conditions that may mimic the presentation of testicular torsion. Since testicular torsion is an extremely time-sensitive diagnosis, it may also be a subject of many medicolegal challenges. This review article serves as a guide for clinicians involved with the diagnosis and management of testicular torsion. We review and discuss detection and management strategies based on their validity, statistical significance, and effectiveness in enabling prompt diagnosis and management of testicular torsion. Medicolegal implications of testicular torsion are also highlighted.Keywords: testis torsion, scrotal pain, acute scrotum, emergency room, orchidectomy

Since being approved by the United States Food and Drug Administration (FDA) in 2013, sodium-glucose cotransporter-2 inhibitors (SGLT2is) have emerged as an appealing therapeutic choice for patients with diabetes due to their favorable effects on renal and cardiac health. Recent trials have further expanded the application of these drugs by showing a decrease in mortality rates among patients with both reduced and preserved ejection fraction heart failure, even in those without diabetes. Common adverse effects of SGLT2is include increased urinary frequency and urinary tract infections stemming from elevated glycosuria. Here, we present a case report involving a 66-year-old man who developed Fournier's gangrene (FG) shortly after initiating dapagliflozin - a rare but dangerous adverse effect associated with this medication., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shaykh et al.)

Amiodarone is commonly used to prevent and treat life-threatening cardiac arrhythmias. However, it is also known to have an extensive side effect profile. A rare adverse effect of amiodarone is epididymitis. Epididymitis is inflammation of the epididymis that causes moderate pain in the posterior scrotum. The patient, in this case, developed left scrotal pain seven months after starting amiodarone and presented with symptoms consistent with epididymitis. The patient's work-up included urinalysis with culture, treatment with antibiotics, and testicular ultrasound before being diagnosed with amiodarone-induced epididymitis. This diagnosis led to the discontinuation of amiodarone, which resulted in the complete resolution of the patient's symptoms within two weeks. This case report is intended to increase awareness of epididymitis as a possible adverse effect of amiodarone and to stress the importance of considering this when there are no apparent anatomical or infectious causes of epididymitis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Lyon et al.)

Testicular torsion (TT) is a urological emergency, which requires a time-sensitive approach to diagnosis and management. TT predominantly presents with severe, sudden onset, unilateral testicular pain in men under the age of 21. It is a clinical diagnosis with assistance from a scrotal ultrasound or confirmation via scrotal exploration. Here we present an interesting case of a 67-year-old man with TT. This case demonstrates that medical professionals should have a high degree of clinical suspicion for men of all ages with unilateral scrotal pain. [ABSTRACT FROM AUTHOR]

Pulsed radiofrequency, short bursts of radiofrequency energy, has been used by pain practitioners as a non- or minimally neurodestructive technique, an alternative to radiofrequency heat lesions. The clinical advantages and mechanisms of this treatment remain unclear. To review the current clinical implication of the pulsed radiofrequency technique for male patients with chronic scrotal pain. We systematically searched the English literature available at the EMBASE, MEDLINE/PubMed, Google Scholar, and Cochrane Library from inception to 22 November 2022. Only reports on a pulsed radiofrequency application on male patients with chronic scrotal pain were included. The final analysis yielded six reports on the clinical use of pulsed radiofrequency applications in male patients with chronic scrotal pain: six full publications, three case reports, one case series, one prospective uncontrolled pilot study, and one prospective randomized, controlled clinical trial. The accumulation of these data shows that using pulsed radiofrequency generates an increasing interest in pain physicians, radiologists, and urologists for managing chronic scrotal pain. No side effects related to the pulsed radiofrequency technique were reported to date. Further research on the clinical and biological effects is justified. Large sample sizes and randomized clinical trials are warranted.

Background: Acute scrotal pain is most commonly caused by testicular torsion, torsion of the appendix testis, epididymitis and orchitis. Its complications can be diagnosed on Ultrasound and histopathology for surgical procedures. Objective: To find out the diagnostic accuracy of color Doppler ultrasound for the diagnosis of painful scrotal by taking histopathology as the gold standard. Methodology: It was across-sectional observational study conducted on 141 patients of scrotal masses that fulfilling inclusion criteria selected from Gondal Medical Complex Gujranwala. Informed consent was obtained from all the patients. All patients were scanned on Toshiba Nemio 20 series with 11MHz biconvex and linear transducers. Diagnostic accuracy was determined by comparing it with the findings of histopathology by taking histopathology as the gold standard. Results: In this study, the mean age of patients was 37.0 ± 11.58 years. All the patients were subjected to histopathology. Amongst them 61 (43.3%) patients had positive results and 80(56.74%) patients were diagnosed negative. On Color Doppler ultrasonography, 64 (45.4%) patients had positive, while 77(54.6%) negative findings. The sensitivity, specificity, positive and negative predictive values of Doppler sonography were 70.49%, 73.75%, 67.19% and 76.62% respectively. This study showed that the overall diagnostic accuracy of Doppler ultrasonography was 72.34%. Conclusion: Doppler ultrasonography can be reliably being used to detect painful scrotal. Doppler ultrasound is an effective and non-invasive technique as a primary diagnostic tool to get rid of excessive surgery burden. [ABSTRACT FROM AUTHOR]

Background: Acute scrotal pain is most commonly caused by testicular torsion, torsion of the appendix testis, epididymitis and orchitis. Its complications can be diagnosed on Ultrasound and histopathology for surgical procedures. Objective: To find out the diagnostic accuracy of color Doppler ultrasound for the diagnosis of painful scrotal by taking histopathology as the gold standard. Methodology: It was across-sectional observational study conducted on 141 patients of scrotal masses that fulfilling inclusion criteria selected from Gondal Medical Complex Gujranwala. Informed consent was obtained from all the patients. All patients were scanned on Toshiba Nemio 20 series with 11MHz biconvex and linear transducers. Diagnostic accuracy was determined by comparing it with the findings of histopathology by taking histopathology as the gold standard. Results: In this study, the mean age of patients was 37.0 ± 11.58 years. All the patients were subjected to histopathology. Amongst them 61 (43.3%) patients had positive results and 80(56.74%) patients were diagnosed negative. On Color Doppler ultrasonography, 64 (45.4%) patients had positive, while 77(54.6%) negative findings. The sensitivity, specificity, positive and negative predictive values of Doppler sonography were 70.49%, 73.75%, 67.19% and 76.62% respectively. This study showed that the overall diagnostic accuracy of Doppler ultrasonography was 72.34%. Conclusion: Doppler ultrasonography can be reliably being used to detect painful scrotal. Doppler ultrasound is an effective and non-invasive technique as a primary diagnostic tool to get rid of excessive surgery burden. [ABSTRACT FROM AUTHOR]

Background: Acute scrotal pain is most commonly caused by testicular torsion, torsion of the appendix testis, epididymitis and orchitis. Its complications can be diagnosed on Ultrasound and histopathology for surgical procedures. Objective: To find out the diagnostic accuracy of color Doppler ultrasound for the diagnosis of painful scrotal by taking histopathology as the gold standard. Methodology: It was across-sectional observational study conducted on 141 patients of scrotal masses that fulfilling inclusion criteria selected from Gondal Medical Complex Gujranwala. Informed consent was obtained from all the patients. All patients were scanned on Toshiba Nemio 20 series with 11MHz biconvex and linear transducers. Diagnostic accuracy was determined by comparing it with the findings of histopathology by taking histopathology as the gold standard. Results: In this study, the mean age of patients was 37.0 ± 11.58 years. All the patients were subjected to histopathology. Amongst them 61 (43.3%) patients had positive results and 80(56.74%) patients were diagnosed negative. On Color Doppler ultrasonography, 64 (45.4%) patients had positive, while 77(54.6%) negative findings. The sensitivity, specificity, positive and negative predictive values of Doppler sonography were 70.49%, 73.75%, 67.19% and 76.62% respectively. This study showed that the overall diagnostic accuracy of Doppler ultrasonography was 72.34%. Conclusion: Doppler ultrasonography can be reliably being used to detect painful scrotal. Doppler ultrasound is an effective and non-invasive technique as a primary diagnostic tool to get rid of excessive surgery burden. [ABSTRACT FROM AUTHOR]

A 26-year-old patient with cryptozoospermia turned to the International Center for Reproductive Medicine for infertility. The man underwent surgical treatment for right-sided cryptorchidism in childhood. Subsequently, he was repeatedly examined and treated for scrotal pain. An ultrasound examination of the scrotum revealed bilateral testicular microlithiasis and signs of neoplasm of the left testicle that was not detected by palpation. Based on the research data, the patient underwent left orchifuniculectomy. Based on a histological examination, the diagnosis was established: a mixed germ cell tumor seminoma and teratoma against the background of intratubular germ cell neoplasia. A case from practice allows us to justify the expansion of indications for ultrasound of the scrotum in the non-inflammatory chronic pelvic pain syndrome (scrotal pain).

Aim: Delayed presentation in acute testicular torsion increases risk of testicular loss. We investigated whether there is a delay in presentation with suspected torsion in patients from an ethnic minority. Patients and methods: A retrospective audit of patients undergoing scrotal exploration for suspected torsion from September 2014 to September 2019 was completed. Notes were used to identify time between onset of pain and presentation to hospital. Patients' ethnicity was identified through voluntary demographic information. Median time to presentation was compared between ethnic minorities and white British patients, as well as exploration findings. Results: Ethnic minority patients (n =29) with suspected torsion presented significantly later with a median of 19 hours (range 1.3–192) compared to 4 hours (0.5–96) in white British patients (n =65). (p <0.001) In patients found to have torsion with or without testicular loss, ethnic minority patients (n =18) presented at a median of 17.5 hours (3.1–192) compared to 3 hours (0.5–84) in white British patients (n =33), a statistically significant delay (p <0.001). The relative risk of ethnic minorities requiring orchidectomy when presenting with torsion was 12.83. Conclusion(s): In our population, ethnic minorities present later with acute scrotal pain, increasing their risk of testicular loss. More study is required to identify causes of delayed presentation in these patients with the aim of improving health education. Level of evidence: 3 [ABSTRACT FROM AUTHOR]

The management of pain is a complex condition that will be encountered by most practicing clinicians. In the genitourinary community, testicular pain may be classified as acute or chronic. Initial evaluation of chronic groin and scrotal content pain (CGSCP) begins with a detailed history and physical examination to elucidate the presenting pathology. Multiple therapy algorithms have been proposed with no definitive consensus; however, most begin with conservative intervention and medical management prior to advancing to more invasive procedures. Surgical approaches may range from reconstruction, as in vasovasostomy for post-vasectomy pain syndrome, to excision of the offending agent, as in epididymectomy. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment. [ABSTRACT FROM AUTHOR]

Testicular torsion (TT) presents as an acute scrotal pain, associated with anatomical, traumatic and environmental factors. This is a case of a 24 – year old transwoman with right scrotal pain and a Doppler ultrasound result of decrease flow in the right testicle. Patient wanted to have bilateral orchiectomy but after counselling, radical orchiectomy was performed. As a primary care provider, we should recognize TT as a possible cause of testicular pain using a triad of history, examination and investigation. This highlights awareness among transgenders, that tucking can limit their chances to have a biological child in the future.

The differential diagnosis of scrotal pain and swelling in adolescent males includes testicular and appendage torsion, epididymitis, epididymo-orchitis, trauma and incarcerated hernia. Physical examination, ultrasound and urinalysis often can identify the etiology of the scrotal pain and swelling. We present a case of left scrotal pain and swelling that was initially concerning for a paratesticular mass. Repeat examination and further imaging during pre-operative assessment was consistent with left-sided vasitis. The diagnosis of vasitis is difficult with ultrasound and commonly requires CT or MRI to differentiate from incarcerated inguinal hernia. Recognition of this uncommonly reported condition may prevent unnecessary surgeries.

Introduction: Pain management of patients with chronic pelvic pain syndrome (CPPS) is challenging, because pain is often refractory to conventional treatments. Botulinum toxin A (BTX-A) may represent a promising therapeutic strategy for these patients. The aim of this systematic review was to investigate the role of BTX-A in CPPS treatment. Methods: We reviewed the literature for prospective studies evaluating the use of BTX-A in the treatment of CPPS. A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed from English language articles published between January 2000 and October 2021. The primary outcome was to evaluate pain improvement in CPPS after BTX-A treatment. Pooled meta-analysis of the included studies, considering the effect of BTX-A on pain evaluated at last available follow-up compared to baseline values, was performed together with meta-regression analysis. Results: After screening 1001 records, 18 full-text manuscripts were selected, comprising 13 randomized clinical trials and five comparative studies. They covered overall 896 patients of both sexes and several subtype of CPPS (interstitial cystitis/bladder pain syndrome, chronic prostatitis/prostate pain syndrome, chronic scrotal pain, gynecological pelvic pain, myofascial pelvic pain). The clinical and methodological heterogeneity of studies included makes it difficult to do an overall estimation of the real effect of BTX-A on pain and other functional outcomes of various CPPS subtypes. However, considering pooled meta-analysis results, a benefit in pain relief was showed for BTX-A-treated patients both in the overall studies populations and in the overall cohorts of patients with CPP due to bladder, prostate, and gynecological origin. Conclusions: BTX-A could be an efficacious treatment for some specific CPPS subtypes. Higher level studies are needed to assess the efficacy and safety of BTX-A and provide objective indications for its use in CPPS management.

Background: Testicular torsion (TT) is a urological emergency that affects one in 4000 males younger than 25 years. Delays in the management of TT may result in testicular ischaemia, testicular necrosis, orchidectomy and infertility. This review assesses the validity of near‐infrared spectroscopy (NIRS) as a diagnostic tool in the assessment and diagnosis of TT. Methods: A systematic search of Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, PubMed, Scopus and Web of Science databases was performed in January 2019 using specific search terms. Selected studies were ranked and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. Results: A total of nine studies that included 253 subjects (88 animals and 165 humans) with a mean sample size of 28.1 (standard deviation 40.8) subjects were included. The mean difference in testicular tissue oxygen saturation between torsed and non‐torsed testes (Δ%StO2) were 45%, 42% (±5%), 26% and 5–18% in four animal studies and 2.0%, 3.0%, 6.7%, 6.8% and 23.0% in five human studies. The tissue oxygen saturation difference between contralateral healthy testes (controls) ranged from 1% to 10% in the five studies that alluded to this. Conclusion: The current body of evidence does not support the use of NIRS in the work‐up of TT. Well‐designed clinical trials with large patient samples are required to determine whether NIRS may have some future role as a diagnostic modality in TT. [ABSTRACT FROM AUTHOR]

Scrotal ultrasound helps in the rapid diagnosis of complete testicular torsion and assessment of alternative causes of acute scrotal pain. Early detection of torsion of the testis and reperfusion, either manually or surgically, is paramount to preserving testicular viability. Manual detorsion also offers immediate symptom relief by alleviating ischemia. Bedside ultrasound performed by a trained emergency physician (EP) can significantly reduce the time to diagnosis and reperfusion by means of performing an ultrasound-guided manual detorsion in the emergency department (ED). We report two cases of ultrasound-guided manual detorsion of testis that were performed successfully by EPs in the ED. After manual detorsion, both patients underwent nonemergent orchidopexy and recovered well after surgery. Manual testicular detorsion is a simple, safe, and effective maneuver that can be performed in the ED by EPs. Bedside ultrasound is helpful in confirming the diagnosis of complete torsion of the testicle (no blood flow) and successful reperfusion after manual detorsion. We recommend EPs be trained to perform scrotal ultrasound and manual detorsion of a torted testicle. We strongly emphasize that manual detorsion of the testes is not a substitute for definitive surgical management and should only be used as a temporary measure for reperfusion to allow more time to organize the logistics of surgery, which can be critical in remote settings. [ABSTRACT FROM AUTHOR]

Background: The incidence of indirect inguinal hernia in young children ranges from 0.8% to 4.4%. Infants are at a high risk of testicular ischemia from indirect inguinal hernia due to their delicate vascular supply. Case report: A 5-year-old patient presented with a rare case of acute testicular ischemia secondary to an incarcerated inguinal hernia. He underwent surgery that successfully salvaged his testicle. Conclusion: Emergency medicine providers need to clinically suspect for testicular ischemia even in the presence of examination findings suggestive of an alternative diagnosis, such as inguinal hernia. [ABSTRACT FROM AUTHOR]

Background and Objectives: Evaluating the effectiveness of laparoscopic varicocelectomy in the management of chronic scrotal pain. Materials and Methods: Between 2016 and 2018, 100 patients underwent laparoscopic varicocelectomy for chronic scrotal pain that is increasingly difficult with physical activity. All patients were monitored at 3 and 6 months with a physical examination, analog scale score, and ultrasonographic scanning in some cases. Results: The mean age was 38.2 years (age range 23-54 years). Follow-up period was 6 months. Bilateral varicoceles were present in 20 patients (20%), and a unilateral varicocele was present in 80 patients (80%). The varicocele was grade 3 in 57 patients (57%), grade 2 in 30 (30%), and grade 1 in 13 (13%). The mean preoperative visual analog scale score was 4.8 on a scale from 0 to 10. The mean postoperative visual analog scale score at 3 months was 0.8. After the procedure, 80 patients (80%) had a significant improvement in the visual analog scale score (P<.001), 15(15%) had mild improvement and 5(5%) remained unchanged. During follow-up, we observed 11(11%) recurrences whereas de novo hydrocele formation was identified in 7 patients (7%). Conclusion: Laparoscopic varicocelectomy is effective in the treatment of symptomatic varicoceles with a low level of complication rate and good post operative pain relief. [ABSTRACT FROM AUTHOR]